Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

被引：10

作者：

Benitez, Ivan D. ^{[1
,2
]}

de Batlle, Jordi ^{[1
,2
]}

Torres, Gerard ^{[1
,2
]}

Gonzalez, Jessica ^{[1
,2
]}

De Gonzalo-Calvo, David ^{[1
,2
]}

Targa, Adriano D. S. ^{[1
,2
]}

Gort-Paniello, Clara ^{[1
,2
]}

Moncusi-Moix, Anna ^{[1
,2
]}

Ceccato, Adrian ^{[2
,3
]}

Fernandez-Barat, Laia ^{[2
,4
,5
]}

Ferrer, Ricard ^{[2
,6
]}

Garcia-Gasulla, Dario ^{[7
]}

Menendez, Rosario ^{[2
,8
]}

Motos, Anna ^{[2
,4
,5
]}

Penuelas, Oscar ^{[2
,9
,10
]}

Riera, Jordi ^{[2
,6
]}

Bermejo-Martin, Jesus F. ^{[2
,11
,12
]}

Penasco, Yhivian ^{[13
]}

Ricart, Pilar ^{[14
]}

Martin Delgado, Maria Cruz ^{[15
]}

Aguilera, Luciano ^{[16
]}

Rodriguez, Alejandro ^{[17
]}

Boado Varela, Maria Victoria ^{[18
]}

Suarez-Sipmann, Fernando ^{[19
]}

Carlos Pozo-Laderas, Juan ^{[20
]}

Sole-Violan, Jordi ^{[21
,22
]}

Nieto, Maite ^{[23
]}

Andrea Novo, Mariana ^{[24
]}

Barberan, Jose ^{[25
]}

Amaya Villar, Rosario ^{[26
]}

Garnacho-Montero, Jose ^{[27
]}

Luis Garcia-Garmendia, Jose ^{[28
]}

Gomez, Jose M. ^{[29
]}

Angel Lorente, Jose ^{[2
,9
,10
]}

Blandino Ortiz, Aaron ^{[30
]}

Tamayo Lomas, Luis ^{[31
]}

Lopez-Ramos, Esther ^{[32
]}

Ubeda, Alejandro ^{[33
]}

Catalan-Gonzalez, Mercedes ^{[34
]}

Sanchez-Miralles, Angel ^{[35
]}

Martinez Varela, Ignacio ^{[36
]}

Jorge Garcia, Ruth Noemi ^{[37
]}

Franco, Nieves ^{[38
]}

Gumucio-Sanguino, Victor D. ^{[39
,40
]}

Huerta Garcia, Arturo ^{[41
,42
]}

Bustamante-Munguira, Elena ^{[43
]}

Jorge Valdivia, Luis ^{[44
]}

Caballero, Jesus ^{[45
,46
]}

Gallego, Elena ^{[47
]}

Martinez de la Gandara, Amalia ^{[48
]}

机构：

[1] Univ Hosp Arnau de Vilanova & Santa Maria, IRBLleida, Translat Res Resp Med, Avda Alcalde Rovira Roure 80, Lleida 25198, Spain

[2] Inst Hlth Carlos III, CIBER Resp Dis CIBERES, Madrid, Spain

[3] ParcTauli Hosp Univ, Crit Care Ctr, Inst Invest & Innovacio Parc Tauli I3PT, Sabadell, Spain

[4] Hosp Clin Barcelona, Dept Pneumol, Barcelona, Spain

[5] Univ Barcelona, August Pi & Sunyer Biomed Res Inst IDIBAPS, Barcelona, Spain

[6] Vall dHebron Hosp Univ, Vall dHebron Inst Recerca VHIR, Intens Care Dept, SODIR Res Grp, Barcelona, Spain

[7] Barcelona Supercomp Ctr BSC, Barcelona, Spain

[8] Univ & Polytech Hosp La Fe, Pulmonol Serv, Valencia, Spain

[9] Hosp Univ Getafe, Madrid, Spain

[10] Univ Europea, Madrid, Spain

[11] Hosp Univ Rio Hortega Valladolid, Valladolid, Spain

[12] Inst Invest Biomed Salamanca IBSAL, Grp Biomed Res Sepsis BioSepsis, Salamanca, Spain

[13] Hosp Univ Marques de Valdecilla, Serv Med Intens, Santander, Spain

[14] Hosp Univ Germans Trias, Serv Med Intens, Badalona, Spain

[15] Hosp Univ Torrejon Univ Francisco de Vitoria, Madrid, Spain

[16] Hosp Univ Basurto, Serv Anestesiol & Reanimac, Bilbao, Spain

[17] Hosp Joan 23, Crit Care Dept, Tarragona, Spain

[18] Hosp Cruces, Serv Med Intens, Baracaldo, Vizcaya, Spain

[19] Hosp Univ La Princesa, Intens Care Unit, Madrid, Spain

[20] Hosp Univ Reina Sofia, Inst Maimonides IMIBIC, UGC Med Intens, Cordoba, Spain

[21] Hosp Dr Negrin Gran Canaria, Crit Care Dept, Las Palmas Gran Canaria, Gran Canaria, Spain

[22] Univ Fernando Pessoa, Canarias, Spain

[23] Hosp Univ Segovia, Segovia, Spain

[24] Hosp Univ Son Espases, Serv Med Intens, Palma De Mallorca, Illes Balears, Spain

[25] Univ San Pablo CEU, Hosp Univ HM Monteprincipe, Madrid, Spain

[26] Hosp Univ Virgen de Rocio, Intens Care Clin Unit, Seville, Spain

[27] Hosp Univ Virgen Macarena, Intens Care Clin Unit, Seville, Spain

[28] Hosp San Juan de Dios del Aljarafe, Intens Care Unit, Seville, Spain

[29] Hosp Gen Univ Gregorio Maranon, Madrid, Spain

[30] Hosp Univ Ramon y Cajal, Serv Med Intens, Madrid, Spain

[31] Hosp Univ Rio Hortega Valladolid, Crit Care Dept, Valladolid, Spain

[32] Hosp Univ Principe Asturias, Serv Med Intens, Madrid, Spain

[33] Hosp Punta Europa, Serv Med Intens, Algeciras, Spain

[34] Hosp Univ 12 Octubre, Dept Intens Care Med, Madrid, Spain

[35] Hosp St Joan Alacant, Alacant, Spain

[36] Hosp Univ Lucus Augusti, Crit Care Dept, Lugo, Spain

[37] Hosp Nuestra Senora de Gracia, Intens Care Dept, Zaragoza, Spain

[38] Hosp Univ Mostoles, Madrid, Spain

[39] Hosp Univ Bellvitge, Dept Intens Care, Barcelona, Spain

[40] Bellvitge Biomed Res Inst IDIBELL, Barcelona, Spain

[41] Clin Sagrada Familia, Pulm & Crit Care Div, Barcelona, Spain

[42] Clin Sagrada Familia, Emergency Dept, Barcelona, Spain

[43] Hosp Clin Univ Valladolid, Dept Intens Care Med, Valladolid, Spain

[44] Hosp Univ Leon, Leon, Spain

[45] Hosp Arnau Vilanova, Crit Care Dept, Lleida, Spain

[46] IRBLleida, Lleida, Spain

[47] Hosp Univ San Pedro de Alcantara, Unidad Cuidados Intens, Caceres, Spain

[48] Hosp Univ Infanta Leonor, Dept Intens Med, Madrid, Spain

[49] Hosp Univ & Politecn La Fe, Serv Med Intens, Valencia, Spain

[50] Hosp Univ Mutua Terrassa, Serv Med Intens, Barcelona, Spain

来源：

LANCET REGIONAL HEALTH-EUROPE | 2022年 / 18卷

关键词：

COVID-19; Critical Care; Prognosis; PHENOTYPES;

D O I：

10.1016/j.lanepe.2022.100422

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

引用

页数：16

共 40 条

[1] Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis [J].

Alqahtani, Jaber S. ;

Oyelade, Tope ;

Aldhahir, Abdulelah M. ;

Alghamdi, Saeed M. ;

Almehmadi, Mater ;

Alqahtani, Abdullah S. ;

Quaderi, Shumonta ;

Mandal, Swapna ;

Hurst, John R. .

PLOS ONE, 2020, 15 (05)

[2]

[Anonymous], EUR RESPIR J, DOI DOI 10.1183/13993003.00547-2020

[3] Introduction to the Analysis of Survival Data in the Presence of Competing Risks [J].

Austin, Peter C. ;

Lee, Douglas S. ;

Fine, Jason P. .

CIRCULATION, 2016, 133 (06) :601-609

[4] Clinical phenotypes of critically ill COVID-19 patients [J].

Azoulay, Elie ;

Zafrani, Lara ;

Mirouse, Adrien ;

Lengline, Etienne ;

Darmon, Michael ;

Chevret, Sylvie .

INTENSIVE CARE MEDICINE, 2020, 46 (08) :1651-1652

[5] Latent variable regression for multiple discrete outcomes [J].

Bandeen-Roche, K ;

Miglioretti, DL ;

Zeger, SL ;

Rathouz, PJ .

JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1997, 92 (440) :1375-1386

[6] Immune Dysfunction in Patients with Chronic Obstructive Pulmonary Disease [J].

Bhat, Tariq A. ;

Panzica, Louis ;

Kalathil, Suresh Gopi ;

Thanavala, Yasmin .

ANNALS OF THE AMERICAN THORACIC SOCIETY, 2015, 12 :S169-S175

[7] Longitudinal respiratory subphenotypes in patients with COVID-19-related acute respiratory distress syndrome: results from three observational cohorts [J].

Bos, Lieuwe D. J. ;

Sjoding, Michael ;

Sinha, Pratik ;

Bhavani, Sivasubramanium, V ;

Lyons, Patrick G. ;

Bewley, Alice F. ;

Botta, Michela ;

Tsonas, Anissa M. ;

Neto, Ary Serpa ;

Schultz, Marcus J. ;

Dickson, Robert P. ;

Paulus, Frederique .

LANCET RESPIRATORY MEDICINE, 2021, 9 (12) :1377-1386

[8] Tobacco Smoking Increases the Lung Gene Expression of ACE2, the Receptor of SARS-CoV-2 [J].

Cai, Guoshuai ;

Bosse, Yohan ;

Xiao, Feifei ;

Kheradmand, Farrah ;

Amos, Christopher I. .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2020, 201 (12) :1557-1559

[9]

Chen H, 2021, FRONT MED, V8, P1

[10] Identification of Distinct Immunophenotypes in Critically Ill Coronavirus Disease 2019 Patients [J].

Dupont, Thibault ;

Caillat-Zucman, Sophie ;

Fremeaux-Bacchi, Veronique ;

Morin, Florence ;

Lengline, Etienne ;

Darmon, Michael ;

de Latour, Regis Peffault ;

Zafrani, Lara ;

Azoulay, Elie ;

Dumas, Guillaume .

CHEST, 2021, 159 (05) :1884-1893

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