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For: Sinha P, Delucchi KL, Chen Y, Zhuo H, Abbott J, Wang C, Wickersham N, McNeil JB, Jauregui A, Ke S, Vessel K, Gomez A, Hendrickson CM, Kangelaris KN, Sarma A, Leligdowicz A, Liu KD, Matthay MA, Ware LB, Calfee CS. Latent class analysis-derived subphenotypes are generalisable to observational cohorts of acute respiratory distress syndrome: a prospective study. Thorax 2022;77:13-21. [PMID: 34253679 PMCID: PMC8688287 DOI: 10.1136/thoraxjnl-2021-217158] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/01/2021] [Indexed: 01/03/2023]

For:	Sinha P, Delucchi KL, Chen Y, Zhuo H, Abbott J, Wang C, Wickersham N, McNeil JB, Jauregui A, Ke S, Vessel K, Gomez A, Hendrickson CM, Kangelaris KN, Sarma A, Leligdowicz A, Liu KD, Matthay MA, Ware LB, Calfee CS. Latent class analysis-derived subphenotypes are generalisable to observational cohorts of acute respiratory distress syndrome: a prospective study. Thorax 2022;77:13-21. [PMID: 34253679 PMCID: PMC8688287 DOI: 10.1136/thoraxjnl-2021-217158] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/01/2021] [Indexed: 01/03/2023]

Number

Cited by Other Article(s)

Wildi K, Bouquet M, Ainola C, Livingstone S, Colombo SM, Heinsar S, Sato N, Sato K, Wilson E, Abbate G, Passmore MR, Hyslop K, Liu K, Li Bassi G, Suen JY, Fraser JF. Differential Protein Expression among Two Different Ovine ARDS Phenotypes-A Preclinical Randomized Study. Metabolites 2022;12:metabo12070655. [PMID: 35888779 PMCID: PMC9319228 DOI: 10.3390/metabo12070655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/25/2023] Open

Affiliation(s)

Karin Wildi Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, 4031 Basel, Switzerland Correspondence:
Mahe Bouquet Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Carmen Ainola Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Samantha Livingstone Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Sebastiano Maria Colombo Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Silver Heinsar Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Noriko Sato Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
Kei Sato Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Emily Wilson Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Gabriella Abbate Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Margaret R. Passmore Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Kieran Hyslop Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
Keibun Liu Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
Gianluigi Li Bassi Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia Medical Faculty, Queensland University of Technology, Brisbane 4059, Australia Uniting Care Hospitals, St Andrews War Memorial and The Wesley Intensive Care Units, Brisbane 4001, Australia
Jacky Y. Suen Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
John F. Fraser Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.) Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia Uniting Care Hospitals, St Andrews War Memorial and The Wesley Intensive Care Units, Brisbane 4001, Australia

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Diamond JM. Don't Inhale: Acute Respiratory Distress Syndrome Risk and Tobacco Exposure in Patients with Sepsis. Am J Respir Crit Care Med 2022;205:866-867. [PMID: 35130469 PMCID: PMC9838625 DOI: 10.1164/rccm.202201-0034ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open

Maddali MV, Churpek M, Pham T, Rezoagli E, Zhuo H, Zhao W, He J, Delucchi KL, Wang C, Wickersham N, McNeil JB, Jauregui A, Ke S, Vessel K, Gomez A, Hendrickson CM, Kangelaris KN, Sarma A, Leligdowicz A, Liu KD, Matthay MA, Ware LB, Laffey JG, Bellani G, Calfee CS, Sinha P. Validation and utility of ARDS subphenotypes identified by machine-learning models using clinical data: an observational, multicohort, retrospective analysis. THE LANCET. RESPIRATORY MEDICINE 2022;10:367-377. [PMID: 35026177 PMCID: PMC8976729 DOI: 10.1016/s2213-2600(21)00461-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022]

Abstract

BACKGROUND

Two acute respiratory distress syndrome (ARDS) subphenotypes (hyperinflammatory and hypoinflammatory) with distinct clinical and biological features and differential treatment responses have been identified using latent class analysis (LCA) in seven individual cohorts. To facilitate bedside identification of subphenotypes, clinical classifier models using readily available clinical variables have been described in four randomised controlled trials. We aimed to assess the performance of these models in observational cohorts of ARDS.

METHODS

In this observational, multicohort, retrospective study, we validated two machine-learning clinical classifier models for assigning ARDS subphenotypes in two observational cohorts of patients with ARDS: Early Assessment of Renal and Lung Injury (EARLI; n=335) and Validating Acute Lung Injury Markers for Diagnosis (VALID; n=452), with LCA-derived subphenotypes as the gold standard. The primary model comprised only vital signs and laboratory variables, and the secondary model comprised all predictors in the primary model, with the addition of ventilatory variables and demographics. Model performance was assessed by calculating the area under the receiver operating characteristic curve (AUC) and calibration plots, and assigning subphenotypes using a probability cutoff value of 0·5 to determine sensitivity, specificity, and accuracy of the assignments. We also assessed the performance of the primary model in EARLI using data automatically extracted from an electronic health record (EHR; EHR-derived EARLI cohort). In Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE; n=2813), a multinational, observational ARDS cohort, we applied a custom classifier model (with fewer variables than the primary model) to determine the prognostic value of the subphenotypes and tested their interaction with the positive end-expiratory pressure (PEEP) strategy, with 90-day mortality as the dependent variable.

FINDINGS

The primary clinical classifier model had an area under receiver operating characteristic curve (AUC) of 0·92 (95% CI 0·90-0·95) in EARLI and 0·88 (0·84-0·91) in VALID. Performance of the primary model was similar when using exclusively EHR-derived predictors compared with manually curated predictors (AUC=0·88 [95% CI 0·81-0·94] vs 0·92 [0·88-0·97]). In LUNG SAFE, 90-day mortality was higher in patients assigned the hyperinflammatory subphenotype than in those with the hypoinflammatory phenotype (414 [57%] of 725 vs 694 [33%] of 2088; p<0·0001). There was a significant treatment interaction with PEEP strategy and ARDS subphenotype (p=0·041), with lower 90-day mortality in the high PEEP group of patients with the hyperinflammatory subphenotype (hyperinflammatory subphenotype: 169 [54%] of 313 patients in the high PEEP group vs 127 [62%] of 205 patients in the low PEEP group; hypoinflammatory subphenotype: 231 [34%] of 675 patients in the high PEEP group vs 233 [32%] of 734 patients in the low PEEP group).

INTERPRETATION

Classifier models using clinical variables alone can accurately assign ARDS subphenotypes in observational cohorts. Application of these models can provide valuable prognostic information and could inform management strategies for personalised treatment, including application of PEEP, once prospectively validated.

FUNDING

US National Institutes of Health and European Society of Intensive Care Medicine.

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Affiliation(s)

Manoj V Maddali Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA; Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
Matthew Churpek Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
Tai Pham Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France; Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
Emanuele Rezoagli Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
Hanjing Zhuo Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
Wendi Zhao Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
June He Division of Clinical and Translational Research, Washington University School of Medicine, St Louis, MO, USA
Kevin L Delucchi Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
Chunxue Wang Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Nancy Wickersham Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
J Brennan McNeil Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Alejandra Jauregui Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
Serena Ke Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
Kathryn Vessel Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
Antonio Gomez Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
Carolyn M Hendrickson Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
Kirsten N Kangelaris Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
Aartik Sarma Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA
Aleksandra Leligdowicz Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
Kathleen D Liu Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
Michael A Matthay Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA; Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA
Lorraine B Ware Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
John G Laffey School of Medicine, Regenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland; Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland
Giacomo Bellani Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, ASST Monza-Ospedale San Gerardo, Monza, Italy
Carolyn S Calfee Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA
Pratik Sinha Division of Clinical and Translational Research, Washington University School of Medicine, St Louis, MO, USA; Department of Anesthesia, Division of Critical Care, Washington University, St Louis, MO, USA.

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Azad TD, Shah PP, Kim HB, Stevens RD. Endotypes and the Path to Precision in Moderate and Severe Traumatic Brain Injury. Neurocrit Care 2022;37:259-266. [PMID: 35314969 DOI: 10.1007/s12028-022-01475-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/15/2022] [Indexed: 12/19/2022]

Parsons PE. BIOMARKERS IN THE ACUTE RESPIRATORY DISTRESS SYNDROME: PAST, PRESENT, AND FUTURE. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2022;132:107-116. [PMID: 36196169 PMCID: PMC9480556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]

Wick KD, McAuley DF, Levitt JE, Beitler JR, Annane D, Riviello ED, Calfee CS, Matthay MA. Promises and challenges of personalized medicine to guide ARDS therapy. Crit Care 2021;25:404. [PMID: 34814925 PMCID: PMC8609268 DOI: 10.1186/s13054-021-03822-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/09/2021] [Indexed: 02/08/2023] Open

Conway Morris A, Kohler K, Shankar-Hari M. ARDS subphenotypes: searching for Rorschach among the roentgenograms? Thorax 2021;77:2-4. [PMID: 34253680 DOI: 10.1136/thoraxjnl-2021-217428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 11/03/2022]