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Wittermans E, van der Zee PA, Qi H, van de Garde EMW, Blum CA, Christ-Crain M, Gommers D, Grutters JC, Voorn GP, Bos WJW, Endeman H. Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies. ERJ Open Res 2022; 8:00489-2021. [PMID: 35036417 PMCID: PMC8752939 DOI: 10.1183/23120541.00489-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Latent class analysis (LCA) has identified subgroups with meaningful treatment implications in acute respiratory distress syndrome. We performed a secondary analysis of three studies to assess whether LCA can identify clinically distinct subgroups in community-acquired pneumonia (CAP) and whether the treatment effect of adjunctive corticosteroids differs between subgroups. Methods LCA was performed on baseline clinical and biomarker data from the Ovidius trial (n=304) and the Steroids in Pneumonia (STEP) trial (n=727), both randomised controlled trials investigating adjunctive corticosteroid treatment in CAP, and the observational TripleP cohort (n=201). Analyses were conducted independently in two cohorts (Ovidius–TripleP combined and the STEP trial). In both cohorts, differences in clinical outcomes and response to adjunctive corticosteroid treatment were examined between subgroups identified through LCA. Results A two-class model fitted both cohorts best. Class 2 patients had more signs of systemic inflammation compared to class 1. In both cohorts, length of stay was longer and in-hospital mortality rate was higher in class 2. In the Ovidius trial, corticosteroids reduced the median length of stay in class 2 (6.5 versus 9.5 days) but not in class 1 (p-value for interaction=0.02). In the STEP trial, there was no significant interaction for length of stay. We found no significant interaction between class assignment and adjunctive corticosteroid treatment for secondary outcomes. Conclusions In two independent cohorts, LCA identified two classes of CAP patients with different clinical characteristics and outcomes. Given the different response to adjunctive corticosteroids in the Ovidius trial, LCA might provide a useful basis to improve patient selection for future trials. Latent class analysis of baseline clinical and biomarker data identified two distinct classes of patients with community-acquired pneumonia in two cohorts. In one cohort, the response to adjunctive corticosteroid treatment differed between classes.https://bit.ly/3ClR92L
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Affiliation(s)
- Esther Wittermans
- Dept of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.,Dept of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.,These authors contributed equally
| | - Philip A van der Zee
- Dept of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands.,These authors contributed equally
| | - Hongchao Qi
- Dept of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ewoudt M W van de Garde
- Dept of Clinical Pharmacology, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Claudine A Blum
- Depts of General Internal and Emergency Medicine, and Endocrinology, Diabetology and Clinical Nutrition, Medical University Clinic, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Depts of Endocrinology, Diabetology and Metabolism, and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Diederik Gommers
- Dept of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan C Grutters
- Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G Paul Voorn
- Dept of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Willem Jan W Bos
- Dept of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.,Dept of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henrik Endeman
- Dept of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
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Feng Y, Wang Y, Zeng C, Mao H. Artificial Intelligence and Machine Learning in Chronic Airway Diseases: Focus on Asthma and Chronic Obstructive Pulmonary Disease. Int J Med Sci 2021; 18:2871-2889. [PMID: 34220314 PMCID: PMC8241767 DOI: 10.7150/ijms.58191] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/20/2021] [Indexed: 02/05/2023] Open
Abstract
Chronic airway diseases are characterized by airway inflammation, obstruction, and remodeling and show high prevalence, especially in developing countries. Among them, asthma and chronic obstructive pulmonary disease (COPD) show the highest morbidity and socioeconomic burden worldwide. Although there are extensive guidelines for the prevention, early diagnosis, and rational treatment of these lifelong diseases, their value in precision medicine is very limited. Artificial intelligence (AI) and machine learning (ML) techniques have emerged as effective methods for mining and integrating large-scale, heterogeneous medical data for clinical practice, and several AI and ML methods have recently been applied to asthma and COPD. However, very few methods have significantly contributed to clinical practice. Here, we review four aspects of AI and ML implementation in asthma and COPD to summarize existing knowledge and indicate future steps required for the safe and effective application of AI and ML tools by clinicians.
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Affiliation(s)
- Yinhe Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Department of Respiratory and Critical Care Medicine, People's Hospital of Deyang City, Affiliated Hospital of Chengdu College of Medicine, Deyang, Sichuan Province, China
| | - Yubin Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chunfang Zeng
- Department of Respiratory and Critical Care Medicine, People's Hospital of Deyang City, Affiliated Hospital of Chengdu College of Medicine, Deyang, Sichuan Province, China
| | - Hui Mao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Sinha P, Calfee CS, Delucchi KL. Practitioner's Guide to Latent Class Analysis: Methodological Considerations and Common Pitfalls. Crit Care Med 2021; 49:e63-e79. [PMID: 33165028 PMCID: PMC7746621 DOI: 10.1097/ccm.0000000000004710] [Citation(s) in RCA: 216] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Latent class analysis is a probabilistic modeling algorithm that allows clustering of data and statistical inference. There has been a recent upsurge in the application of latent class analysis in the fields of critical care, respiratory medicine, and beyond. In this review, we present a brief overview of the principles behind latent class analysis. Furthermore, in a stepwise manner, we outline the key processes necessary to perform latent class analysis including some of the challenges and pitfalls faced at each of these steps. The review provides a one-stop shop for investigators seeking to apply latent class analysis to their data.
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Affiliation(s)
- Pratik Sinha
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine; University of California, San Francisco; San Francisco, CA
- Department of Anesthesia; University of California, San Francisco; San Francisco, CA
| | - Carolyn S. Calfee
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine; University of California, San Francisco; San Francisco, CA
- Department of Anesthesia; University of California, San Francisco; San Francisco, CA
| | - Kevin L. Delucchi
- Department of Psychiatry; University of California, San Francisco; San Francisco, CA
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4
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Jain NM, Culley A, Knoop T, Micheel C, Osterman T, Levy M. Conceptual Framework to Support Clinical Trial Optimization and End-to-End Enrollment Workflow. JCO Clin Cancer Inform 2019; 3:1-10. [PMID: 31225983 PMCID: PMC6873934 DOI: 10.1200/cci.19.00033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 12/19/2022] Open
Abstract
In this work, we present a conceptual framework to support clinical trial optimization and enrollment workflows and review the current state, limitations, and future trends in this space. This framework includes knowledge representation of clinical trials, clinical trial optimization, clinical trial design, enrollment workflows for prospective clinical trial matching, waitlist management, and, finally, evaluation strategies for assessing improvement.
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Affiliation(s)
- Neha M. Jain
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Teresa Knoop
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Mia Levy
- Vanderbilt University Medical Center, Nashville, TN
- Rush University Medical Center, Chicago, IL
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