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Combes A, Auzinger G, Camporota L, Capellier G, Consales G, Couto AG, Dabrowski W, Davies R, Demirkiran O, Gómez CF, Franz J, Hilty MP, Pestaña D, Rovina N, Tully R, Turani F, Kurz J, Harenski K. Expert perspectives on ECCO 2R for acute hypoxemic respiratory failure: consensus of a 2022 European roundtable meeting. Ann Intensive Care 2024; 14:132. [PMID: 39174831 PMCID: PMC11341504 DOI: 10.1186/s13613-024-01353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND By controlling hypercapnia, respiratory acidosis, and associated consequences, extracorporeal CO2 removal (ECCO2R) has the potential to facilitate ultra-protective lung ventilation (UPLV) strategies and to decrease injury from mechanical ventilation. We convened a meeting of European intensivists and nephrologists and used a modified Delphi process to provide updated insights into the role of ECCO2R in acute respiratory distress syndrome (ARDS) and to identify recommendations for a future randomized controlled trial. RESULTS The group agreed that lung protective ventilation and UPLV should have distinct definitions, with UPLV primarily defined by a tidal volume (VT) of 4-6 mL/kg predicted body weight with a driving pressure (ΔP) ≤ 14-15 cmH2O. Fourteen (93%) participants agreed that ECCO2R would be needed in the majority of patients to implement UPLV. Furthermore, 10 participants (majority, 63%) would select patients with PaO2:FiO2 > 100 mmHg (> 13.3 kPa) and 14 (consensus, 88%) would select patients with a ventilatory ratio of > 2.5-3. A minimum CO2 removal rate of 80 mL/min delivered by continuous renal support machines was suggested (11/14 participants, 79%) for this objective, using a short, double-lumen catheter inserted into the right internal jugular vein as the preferred vascular access. Of the participants, 14/15 (93%, consensus) stated that a new randomized trial of ECCO2R is needed in patients with ARDS. A ΔP of ≥ 14-15 cmH2O was suggested by 12/14 participants (86%) as the primary inclusion criterion. CONCLUSIONS ECCO2R may facilitate UPLV with lower volume and pressures provided by the ventilator, while controlling respiratory acidosis. Since recent European Society of Intensive Care Medicine guidelines on ARDS recommended against the use of ECCO2R for the treatment of ARDS outside of randomized controlled trials, new trials of ECCO2R are urgently needed, with a ΔP of ≥ 14-15 cmH2O suggested as the primary inclusion criterion.
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Affiliation(s)
- Alain Combes
- Institute of Cardiometabolism and Nutrition, INSERM Unité Mixte de Recherche (UMRS) 1166, Sorbonne Université, 47, Boulevard de l'Hôpital, 75013, Paris, France.
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.
| | - Georg Auzinger
- Department of Critical Care, King's College Hospital, London, SE5 9RS, UK
- Department of Critical Care, Cleveland Clinic, London, SW1Y 7SW, UK
| | - Luigi Camporota
- Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, SE1 1UL, UK
| | - Gilles Capellier
- University of Franche-Comté, 25000, Besançon, France
- Department of Epidemiology and Health, Monash University, Melbourne, VIC, 3004, Australia
| | - Guglielmo Consales
- Anesthesia, Intensive Care and Emergency Department, Prato Hospital, Azienda Toscana Centro, Prato, Italy
| | - Antonio Gomis Couto
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, 28033, Madrid, Spain
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954, Lublin, Poland
| | - Roger Davies
- Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, UK
- Division of Anaesthetics, Intensive Care and Pain Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, SW10 9NH, UK
| | - Oktay Demirkiran
- Department of Anesthesiology and Intensive Care, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, 34098, Turkey
| | - Carolina Ferrer Gómez
- Anesthesiology and Intensive Care Department, Consorcio Hospital General Universitario de Valencia, 46014, Valencia, Spain
| | - Jutta Franz
- Department of Cardiology and Internal Intensive Care, Rems-Murr-Kliniken Winnenden, 71364, Winnenden, Germany
| | - Matthias Peter Hilty
- Institute of Intensive Care Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
| | - David Pestaña
- Servicio de Anestesia-Reanimación, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9, 28034, Madrid, Spain
- Facultad de Medicina, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, 28034, Madrid, Spain
| | - Nikoletta Rovina
- 1st Respiratory Department, National and Kapodistrian University of Athens Medical School, "Sotiria" Chest Hospital, 152 Mesogion Av, 11527, Athens, Greece
| | - Redmond Tully
- Royal Oldham Hospital, Northern Care Alliance NHS Trust, Oldham, OL1 2JH, UK
| | - Franco Turani
- Department of Intensive Care, Aurelia Hospital, Via Aurelia 860, 00165, Rome, Italy
- Cardiac Anaesthesia European Hospital, Via Portuense, 760, 00416, Rome, Italy
| | - Joerg Kurz
- Baxter Healthcare, Edisonstr 4, 85716, Unterschleißheim, Germany
| | - Kai Harenski
- Baxter Healthcare, Edisonstr 4, 85716, Unterschleißheim, Germany
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Antonucci E, Garcia B, Chen D, Matthay MA, Liu KD, Legrand M. Incidence of acute kidney injury and attributive mortality in acute respiratory distress syndrome randomized trials. Intensive Care Med 2024; 50:1240-1250. [PMID: 38864911 PMCID: PMC11306535 DOI: 10.1007/s00134-024-07485-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/06/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE The development of acute kidney injury (AKI) after the acute respiratory distress syndrome (ARDS) reduces the chance of organ recovery and survival. The purpose of this study was to examine the AKI rate and attributable mortality in ARDS patients. METHODS We performed an individual patient-data analysis including 10 multicenter randomized controlled trials conducted over 20 years. We employed a Super Learner ensemble technique, including a time-dependent analysis, to estimate the adjusted risk of AKI. We calculated the mortality attributable to AKI using an inverse probability of treatment weighting estimator integrated with the Super Learner. RESULTS There were 5148 patients included in this study. The overall incidence of AKI was 43.7% (n = 2251). The adjusted risk of AKI ranged from 38.8% (95% confidence interval [CI], 35.7 to 41.9%) in ARMA, to 55.8% in ROSE (95% CI, 51.9 to 59.6%). 37.1% recovered rapidly from AKI, with a significantly lower recovery rate in recent trials (P < 0.001). The 90-day excess in mortality attributable to AKI was 15.4% (95% CI, 12.8 to 17.9%). It decreased from 25.4% in ARMA (95% CI, 18.7 to 32%), to 11.8% in FACTT (95% CI, 5.5 to 18%) and then remained rather stable over time. The 90-day overall excess in mortality attributable to acute kidney disease was 28.4% (95% CI, 25.3 to 31.5%). CONCLUSIONS The incidence of AKI appears to be stable over time in patients with ARDS enrolled in randomized trials. The development of AKI remains a significant contributing factor to mortality. These estimates are essential for designing future clinical trials for AKI prevention or treatment.
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Affiliation(s)
- Edoardo Antonucci
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Bruno Garcia
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Intensive Care, Centre Hospitalier Universitaire de Lille, Lille, France
- Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, Brussels, Belgium
| | - David Chen
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Michael A Matthay
- Cardiovascular Research Institute (CVRI), University of California San Francisco, Medicine and Anesthesia, San Francisco, CA, USA
| | - Kathleen D Liu
- Department of Medicine and Anesthesia, Division of Nephrology and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Matthieu Legrand
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
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Evrard B, Sinha P, Delucchi K, Hendrickson CM, Kangelaris KN, Liu KD, Willmore A, Wu N, Neyton L, Schmiege E, Gomez A, Kerchberger VE, Zalucky A, Matthay MA, Ware LB, Calfee CS. Causes and attributable fraction of death from ARDS in inflammatory phenotypes of sepsis. Crit Care 2024; 28:164. [PMID: 38745253 PMCID: PMC11092165 DOI: 10.1186/s13054-024-04943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Hypoinflammatory and hyperinflammatory phenotypes have been identified in both Acute Respiratory Distress Syndrome (ARDS) and sepsis. Attributable mortality of ARDS in each phenotype of sepsis is yet to be determined. We aimed to estimate the population attributable fraction of death from ARDS (PAFARDS) in hypoinflammatory and hyperinflammatory sepsis, and to determine the primary cause of death within each phenotype. METHODS We studied 1737 patients with sepsis from two prospective cohorts. Patients were previously assigned to the hyperinflammatory or hypoinflammatory phenotype using latent class analysis. The PAFARDS in patients with sepsis was estimated separately in the hypo and hyperinflammatory phenotypes. Organ dysfunction, severe comorbidities, and withdrawal of life support were abstracted from the medical record in a subset of patients from the EARLI cohort who died (n = 130/179). Primary cause of death was defined as the organ system that most directly contributed to death or withdrawal of life support. RESULTS The PAFARDS was 19% (95%CI 10,28%) in hypoinflammatory sepsis and, 14% (95%CI 6,20%) in hyperinflammatory sepsis. Cause of death differed between the two phenotypes (p < 0.001). Respiratory failure was the most common cause of death in hypoinflammatory sepsis, whereas circulatory shock was the most common cause in hyperinflammatory sepsis. Death with severe underlying comorbidities was more frequent in hypoinflammatory sepsis (81% vs. 67%, p = 0.004). CONCLUSIONS The PAFARDS is modest in both phenotypes whereas primary cause of death among patients with sepsis differed substantially by phenotype. This study identifies challenges in powering future clinical trials to detect changes in mortality outcomes among patients with sepsis and ARDS.
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Affiliation(s)
- Bruno Evrard
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.
| | - Pratik Sinha
- Division of Clinical and Translational Research, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Anesthesia, Division of Critical Care, Washington University, Saint Louis, MO, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Carolyn M Hendrickson
- 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, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Andrew Willmore
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Nelson Wu
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Lucile Neyton
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emma Schmiege
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Antonio Gomez
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - V Eric Kerchberger
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Zalucky
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Matthay
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
- Cardiovascular Research Institute, 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
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
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Wang DH, Jia HM, Zheng X, Xi XM, Zheng Y, Li WX. Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study. BMC Pulm Med 2024; 24:110. [PMID: 38438849 PMCID: PMC10913263 DOI: 10.1186/s12890-024-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Both sepsis and acute respiratory distress syndrome (ARDS) are common severe diseases in the intensive care unit (ICU). There is no large-scale multicenter study to clarify the attributable mortality of ARDS among septic patients. This study aimed to evaluate the excess mortality of ARDS in critically ill patients with sepsis. METHODS The data were obtained from a multicenter, prospective cohort study in 18 Chinese ICUs between January 2014 and August 2015. The study population was septic patients after ICU admission. The patients were categorized into two groups: those who developed ARDS (ARDS group) within seven days following a sepsis diagnosis and those who did not develop ARDS (non-ARDS group). Applying propensity score matching (PSM), patients were matched 1:1 as ARDS and non-ARDS groups. Mortality attributed to ARDS was calculated. Subsequently, we conducted a survival analysis to estimate the impact of ARDS on mortality. The primary endpoint was 30-day mortality after sepsis diagnosis. RESULTS 2323 septic patients were eligible, 67.8% developed ARDS. After PSM, 737 patients with ARDS were matched 1:1 with 737 non-ARDS patients. ARDS's overall 30-day attributable mortality was 11.9% (95% CI 7.5-16.3%, p < 0.001). Subgroup analysis showed that the 30-day attributable mortality of mild, moderate, and severe ARDS was 10.5% (95% CI 4.0-16.8%, p < 0.001), 11.6% (95% CI 4.7-18.4%, p < 0.001) and 18.1% (95% CI 4.5-30.9%, p = 0.006), respectively. ARDS was an independent risk factor for 30-day mortality, with adjusted hazard ratios of 1.30 (95% CI 1.03-1.64, p = 0.027), 1.49 (95% CI 1.20-1.85, p < 0.001), and 1.95 (95% CI 1.51-2.52, p < 0.001) for mild, moderate, and severe ARDS, respectively. CONCLUSIONS The overall 30-day attributable mortality of ARDS among critically ill patients with sepsis was 11.9%. Compared with mild and moderate ARDS, severe ARDS contributed more to death. ARDS was significantly associated with an increase in the 30-day mortality.
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Affiliation(s)
- Dong-Hui Wang
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China
| | - Hui-Miao Jia
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China
| | - Xi Zheng
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yue Zheng
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China.
| | - Wen-Xiong Li
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China.
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5
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Torres LK, Siempos II. Identifying a hyperinflammatory subphenotype of ARDS associated with worse outcomes: may ferritin help? Thorax 2024; 79:200-201. [PMID: 38286617 PMCID: PMC10980828 DOI: 10.1136/thorax-2023-221131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Lisa K Torres
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ilias I Siempos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Locke BW, Brown J. What Are We Aiming for in Chronic Hypercapnic Respiratory Failure? Respir Care 2023; 68:1775-1778. [PMID: 38007234 PMCID: PMC10676247 DOI: 10.4187/respcare.11573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Affiliation(s)
- Brian W Locke
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine Department of Internal Medicine University of Utah Salt Lake City, Utah
| | - Jeanette Brown
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine Department of Internal Medicine University of Utah Salt Lake City, Utah
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Swets MC, Kerr S, Scott-Brown J, Brown AB, Gupta R, Millar JE, Spata E, McCurrach F, Bretherick AD, Docherty A, Harrison D, Rowan K, Young N, Groeneveld GH, Dunning J, Nguyen-Van-Tam JS, Openshaw P, Horby PW, Harrison E, Staplin N, Semple MG, Lone N, Baillie JK. Evaluation of pragmatic oxygenation measurement as a proxy for Covid-19 severity. Nat Commun 2023; 14:7374. [PMID: 37968269 PMCID: PMC10651917 DOI: 10.1038/s41467-023-42205-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/04/2023] [Indexed: 11/17/2023] Open
Abstract
Choosing optimal outcome measures maximizes statistical power, accelerates discovery and improves reliability in early-phase trials. We devised and evaluated a modification to a pragmatic measure of oxygenation function, the [Formula: see text] ratio. Because of the ceiling effect in oxyhaemoglobin saturation, [Formula: see text] ratio ceases to reflect pulmonary oxygenation function at high [Formula: see text] values. We found that the correlation of [Formula: see text] with the reference standard ([Formula: see text]/[Formula: see text] ratio) improves substantially when excluding [Formula: see text] and refer to this measure as [Formula: see text]. Using observational data from 39,765 hospitalised COVID-19 patients, we demonstrate that [Formula: see text] is predictive of mortality, and compare the sample sizes required for trials using four different outcome measures. We show that a significant difference in outcome could be detected with the smallest sample size using [Formula: see text]. We demonstrate that [Formula: see text] is an effective intermediate outcome measure in COVID-19. It is a non-invasive measurement, representative of disease severity and provides greater statistical power.
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Affiliation(s)
- Maaike C Swets
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Steven Kerr
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Adam B Brown
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Rishi Gupta
- Institute for Global Health, University College London, London, UK
| | | | - Enti Spata
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), Oxford, UK
| | - Fiona McCurrach
- EMERGE, NHS Lothian, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew D Bretherick
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Annemarie Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Harrison
- Intensive Care National Audit & Research Centre, London, UK
| | - Kathy Rowan
- Intensive Care National Audit & Research Centre, London, UK
| | - Neil Young
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Geert H Groeneveld
- Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Jake Dunning
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | | | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter W Horby
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Ewen Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Natalie Staplin
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), Oxford, UK
| | - Malcolm G Semple
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Nazir Lone
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK.
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
- Baillie Gifford Pandemic Science Hub, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
- MRC Human Genetics Unit, Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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