PDF(Pubmed)
Abstract：
Biological phenotypes in patients with the acute respiratory distress syndrome (ARDS) have previously been described. We hypothesized that the trajectory of PaO2/FIO2 ratio could be used to identify phenotypes of ARDS. We used a retrospective cohort analysis of an ARDS database to identify latent classes in the trajectory of PaO2/FIO2 ratio over time. We included all adult patients admitted to an intensive care unit who met the Berlin criteria for ARDS over a 4-year period in tertiary adult intensive care units in Manitoba, Canada. Baseline demographics were collected along with the daily PaO2/FIO2 ratio collected on admission and on days 1-7, 14 and 28. We used joint growth mixture modeling to test whether ARDS patients exhibit distinct phenotypes with respect to both longitudinal PaO2/FIO2 ratio and survival. The resulting latent classes were compared on several demographic variables. In our study group of 209 patients, we found that four latent trajectory classes of PaO2/FIO2 ratio was optimal. These four classes differed in their baseline PaO2/FIO2 ratio and their trajectory of improvement during the 28 days of the study. Despite similar baseline characteristics the hazard for death for the classes differed over time. This difference was largely driven by withdrawal of life sustaining therapy in one of the classes. Latent classes were identified in the trajectory of the PaO2/FIO2 ratio over time, suggesting the presence of different ARDS phenotypes. Future studies should confirm the existence of this finding and determine the cause of mortality differences between classes.
摘要：
先前已经描述了患有急性呼吸窘迫综合征（ARDS）的患者的生物学表型。我们假设PaO2/FIO2比值的轨迹可用于鉴定ARDS的表型。我们对ARDS数据库进行了回顾性队列分析，以确定PaO2/FIO2比值随时间变化的潜在类别。我们纳入了曼尼托巴省三级成人重症监护病房中所有符合柏林ARDS标准的重症监护病房的成年患者，加拿大。收集基线人口统计数据以及入院时和第1-7、14和28天收集的每日PaO2/FIO2比率。我们使用联合生长混合物模型来测试ARDS患者在纵向PaO2/FIO2比率和生存率方面是否表现出不同的表型。在几个人口统计学变量上比较了所得的潜在类别。在我们的209名患者的研究组中，我们发现PaO2/FIO2比值的四种潜在轨迹类别是最佳的。在研究的28天期间，这四个类别的基线PaO2/FIO2比率及其改善轨迹有所不同。尽管基线特征相似，但该类别的死亡风险随时间不同而不同。这种差异在很大程度上是由其中一个类别中的生命维持疗法的退出所致。随着时间的推移，在PaO2/FIO2比率的轨迹中确定了潜在类别，提示存在不同的ARDS表型。未来的研究应该证实这一发现的存在，并确定不同类别之间死亡率差异的原因。
