COVID-19相关的急性呼吸窘迫综合征(CARDS)被认为与典型的ARDS不同。虽然通过潜在类别分析(LCA)已经鉴定了ARDS的不同表型,目前尚不清楚CARDS是否存在这种表型,以及它们如何影响临床结局.为了解决这个问题,我们对现有证据进行了系统回顾.我们搜查了好几个,包括PubMed,EBSCO主机,和WebofScience,从成立到2022年7月1日。我们的暴露和感兴趣的结果是不同的CARDS表型鉴定及其相关结果,例如28天,90天,180天死亡率,无呼吸机日,以及其他相关成果。我们确定了四项研究,共1776名CARDS患者。在四项研究中,三人使用LCA来鉴定CARDS的亚表型(SP)。一项基于纵向数据的研究确定了两个SP,与SP1相比,SP2与较差的通气和机械参数相关。其他两项基于基线数据的研究也确定了两个SP,SP2和SP1与高炎症和低炎症相关,分别。第四项研究使用多因素分析确定了三个主要按合并症分层的SP。所有研究都确定了与较差结局相关的子表型,包括死亡率,无呼吸机日,多器官损伤,和肺栓塞.两项研究报告了SP对皮质类固醇的不同反应,高炎症和低炎症SP的死亡率改善。总的来说,我们的综述强调了表型分析在理解CARDS及其对疾病管理和预后的影响方面的重要性.然而,为了确保研究之间的一致性和可比性,必须采用一致的表型鉴定方法.我们建议按表型分层的随机临床试验只能在达成共识后开始。
■COVID-19ARDS亚型和结果。
COVID-19-related acute respiratory distress syndrome (CARDS) has been suggested to differ from the typical ARDS. While distinct phenotypes of ARDS have been identified through latent class analysis (LCA), it is unclear whether such phenotypes exist for CARDS and how they affect clinical outcomes. To address this question, we conducted a systematic review of the current evidence.We searched several, including PubMed, EBSCO Host, and Web of Science, from inception to July 1, 2022. Our exposure and outcome of interest were different CARDS phenotypes identified and their associated outcomes, such as 28-day, 90-day, 180-day mortality, ventilator-free days, and other relevant outcomes.We identified four studies comprising a total of 1776 CARDS patients.Of the four studies, three used LCA to identify subphenotypes (SPs) of CARDS. One study based on longitudinal data identified two SPs, with SP2 associated with worse ventilation and mechanical parameters than SP1. The other two studies based on baseline data also identified two SPs, with SP2 and SP1 were associated with hyperinflammatory and hypoinflammatory CARDS, respectively. The fourth study identified three SPs primarily stratified by comorbidities using multifactorial analysis.All studies identified a subphenotype associated with poorer outcomes, including mortality, ventilator-free days, multiple-organ injury, and pulmonary embolism. Two studies reported differential responses to corticosteroids among the SPs, with improved mortality in the hyperinflammatory and worse in the hypoinflammatory SPs.Overall, our review highlights the importance of phenotyping in understanding CARDS and its impact on disease management and prognostication. However, a consensus approach to phenotyping is necessary to ensure consistency and comparability across studies. We recommend that randomized clinical trials stratified by phenotype should only be initiated after such consensus is reached.
UNASSIGNED: COVID-19 ARDS subphenotypes and outcomes.