Distinct clinical phenotypes in paediatric cancer patients with sepsis are associated with different outcomes-an international multicentre retrospective study.
Distinct clinical phenotypes in paediatric cancer patients with sepsis are associated with different outcomes-an international multicentre retrospective study.
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DOI：
10.1016/j.eclinm.2023.102252
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发表时间：
2023-11
影响因子：
15.1
通讯作者：
Sanchez-Pinto, L. Nelson
中科院分区：
文献类型：
--
作者：
Wosten-van Asperen, Roelie M.;la Roi-Teeuw, Hannah M.;van Amstel, Rombout B. E.;Bos, Lieuwe D. J.;Tissing, Wim J. E.;Jordan, Iolanda;Dohna-Schwake, Christian;Bottari, Gabriella;Pappachan, John;Crazzolara, Roman;Comoretto, Rosanna I.;Mizia-Malarz, Agniezka;Moscatelli, Andrea;Sanchez-Martin, Maria;Willems, Jef;Rogerson, Colin M.;Bennett, Tellen D.;Luo, Yuan;Atreya, Mihir R.;Faustino, E. Vincent S.;Geva, Alon;Weiss, Scott L.;Schlapbach, Luregn J.;Sanchez-Pinto, L. Nelson
识别脓毒症患者的表型可能使精准医学方法成为可能。然而，这些表型对特定患者群体的普遍性尚不清楚。鉴于与非癌症患者相比，患有败血症的儿科癌症患者具有不同的宿主反应和病原体特征以及更高的死亡率，我们确定在这一特定患者群体中是否存在独特的、可重复的和临床相关的败血症表型。我们研究了25个儿科重症监护病房（picu）之一的潜在恶性肿瘤脓毒症患者，这些患者参与了欧洲SCOTER研究（n = 383例患者，研究期为2018年1月1日至2020年1月1日）和美国新型数据驱动的儿童脓毒症表型研究（n = 1898例患者，研究期为2012年1月1日至2018年1月1日）的两个大型多中心观察性队列。我们独立地在两个队列中使用潜在类分析（LCA），利用PICU入院前24小时的人口学、临床和实验室数据来确定表型。然后，我们在两个队列中测试了表型与临床结果的关联。LCA确定了两种不同的表型，在两个队列中具有可比性。表型1的特点是血清碳酸氢盐和白蛋白较低，与表型2相比，乳酸和肝、肾、凝血异常明显增加。表型1患者的90天死亡率更高（欧洲队列29.2%对13.4%，美国队列27.3%对11.4%,p < 0.001），并且比表型2患者接受更多的血管加压剂和肾脏替代治疗。在调整了器官功能障碍的严重程度、血液学癌症、既往干细胞移植和年龄后，表型1与90天调整后的死亡OR相关，欧洲队列为1.9(1.04-3.34)，美国队列为1.6（1.2-2.2）。我们在儿童癌症患者中确定了两种临床相关的脓毒症表型，这两种表型在两个具有预后意义的国际多中心队列中是可重复的。这些结果可能指导有关这些特定表型的治疗方法的进一步研究。这项研究的一部分是由。
Identifying phenotypes in sepsis patients may enable precision medicine approaches. However, the generalisability of these phenotypes to specific patient populations is unclear. Given that paediatric cancer patients with sepsis have different host response and pathogen profiles and higher mortality rates when compared to non-cancer patients, we determined whether unique, reproducible, and clinically-relevant sepsis phenotypes exist in this specific patient population. We studied patients with underlying malignancies admitted with sepsis to one of 25 paediatric intensive care units (PICUs) participating in two large, multi-centre, observational cohorts from the European SCOTER study (n = 383 patients; study period between January 1, 2018 and January 1, 2020) and the U.S. Novel Data-Driven Sepsis Phenotypes in Children study (n = 1898 patients; study period between January 1, 2012 and January 1, 2018). We independently used latent class analysis (LCA) in both cohorts to identify phenotypes using demographic, clinical, and laboratory data from the first 24 h of PICU admission. We then tested the association of the phenotypes with clinical outcomes in both cohorts. LCA identified two distinct phenotypes that were comparable across both cohorts. Phenotype 1 was characterised by lower serum bicarbonate and albumin, markedly increased lactate and hepatic, renal, and coagulation abnormalities when compared to phenotype 2. Patients with phenotype 1 had a higher 90-day mortality (European cohort 29.2% versus 13.4%, U.S. cohort 27.3% versus 11.4%, p < 0.001) and received more vasopressor and renal replacement therapy than patients with phenotype 2. After adjusting for severity of organ dysfunction, haematological cancer, prior stem cell transplantation and age, phenotype 1 was associated with an adjusted OR of death at 90-day of 1.9 (1.04–3.34) in the European cohort and 1.6 (1.2–2.2) in the U.S. cohort. We identified two clinically-relevant sepsis phenotypes in paediatric cancer patients that are reproducible across two international, multicentre cohorts with prognostic implications. These results may guide further research regarding therapeutic approaches for these specific phenotypes. Part of this study is funded by the .
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影响因子：
36.4
作者：
Agyeman, Philipp K. A.;Schlapbach, Luregn J.;Berger, Christoph
通讯作者：
Berger, Christoph
影响因子：
76.2
作者：
Calfee, Carolyn S.;Delucchi, Kevin;Parsons, Polly E.;Thompson, B. Taylor;Ware, Lorraine B.;Matthay, Michael A.
通讯作者：
Matthay, Michael A.
影响因子：
8
作者：
Bembea, Melania M.;Agus, Michael;Akcan-Arikan, Ayse;Alexander, Peta;Basu, Rajit;Bennett, Tellen D.;Bohn, Desmond;Brandao, Leonardo R.;Brown, Ann-Marie;Carcillo, Joseph A.;Checchia, Paul;Cholette, Jill;Cheifetz, Ira M.;Cornell, Timothy;Doctor, Allan;Eckerle, Michelle;Erickson, Simon;Farris, Reid W. D.;Faustino, E. Vincent S.;Fitzgerald, Julie C.;Fuhrman, Dana Y.;Giuliano, John S., Jr.;Guilliams, Kristin;Gaies, Michael;Gorga, Stephen M.;Hall, Mark;Hanson, Sheila J.;Hartman, Mary;Hassinger, Amanda B.;Irving, Sharon Y.;Jeffries, Howard;Jouvet, Philippe;Kannan, Sujatha;Karam, Oliver;Khemani, Robinder G.;Kissoon, Niranjan;Lacroix, Jacques;Laussen, Peter;Leclerc, Francis;Lee, Jan Hau;Leteurtre, Stephane;Lobner, Katie;McKiernan, Patrick J.;Menon, Kusum;Monagle, Paul;Muszynski, Jennifer A.;Odetola, Folafoluwa;Parker, Robert;Pathan, Nazima;Pierce, Richard W.;Pineda, Jose;Prince, Jose M.;Robinson, Karen A.;Rowan, Courtney M.;Ryerson, Lindsay M.;Sanchez-Pinto, L. Nelson;Schlapbach, Luregn J.;Selewski, David T.;Shekerdemian, Lara S.;Simon, Dennis;Smith, Lincoln S.;Squires, James E.;Squires, Robert H.;Sutherland, Scott M.;Ouellette, Yves;Spaeder, Michael C.;Srinivasan, Vijay;Steiner, Marie E.;Tasker, Robert C.;Thiagarajan, Ravi;Thomas, Neal;Tissieres, Pierre;Traube, Chani;Tucci, Marisa;Typpo, Katri, V;Wainwright, Mark S.;Ward, Shan L.;Watson, R. Scott;Weiss, Scott;Whitney, Jane;Willson, Doug;Wynn, James L.;Yehya, Nadir;Zimmerman, Jerry J.
通讯作者：
Zimmerman, Jerry J.
影响因子：
51.1
作者：
Gatta, Gemma;Botta, Laura;Peris-Bonet, Rafael
通讯作者：
Peris-Bonet, Rafael
影响因子：
8.8
作者：
Lindell, Robert B.;Nishisaki, Akira;Fitzgerald, Julie C.
通讯作者：
Fitzgerald, Julie C.