Clinical phenotypes of patients hospitalized for an asthma exacerbation: prognostic implications.
Clinical phenotypes of patients hospitalized for an asthma exacerbation: prognostic implications.
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因哮喘恶化住院患者的临床表型：预后影响。
DOI：
10.1016/j.jaip.2020.09.031
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Peter Gerard Gibson
中科院分区：
文献类型：
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作者：
Xin Zhang;Li Zhang;Gang Wang;Min Feng;Rui Liang;Vanessa McDonald;Hong Ping Zhang;He Yu;Zong An Liang;Lei Wang;Guy B Marks;Wei Min Li;Gang Wang;Peter Gerard Gibson
背景：急性哮喘加重(AE)引起的住院是一种非常有害的情况，需要严密的管理以防止进一步恶化，包括机械通气、重症监护病房(ICU)入院和死亡。然而，因AEs住院的患者具有高度的异质性，并且在很大程度上仍未被探索。目的：确定需要住院的AEs的临床和炎症表型与住院结果相关。方法：我们对连续招募的825名因AEs住院的患者进行了等级聚类分析。Logistic回归被用来量化已识别的表型与住院结果的独立相关性。结果：我们确定了三类患者，它们具有显著不同的特征，与住院期间的不良结果相关。第1群(n=526，63.8%)为晚发表型，第2群(n=97，11.8%)为早发表型，第3群(n=202，24.5%)为嗜酸性粒细胞较少、合并较多的表型。与第一组相比，第二组和第三组的死亡风险(分别为18.10和19.17)和机械通气风险(分别为2.56和5.71)增加。第三组的患者住院时间延长(11天)，住院直接费用增加(13,481.57元人民币)，住ICU的风险(RRadj 2.14)更高。决策树正确分配了90.8%的参与者。这些新的表型可能对因AEs住院的患者的管理具有重要的和临床相关的意义。
BACKGROUND.Hospitalization due to acute asthma exacerbation (AE) is a highly detrimental situation requiring critical management to prevent further deterioration, including mechanical ventilation, intensive care unit (ICU) admission, and death. However, patients hospitalized for AEs are highly heterogeneous and remain largely unexplored..OBJECTIVE.Identify clinical and inflammatory phenotypes of AE requiring hospitalization associated with in-hospital outcomes..METHODS.We performed a hierarchical cluster analysis of 825 consecutively recruited patients hospitalized for AEs. Logistic regressions were conducted to quantify the independent associations of the identified phenotypes with in-hospital outcomes. Decision tree analysis was developed to predict cluster assignment..RESULTS.We identified three clusters of patients, which had significantly different characteristics associated with in-hospital adverse outcomes. Cluster 1 (n=526, 63.8%) was a late-onset phenotype, cluster 2 (n=97, 11.8%) was an early-onset phenotype, and cluster 3 (n=202, 24.5%) was a phenotype with fewer eosinophils and more comorbidities. Clusters 2 and 3 had an elevated risk of death (RRadj 18.10 and 19.17, respectively) and mechanical ventilation (RRadj 2.56 and 5.71, respectively) than did cluster 1. Individuals in cluster 3 had an extended length of hospital stay (11 days), increased hospitalization direct costs (13,481.57 Chinese Yuan[CNY]), and a higher risk of ICU admission (RRadj 2.14) than individuals in clusters 1 and 2. The decision tree assigned 90.8% of the participants correctly..CONCLUSIONS.We identified three phenotypes with differential clinical and inflammatory characteristics associated with in-hospital adverse outcomes. These new phenotypes might have important and clinically relevant implications for the management of patients hospitalized for AEs.