The following is a summary of “Inflammatory subphenotypes previously identified in ARDS are associated with mortality at intensive care unit discharge: a secondary analysis of a prospective observational study,” published in the May 2024 issue of Critical Care by Slim et al.

Despite higher mortality after ICU discharge, acute respiratory distress syndrome (ARDS) research has identified inflammatory subphenotypes based on admission biomarkers (interleukin-8, protein C, bicarbonate) that predict outcomes and treatment response.

Researchers conducted a retrospective study to assess whether inflammatory subphenotypes identified in patients with ARDS at admission also predict outcomes in a broader critically ill population discharged from the ICU.

They conducted a secondary analysis of a prospective observational cohort study in two Dutch ICUs (2011 and 2014). All patients alive at ICU discharge were categorized into previously identified inflammatory subphenotypes using a validated parsimonious model based on variables measured at a median of 10.6 hours [IQR, 8.0–31.4] before discharge. The distribution of subphenotypes, clinical characteristics, and outcomes at ICU discharge was examined in the analysis. A sensitivity analysis was conducted, involving a latent class analysis (LCA) to identify subphenotypes based on plasma protein biomarkers reflecting coagulation activation, endothelial cell activation, and inflammation at ICU discharge. Concordance between the sub-phenotyping strategies was also assessed.

The results showed 8,332 patients initially, and 1,483 ICU survivors were categorized into inflammatory subphenotypes. At ICU discharge, 6% (n=86) were hyperinflammatory, and 94% (n=1397) were hyperinflammatory. Patients having hyperinflammatory had higher organ dysfunction (SOFA score 7 [IQR 5–9] vs. 4 [IQR 2–6], P<0.001) and increased mortality (30-day mortality 21% vs. 11%, P=0.005; one-year mortality 48% vs. 28%, P<0.001). LCA identified 2 subphenotypes, with class 1 having significantly higher mortality than class 2, primarily comprising patients with hyperinflammatory.

Investigators concluded that assigning inflammatory subphenotypes based on ICU discharge biomarkers holds promise for predicting short—and long-term outcomes in critically ill patients.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04929-9