Respiratory failure & ventilation
Identification and validation of respiratory subphenotypes in patients with COVID-19 acute respiratory distress syndrome undergoing prone position
An erratum to this article was published (Ann Intensive Care, 22 Jan 2025 ↗)
Authors' conclusion
Our study successfully identified and validated two distinct subphenotypes of COVID-19 ARDS based on key respiratory parameters.
Study context
- Population
- Consecutive ventilated patients with PCR-confirmed COVID-19 and moderate or severe acute respiratory distress syndrome (ARDS) in whom prone positioning was clinically indicated504 development, 214 validation
- Participants
- 718 participants
- Exposure
- Respiratory subphenotype B vs subphenotype A
- Outcome
- Identification and validation of respiratory subphenotypes (PaO2/FiO2 ratio, respiratory compliance, ventilatory ratio assessed longitudinally throughout the first prone session)
Methodological detailstemporal split development and validation cohorts, machine learning (K-means joint trajectory clustering, random forest)
- Temporal split development and validation cohorts
- Machine learning (K-means joint trajectory clustering, random forest)
Main finding
As reported in the abstract
Respiratory subphenotypes
- Two distinct subphenotypes, A and B, identified
- B: lower PaO2/FiO2 response during prone session, higher ventilatory ratio, lower compliance than A
- Subphenotypes reproducible in the validation cohort
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| 60-day mortality · independently associated | 1.89 (1.51–2.36) | |
| 0.512Odds ratio (log scale) |
Ventilator-free days on day 28
- Lower in B
- P < 0.001
Hospital LOS
- Lower in B
- P < 0.001
Baseline characteristics and IL-6
- Higher proportion of females in B
- P < 0.001
- More lung disease in B
- P = 0.005
- Higher baseline SAPS III in B
- P = 0.002
- Higher baseline SOFA in B
- P < 0.001
- Lower BMI in B
- P = 0.05
- Higher IL-6 in B
- P = 0.017
Original publication
Identification and validation of respiratory subphenotypes in patients with COVID-19 acute respiratory distress syndrome undergoing prone position. Ann Intensive Care. Published 29 November 2024. doi:10.
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