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Stability of ARDS subphenotypes over time in two randomised controlled trials
Kevin Delucchi1, Katie R Famous2, Lorraine B Ware3
1Department of Psychiatry, University of California, San Francisco, California, USA.
Thorax
|February 26, 2018
Summary
Acute respiratory distress syndrome (ARDS) subphenotypes are stable in patients over the first three days. This stability suggests subphenotype identification is feasible for clinical trials.
Area of Science:
- Critical care medicine
- Pulmonology
- Clinical trials
Background:
- Two distinct acute respiratory distress syndrome (ARDS) subphenotypes have been identified.
- The durability of these ARDS subphenotypes over time is currently unknown.
Purpose of the Study:
- To determine the stability of ARDS subphenotypes over time.
- To assess the feasibility of subphenotype identification in clinical trials.
Main Methods:
- Secondary analysis of data from two ARDS Network randomized controlled trials (ARMA and ALVEOLI).
- Latent class analysis (LCA) and latent transition analysis (LTA) applied to data from enrollment (day 0) and day 3.
- Analysis was independent of clinical outcomes.
Main Results:
- Two ARDS subphenotypes were consistently identified at days 0 and 3.
- The majority of patients (>94%) remained in their assigned subphenotype class from day 0 to day 3.
- While largely stable, Class 2 showed evidence of progressive organ failure by day 3 compared to Class 1, with worse clinical outcomes.
Conclusions:
- ARDS subphenotypes demonstrate significant stability within the initial 3 days of patient enrollment.
- Subphenotype identification appears feasible for use in clinical trials.
- Subphenotype classification at day 3 was more strongly associated with clinical outcomes than day 0 assignment.
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