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External validation of unsupervised COVID-19 clinical phenotypes and their prognostic impact

Daniele Roberto Giacobbe1,2, Emilio Di Maria1,3, Alberto Stefano Tagliafico1,4

  • 1Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Annals of Medicine
|April 13, 2023
PubMed

Insights

The FEN-COVID-19 phenotyping system accurately predicts mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. Phenotype C showed significantly higher mortality compared to phenotypes A and B, validating its prognostic value.

Area of Science:

  • Internal Medicine
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Hospitalized patients with COVID-19 exhibit diverse clinical presentations.
  • Classifying COVID-19 patients into phenotypes aids in understanding disease severity.
  • The FEN-COVID-19 system categorizes patients based on clinical, laboratory, and hemodynamic features.

Purpose of the Study:

  • To validate the prognostic value of the FEN-COVID-19 phenotyping system in an external cohort.
  • To assess the reproducibility of phenotype development using cluster analysis.
  • To evaluate the association between FEN-COVID-19 phenotypes and mortality in hospitalized COVID-19 patients.

Main Methods:

  • A cohort of 992 hospitalized COVID-19 patients was analyzed.
  • Patients were classified into phenotypes A, B, and C using the FEN-COVID-19 method.
  • Mortality rates were compared across phenotypes using survival analysis.

Main Results:

  • 18% (A), 76% (B), and 6% (C) of patients were assigned to FEN-COVID-19 phenotypes.
  • Phenotype C was associated with significantly higher mortality than phenotypes A and B (HR 3.10 and 2.20, respectively).
  • Cluster analysis identified three phenotypes with a similar prognostic gradient.

Conclusions:

  • The prognostic value of FEN-COVID-19 phenotypes was confirmed in an external cohort.
  • The system effectively predicts mortality risk in hospitalized COVID-19 patients.
  • While validated, the mortality difference between phenotypes A and B was less pronounced than in the original study.
Abstract

Keywords:
COVID-19SARS-CoV-2external validationpandemicphenotypesprognosisunsupervised clustering

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