Acute Respiratory Distress Syndrome Phenotypes After Stem Cell Transplantation: A Latent Class Analysis

Area of Science:

• Critical Care Medicine
• Hematology
• Pulmonology

Background:

• Acute respiratory distress syndrome (ARDS) is a severe complication following hematopoietic cell transplantation (HCT).
• Understanding distinct ARDS phenotypes post-HCT is crucial for improving patient outcomes.

Purpose of the Study:

• To identify and characterize distinct phenotypes of ARDS in patients undergoing HCT.
• To utilize routinely available clinical data at intensive care unit (ICU) admission for phenotype identification.

Main Methods:

• Multicenter retrospective cohort study involving 166 adult patients who developed ARDS post-HCT.
• Latent class analysis was employed to identify distinct patient groups based on clinical variables.
• Model selection utilized metrics such as Bayesian information criteria and entropy for optimal class identification.

Main Results:

• A two-class model optimally described the ARDS cohort, with Class 1 exhibiting worse hypoxemia, higher Pco2, and elevated bilirubin.
• Class 1 patients experienced later onset post-transplant, higher rates of idiopathic pneumonia syndrome, and significantly worse 90-day mortality (72.8% vs. 48.2%).
• Class 2 was characterized by more frequent neutropenia and peri-engraftment respiratory distress syndrome.

Conclusions:

• ARDS following HCT comprises two distinct phenotypes with differing clinical characteristics and prognoses.
• These phenotypes correlate with known post-HCT lung injury syndromes, suggesting different underlying biological mechanisms.
• This classification framework supports the development of targeted therapeutic strategies for ARDS post-HCT.