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患有ARDS风险的患者的炎症亚表型:来自LIPS-A试验的证据
Simone Redaelli1,2,3, Dario von Wedel1,2, Maxime Fosset1,2,4,5
1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Intensive care medicine
|October 31, 2023
概括
在急诊室呈现时,在患有急性呼吸困扰综合征 (ARDS) 风险的患者中早期识别超炎性亚表型可以预测更糟糕的结果并指导治疗策略.
科学领域:
- 临界护理医学 临界护理医学
- 肺部病理学 肺部病理学
- 翻译研究是翻译研究.
背景情况:
- 隐性类分析 (LCA) 之前已经在急性呼吸困扰综合征 (ARDS) 患者中确定过度和非过度炎症的亚表型.
- 在患有ARDS风险的患者中早期识别这些炎症亚表型的能力仍然不清楚.
研究的目的:
- 调查在急诊室呈现时在危险患者中识别炎症亚表型的可行性.
- 确定这些早期亚现象型是否预测ARDS的发展和患者的结果.
主要方法:
- 对LIPS-A试验数据的二次分析.
- 隐性类分析 (LCA) 使用376名患者的临床,血液测试和生物标志物变量进行.
- 在244名患者的小组中,第1天和第4天评估了亚表型稳定性.
主要成果:
- 在急诊室呈现时,确定了两种不同的亚现象:超炎症性 (19.1%) 和非超炎症性 (80.9%).
- 超炎症组的患者表现出更高ARDS发展的趋势 (15.3%与8.2%相比),经历了更少的无呼吸器日,并且在ICU和医院住院时间更长.
- 超炎性亚表型与显著更高的1年死亡率 (34.7%对20%) 相关,并在整个研究期间持续时预测ARDS风险增加.
结论:
- 炎症亚表型可以在急诊室呈现时确定,并且可能在ARDS发展之前出现.
- 这些亚现象类型随着时间的推移而相对稳定.
- 超炎性亚表型与更糟糕的临床结果有关,包括死亡率增加.
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