基于生物异质性的COVID-19严重呼吸衰竭的新型亚型:随机对照试验的二次分析
Narges Alipanah-Lechner1, James Hurst-Hopf2, Kevin Delucchi3
1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, Room M-1083, 505 Parnassus Ave., San Francisco, CA, 94143, USA. narges.alipanah@ucsf.edu.
Critical care (London, England)
|February 21, 2024
概括
确定了两种严重的COVID-19的新生物亚型,与非COVID ARDS亚型不同. 这一发现可能解释了COVID-19住院患者对治疗的不同反应.
科学领域:
- 关键护理医学 关键护理医学
- 免疫学 免疫学 免疫学
- 基因组学和蛋白质组学
背景情况:
- 住院COVID-19患者表现出与不良结果相关的炎症生物标志物,但免疫调节疗法试验显示出混合的结果.
- 患者之间的生物异质性可能导致不一致的治疗反应.
- 隐性类分析 (LCA) 之前在非COVID急性呼吸窘迫综合征 (ARDS) 中确定了不同的亚型.
研究的目的:
- 调查严重COVID-19低血压呼吸衰竭的成年人的生物异质性和临床结果.
- 通过使用临床和蛋白质生物标志物数据,在严重的COVID-19中识别不同的患者亚型.
- 将COVID-19亚型与已确定的非COVID ARDS炎症概况进行比较.
主要方法:
- 从多机构随机对照试验 (I-SPY COVID) 中400名参与者的临床和血蛋白生物标记数据分析.
- 使用Luminex面板和ELISA在招生时测量了17种假设导向蛋白质生物标志物.
- 使用LCA识别潜伏亚型并探索纵向生物标志物变化,将发现与经过验证的非COVID ARDS模型进行比较.
主要成果:
- 参与者的平均年龄为60岁,男性死亡率为67%,28天死亡率为25%.
- 炎症,上皮和内皮损伤的生物标志物与死亡率有关.
- 确定了两种新的COVID-19亚型;亚型2 (27%的参与者) 显示了持续的生物标志物失调,并使亚型1的死亡率翻了一番.
结论:
- 发现了两种新的严重COVID-19生物亚型,具有明显的临床结果.
- 这些COVID-19亚型不同于以前定义的非COVID高和低炎症性ARDS亚型.
- 了解这种生物异质性可以帮助解释不一致的试验结果,并指导COVID-19的未来治疗策略.
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