K-Means集群识别了COVID-19患者的多种临床表型:对死亡风险和Remdesivir影响的影响
Carolina Garcia-Vidal1,2, Christian Teijón-Lumbreras3, Tommaso Francesco Aiello4
1Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain. cgarciav@clinic.cat.
Infectious diseases and therapy
|March 15, 2024
概括
雷姆德西维尔对特定的COVID-19患者群体有好处. 聚类确定了高死亡率的表型,其中雷梅西维尔显著减少了死亡,特别是在病毒载量较高的患者中.
科学领域:
- 传染性疾病 传染性疾病
- 临床医学 临床医学
- 病毒学 病毒学
背景情况:
- 雷梅西维尔在治疗COVID-19中的有效性仍在争论中.
- 鉴定最受益于雷梅西维尔的患者子组对于向治疗至关重要.
研究的目的:
- 确定住院COVID-19患者的临床表型集群,这些患者经历了最大的死亡率从remdesivir中受益.
- 在一个独立的队列中验证这些发现.
主要方法:
- 基于rRT-PCR Ct值,淋巴细胞计数和症状持续时间,使用K-means集群对1160名住院COVID-19患者进行了分组.
- 雷梅西维尔对60天死亡率的影响在每个确定的集群中进行了评估.
- 对981名患者的外部队列进行了验证.
主要成果:
- 确定了五个不同的患者群,死亡率从0%到36.7%不等.
- 鉴定出一种高死亡率的群体,其特点是症状持续时间较短,淋巴细胞数量较低,Ct值较低 (表明病毒载量较高).
- 在这个高死亡率的群体中,雷梅西维尔的使用与显著降低死亡率有关 (10.5%与36.7%,p<0.001).
- 这些发现在外部队列中成功验证了.
结论:
- 根据不同的临床表型,COVID-19患者的死亡率在不同临床表型中存在显著差异.
- K-means集群是一种有效的工具,用于识别那些最有可能从remdesivir治疗中受益的COVID-19患者.
- 在高风险表型中向使用雷梅西维尔药物可能会改善患者的治疗结果.
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