Identifying novel clinical phenotypes of acute respiratory distress syndrome using trajectories of daily fluid balance: a secondary analysis of randomized controlled trials

Previously identified phenotypes of acute respiratory distress syndrome (ARDS) could not reveal the dynamic change of phenotypes over time. We aimed to identify novel clinical phenotypes in ARDS using trajectories of fluid balance, to test whether phenotypes respond differently to different treatmen...

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Bibliographic Details
Published in:European journal of medical research 2024-05, Vol.29 (1), p.299-299, Article 299
Main Authors: Wu, Fei, Shi, Suqin, Wang, Zixuan, Wang, Yurong, Xia, Le, Feng, Qingling, Hang, Xin, Zhu, Min, Zhuang, Jinqiang
Format: Article
Language:English
Subjects:
Acute respiratory distress syndrome
Aged
Female
Fluid balance
Fluid Therapy - methods
Genetic aspects
Health aspects
Humans
Joint latent class mixed model
Male
Middle Aged
Mortality
Phenotype
Randomized Controlled Trials as Topic
Respiratory distress syndrome
Respiratory Distress Syndrome - physiopathology
Respiratory Distress Syndrome - therapy
Strategic planning (Business)
United Kingdom
Water-Electrolyte Balance - physiology
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Summary:Previously identified phenotypes of acute respiratory distress syndrome (ARDS) could not reveal the dynamic change of phenotypes over time. We aimed to identify novel clinical phenotypes in ARDS using trajectories of fluid balance, to test whether phenotypes respond differently to different treatment, and to develop a simplified model for phenotype identification. FACTT (conservative vs liberal fluid management) trial was classified as a development cohort, joint latent class mixed models (JLCMMs) were employed to identify trajectories of fluid balance. Heterogeneity of treatment effect (HTE) for fluid management strategy across phenotypes was investigated. We also constructed a parsimonious probabilistic model using baseline data to predict the fluid trajectories in the development cohort. The trajectory groups and the probabilistic model were externally validated in EDEN (initial trophic vs full enteral feeding) trial. Using JLCMM, we identified two trajectory groups in the development cohort: Class 1 (n = 758, 76.4% of the cohort) had an early positive fluid balance, but achieved negative fluid balance rapidly, and Class 2 (n = 234, 24.6% of the cohort) was characterized by persistent positive fluid balance. Compared to Class 1 patients, patients in Class 2 had significantly higher 60-day mortality (53.5% vs. 17.8%, p 
ISSN:2047-783X
0949-2321
2047-783X
DOI:10.1186/s40001-024-01866-9