Coronavirus Disease 2019 Temperature Trajectories Correlate With Hyperinflammatory and Hypercoagulable Subphenotypes
| العنوان: | Coronavirus Disease 2019 Temperature Trajectories Correlate With Hyperinflammatory and Hypercoagulable Subphenotypes |
|---|---|
| المؤلفون: | Sivasubramanium V. Bhavani, Philip A. Verhoef, Cheryl L. Maier, Chad Robichaux, William F. Parker, Andre Holder, Rishikesan Kamaleswaran, May D. Wang, Matthew M. Churpek, Craig M. Coopersmith |
| المصدر: | Critical Care Medicine |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Male, Organ Dysfunction Scores, Anti-Inflammatory Agents, Hypothermia, Critical Care and Intensive Care Medicine, Dexamethasone, Body Temperature, Cohort Studies, coronavirus disease 2019, Humans, Hyperthermia, Blood Coagulation, Aged, Retrospective Studies, venous thromboembolic event, Inflammation, Academic Medical Centers, group-based trajectory modeling, SARS-CoV-2, COVID-19, temperature, Middle Aged, Feature Articles, Phenotype, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Female, Biomarkers |
| الوصف: | Supplemental Digital Content is available in the text. OBJECTIVES: Body temperature trajectories of infected patients are associated with specific immune profiles and survival. We determined the association between temperature trajectories and distinct manifestations of coronavirus disease 2019. DESIGN: Retrospective observational study. SETTING: Four hospitals within an academic healthcare system from March 2020 to February 2021. PATIENTS: All adult patients hospitalized with coronavirus disease 2019. INTERVENTIONS: Using a validated group-based trajectory model, we classified patients into four previously defined temperature trajectory subphenotypes using oral temperature measurements from the first 72 hours of hospitalization. Clinical characteristics, biomarkers, and outcomes were compared between subphenotypes. MEASUREMENTS AND MAIN RESULTS: The 5,903 hospitalized coronavirus disease 2019 patients were classified into four subphenotypes: hyperthermic slow resolvers (n = 1,452, 25%), hyperthermic fast resolvers (1,469, 25%), normothermics (2,126, 36%), and hypothermics (856, 15%). Hypothermics had abnormal coagulation markers, with the highest d-dimer and fibrin monomers (p < 0.001) and the highest prevalence of cerebrovascular accidents (10%, p = 0.001). The prevalence of venous thromboembolism was significantly different between subphenotypes (p = 0.005), with the highest rate in hypothermics (8.5%) and lowest in hyperthermic slow resolvers (5.1%). Hyperthermic slow resolvers had abnormal inflammatory markers, with the highest C-reactive protein, ferritin, and interleukin-6 (p < 0.001). Hyperthermic slow resolvers had increased odds of mechanical ventilation, vasopressors, and 30-day inpatient mortality (odds ratio, 1.58; 95% CI, 1.13–2.19) compared with hyperthermic fast resolvers. Over the course of the pandemic, we observed a drastic decrease in the prevalence of hyperthermic slow resolvers, from representing 53% of admissions in March 2020 to less than 15% by 2021. We found that dexamethasone use was associated with significant reduction in probability of hyperthermic slow resolvers membership (27% reduction; 95% CI, 23–31%; p < 0.001). CONCLUSIONS: Hypothermics had abnormal coagulation markers, suggesting a hypercoagulable subphenotype. Hyperthermic slow resolvers had elevated inflammatory markers and the highest odds of mortality, suggesting a hyperinflammatory subphenotype. Future work should investigate whether temperature subphenotypes benefit from targeted antithrombotic and anti-inflammatory strategies. |
| تدمد: | 1530-0293 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::98639b0b80cb52bb357416b8dead1827 https://pubmed.ncbi.nlm.nih.gov/35100194 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....98639b0b80cb52bb357416b8dead1827 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15300293 |
|---|