Identification of Endotypes of Hospitalized COVID-19 Patients

Background: Characterization of coronavirus disease 2019 (COVID-19) endotypes may help explain variable clinical presentations and response to treatments. While risk factors for COVID-19 have been described, COVID-19 endotypes have not been elucidated.Objectives: We sought to identify and describe C...

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Autores principales:	Benjamin L. Ranard, Murad Megjhani, Kalijah Terilli, Kevin Doyle, Jan Claassen, Michael R. Pinsky, Gilles Clermont, Yoram Vodovotz, Shadnaz Asgari, Soojin Park
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	COVID-19 cluster analysis endotype phenotype machine learning treatment Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/9d7a77ef5dc944e898229fffc152ff9a
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spelling	oai:doaj.org-article:9d7a77ef5dc944e898229fffc152ff9a2021-11-11T07:01:27ZIdentification of Endotypes of Hospitalized COVID-19 Patients2296-858X10.3389/fmed.2021.770343https://doaj.org/article/9d7a77ef5dc944e898229fffc152ff9a2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.770343/fullhttps://doaj.org/toc/2296-858XBackground: Characterization of coronavirus disease 2019 (COVID-19) endotypes may help explain variable clinical presentations and response to treatments. While risk factors for COVID-19 have been described, COVID-19 endotypes have not been elucidated.Objectives: We sought to identify and describe COVID-19 endotypes of hospitalized patients.Methods: Consensus clustering (using the ensemble method) of patient age and laboratory values during admission identified endotypes. We analyzed data from 528 patients with COVID-19 who were admitted to telemetry capable beds at Columbia University Irving Medical Center and discharged between March 12 to July 15, 2020.Results: Four unique endotypes were identified and described by laboratory values, demographics, outcomes, and treatments. Endotypes 1 and 2 were comprised of low numbers of intubated patients (1 and 6%) and exhibited low mortality (1 and 6%), whereas endotypes 3 and 4 included high numbers of intubated patients (72 and 85%) with elevated mortality (21 and 43%). Endotypes 2 and 4 had the most comorbidities. Endotype 1 patients had low levels of inflammatory markers (ferritin, IL-6, CRP, LDH), low infectious markers (WBC, procalcitonin), and low degree of coagulopathy (PTT, PT), while endotype 4 had higher levels of those markers.Conclusions: Four unique endotypes of hospitalized patients with COVID-19 were identified, which segregated patients based on inflammatory markers, infectious markers, evidence of end-organ dysfunction, comorbidities, and outcomes. High comorbidities did not associate with poor outcome endotypes. Further work is needed to validate these endotypes in other cohorts and to study endotype differences to treatment responses.Benjamin L. RanardBenjamin L. RanardMurad MegjhaniMurad MegjhaniKalijah TerilliKalijah TerilliKevin DoyleJan ClaassenMichael R. PinskyGilles ClermontYoram VodovotzShadnaz AsgariSoojin ParkSoojin ParkFrontiers Media S.A.articleCOVID-19cluster analysisendotypephenotypemachine learningtreatmentMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 cluster analysis endotype phenotype machine learning treatment Medicine (General) R5-920
spellingShingle	COVID-19 cluster analysis endotype phenotype machine learning treatment Medicine (General) R5-920 Benjamin L. Ranard Benjamin L. Ranard Murad Megjhani Murad Megjhani Kalijah Terilli Kalijah Terilli Kevin Doyle Jan Claassen Michael R. Pinsky Gilles Clermont Yoram Vodovotz Shadnaz Asgari Soojin Park Soojin Park Identification of Endotypes of Hospitalized COVID-19 Patients
description	Background: Characterization of coronavirus disease 2019 (COVID-19) endotypes may help explain variable clinical presentations and response to treatments. While risk factors for COVID-19 have been described, COVID-19 endotypes have not been elucidated.Objectives: We sought to identify and describe COVID-19 endotypes of hospitalized patients.Methods: Consensus clustering (using the ensemble method) of patient age and laboratory values during admission identified endotypes. We analyzed data from 528 patients with COVID-19 who were admitted to telemetry capable beds at Columbia University Irving Medical Center and discharged between March 12 to July 15, 2020.Results: Four unique endotypes were identified and described by laboratory values, demographics, outcomes, and treatments. Endotypes 1 and 2 were comprised of low numbers of intubated patients (1 and 6%) and exhibited low mortality (1 and 6%), whereas endotypes 3 and 4 included high numbers of intubated patients (72 and 85%) with elevated mortality (21 and 43%). Endotypes 2 and 4 had the most comorbidities. Endotype 1 patients had low levels of inflammatory markers (ferritin, IL-6, CRP, LDH), low infectious markers (WBC, procalcitonin), and low degree of coagulopathy (PTT, PT), while endotype 4 had higher levels of those markers.Conclusions: Four unique endotypes of hospitalized patients with COVID-19 were identified, which segregated patients based on inflammatory markers, infectious markers, evidence of end-organ dysfunction, comorbidities, and outcomes. High comorbidities did not associate with poor outcome endotypes. Further work is needed to validate these endotypes in other cohorts and to study endotype differences to treatment responses.
format	article
author	Benjamin L. Ranard Benjamin L. Ranard Murad Megjhani Murad Megjhani Kalijah Terilli Kalijah Terilli Kevin Doyle Jan Claassen Michael R. Pinsky Gilles Clermont Yoram Vodovotz Shadnaz Asgari Soojin Park Soojin Park
author_facet	Benjamin L. Ranard Benjamin L. Ranard Murad Megjhani Murad Megjhani Kalijah Terilli Kalijah Terilli Kevin Doyle Jan Claassen Michael R. Pinsky Gilles Clermont Yoram Vodovotz Shadnaz Asgari Soojin Park Soojin Park
author_sort	Benjamin L. Ranard
title	Identification of Endotypes of Hospitalized COVID-19 Patients
title_short	Identification of Endotypes of Hospitalized COVID-19 Patients
title_full	Identification of Endotypes of Hospitalized COVID-19 Patients
title_fullStr	Identification of Endotypes of Hospitalized COVID-19 Patients
title_full_unstemmed	Identification of Endotypes of Hospitalized COVID-19 Patients
title_sort	identification of endotypes of hospitalized covid-19 patients
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/9d7a77ef5dc944e898229fffc152ff9a
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Identification of Endotypes of Hospitalized COVID-19 Patients

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