Clinical Phenotypes of Critically Ill Patients with COVID-19 Infected with Omicron: A Nationwide Prospective Cohort Study.
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Audureau Etienne, Bay Pierre, Préau Sébastien, Favory Raphaël, Guigon Aurélie, Heming Nicholas, Gault Elyanne, Pham Tài, Chaghouri Amal, Turpin Matthieu, Morand-Joubert Laurence, Jochmans Sébastien, Pitsch Aurélia, Meireles Sylvie, Contou Damien, Henry Amandine, Roux Damien, Le Hingrat Quentin, Kimmoun Antoine, Hartard Cédric, Pène Frédéric, L'Honneur Anne-Sophie, Guillon Antoine, Handala Lynda, Tamion Fabienne, Moisan Alice, Daix Thomas, Hantz Sébastien, Delamaire Flora, Thibault Vincent, Darreau Cédric, Thomin Jean, Pawlotsky Jean-Michel, Fourati Slim, de Prost Nicolas, SEVARVIR investigators
Аннотация
METHODS: This multicenter prospective substudy of the SEVARVIR cohort included adult patients from 39 French ICUs between December 2021 and October 2024 with acute respiratory failure and infected with the Omicron variant. Clustering analysis was conducted using Kohonen's self-organizing maps (SOMs) and validated with ClinTrajan, two unsupervised clustering methods, to identify homogeneous patient phenotypes.
RESULTS: During the study period, 777 patients with Omicron infection were included, and 7 distinct clinical clusters were identified. Clusters 1 and 2 included patients with metabolic and cardiovascular comorbidities. Cluster 3 featured younger, mildly ill patients with isolated chronic respiratory failure, while cluster 4 comprised older male patients with isolated respiratory failure. Cluster 5 included patients with isolated hematologic malignancies, cluster 6 patients with multiorgan failure, and cluster 7 organ transplant recipients, with high severity scores and impaired renal function. ICU management varied substantially across clusters. Patients in clusters 5 and 7 had the highest requirements for organ support, with frequent use of invasive mechanical ventilation, vasopressors (cluster 6), and renal replacement therapy (cluster 7). Dexamethasone and tocilizumab were most commonly prescribed in cluster 4 (91.3% and 30.2%, respectively). Mortality at day 28 varied significantly across clusters, ranging from 13.1% in cluster 3 to 41.1% in cluster 6.
CONCLUSIONS: This clustering analysis highlights, for the first time, the clinical heterogeneity of critically ill patients infected with Omicron, identifying seven distinct clusters with varying clinical presentations, management strategies and outcomes. These findings underscore the relevance of a phenotype-driven approach to support personalized treatment strategies and guide future clinical trials.
TRIAL REGISTRATION: Clinicaltrials.gov, NCT05162508. A Graphical Abstract is available for this article.