Novel phenotypes of coronavirus disease: a temperature-based trajectory model

Annals of Intensive Care

Dechang Chen¹  Jing Yan²  Caibao Hu²  Guolong Cai²  Yanfei Shen²  Qianghong Xu²  Jiao Liu³  Xinmei Huang³ 

[1] Department of Intensive Care, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine;Department of Intensive Care, Zhejiang Hospital;Department of Internal Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine;

关键词: COVID-19;    Temperature;    Mortality;    Inflammatory response;    Corticosteroids;   

DOI  :  10.1186/s13613-021-00907-4

来源: DOAJ

【 摘 要 】

Abstract Background Coronavirus disease has heterogeneous clinical features; however, the reasons for the heterogeneity are poorly understood. This study aimed to identify clinical phenotypes according to patients’ temperature trajectory. Method A retrospective review was conducted in five tertiary hospitals in Hubei Province from November 2019 to March 2020. We explored potential temperature-based trajectory phenotypes and assessed patients’ clinical outcomes, inflammatory response, and response to immunotherapy according to phenotypes. Results A total of 1580 patients were included. Four temperature-based trajectory phenotypes were identified: normothermic (Phenotype 1); fever, rapid defervescence (Phenotype 2); gradual fever onset (Phenotype 3); and fever, slow defervescence (Phenotype 4). Compared with Phenotypes 1 and 2, Phenotypes 3 and 4 had a significantly higher C-reactive protein level and neutrophil count and a significantly lower lymphocyte count. After adjusting for confounders, Phenotypes 3 and 4 had higher in-hospital mortality (adjusted odds ratio and 95% confidence interval 2.1, 1.1–4.0; and 3.3, 1.4–8.2, respectively), while Phenotype 2 had similar mortality, compared with Phenotype 1. Corticosteroid use was associated with significantly higher in-hospital mortality in Phenotypes 1 and 2, but not in Phenotypes 3 or 4 (p for interaction < 0.01). A similar trend was observed for gamma-globulin. Conclusions Patients with different temperature-trajectory phenotypes had different inflammatory responses, clinical outcomes, and responses to corticosteroid therapy.

【 授权许可】

Unknown