Six-month and 12-month patient outcomes based on inflammatory subphenotypes in sepsis-associated ARDS: secondary analysis of SAILS-ALTOS trial.

Pubmed ID: 34112703

Pubmed Central ID: PMC8660939

Journal: Thorax

Publication Date: Jan. 1, 2022

Affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

MeSH Terms: Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Quality of Life, Sepsis, Walking, Respiratory Distress Syndrome

Grants: R35 HL140026, N01HR56170, R01 HL091760, UL1 TR000424

Authors: Calfee CS, Hough CL, Sinha P, Hashem MD, Hopkins RO, Colantuoni E, Dinglas VD, Aronson Friedman L, Morris PE, Jackson JC, Needham DM

Cite As: Hashem MD, Hopkins RO, Colantuoni E, Dinglas VD, Sinha P, Aronson Friedman L, Morris PE, Jackson JC, Hough CL, Calfee CS, Needham DM. Six-month and 12-month patient outcomes based on inflammatory subphenotypes in sepsis-associated ARDS: secondary analysis of SAILS-ALTOS trial. Thorax 2022 Jan;77(1):22-30. Epub 2021 Jun 10.

Studies:

Abstract

BACKGROUND: Prior acute respiratory distress syndrome (ARDS) trials have identified hypoinflammatory and hyperinflammatory subphenotypes, with distinct differences in short-term outcomes. It is unknown if such differences extend beyond 90 days or are associated with physical, mental health or cognitive outcomes. METHODS: 568 patients in the multicentre Statins for Acutely Injured Lungs from Sepsis trial of rosuvastatin versus placebo were included and assigned a subphenotype. Among 6-month and 12-month survivors (N=232 and 219, respectively, representing 243 unique survivors), subphenotype status was evaluated for association with a range of patient-reported outcomes (eg, mental health symptoms, quality of life). Patient subsets also were evaluated with performance-based tests of physical function (eg, 6 min walk test) and cognition. FINDINGS: The hyperinflammatory versus hypoinflammatory subphenotype had lower overall 12-month cumulative survival (58% vs 72%, p<0.01); however, there was no significant difference in survival beyond 90 days (86% vs 89%, p=0.70). Most survivors had impairment across the range of outcomes, with little difference between subphenotypes at 6-month and 12-month assessments. For instance, at 6 months, in comparing the hypoinflammatory versus hyperinflammatory subphenotypes, respectively, the median (IQR) patient-reported SF-36 mental health domain score was 47 (33-56) vs 44 (35-56) (p=0.99), and the per cent predicted 6 min walk distance was 66% (48%, 80%) vs 66% (49%, 79%) (p=0.76). INTERPRETATION: Comparing the hyperinflammatory versus hypoinflammatory ARDS subphenotype, there was no significant difference in survival beyond 90 days and no consistent findings of important differences in 6-month or 12-month physical, cognitive and mental health outcomes. These findings, when considered with prior results, suggest that inflammatory subphenotypes largely reflect the acute phase of illness and its short-term impact.