• Daniele Roberto Giacobbe, Emilio Di Maria, Alberto Stefano Tagliafico, Martina Bavastro, Carlo Simone Trombetta, Cristina Marelli, Gabriele Di Meco, Greta Cattardico, Sara Mora, Alessio Signori, Antonio Vena, Malgorzata Mikulska, Chiara Dentone, Bianca Bruzzone, Bianca Bignotti, Andrea Orsi, Chiara Robba, Lorenzo Ball, Iole Brunetti, Denise Battaglini, Antonio Di Biagio, Maria Pia Sormani, Paolo Pelosi, Mauro Giacomini, Giancarlo Icardi, and Matteo Bassetti.
• Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
• Ann. Med. 2023 Dec 1; 55 (1): 21952042195204.

BackgroundHospitalized patients with coronavirus disease 2019 (COVID-19) can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features. We aimed to validate in an external cohort of hospitalized COVID-19 patients the prognostic value of a previously described phenotyping system (FEN-COVID-19) and to assess the reproducibility of phenotypes development as a secondary analysis.MethodsPatients were classified in phenotypes A, B or C according to the severity of oxygenation impairment, inflammatory response, hemodynamic and laboratory tests according to the FEN-COVID-19 method.ResultsOverall, 992 patients were included in the study, and 181 (18%), 757 (76%) and 54 (6%) of them were assigned to the FEN-COVID-19 phenotypes A, B, and C, respectively. An association with mortality was observed for phenotype C vs. A (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.81-5.30, p < 0.001) and for phenotype C vs. B (HR 2.20, 95% CI 1.50-3.23, p < 0.001). A non-statistically significant trend towards higher mortality was also observed for phenotype B vs. A (HR 1.41; 95% CI 0.92-2.15, p = 0.115). By means of cluster analysis, three different phenotypes were also identified in our cohort, with an overall similar gradient in terms of prognostic impact to that observed when patients were assigned to FEN-COVID-19 phenotypes.ConclusionsThe prognostic impact of FEN-COVID-19 phenotypes was confirmed in our external cohort, although with less difference in mortality between phenotypes A and B than in the original study.

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