• Philip A Verhoef, Alexandra B Spicer, Carlos Lopez-Espina, Akhil Bhargava, Lee Schmalz, Matthew D Sims, Ashok V Palagiri, Karthik V Iyer, Matthew J Crisp, Alexandra Halalau, Nicholas Maddens, Falgun Gosai, Anwaruddin Syed, Saleem Azad, Aimee Espinosa, Francisco Davila, Hugo Davila, Neil R Evans, Scott Smith, Bobby Reddy, Pratik Sinha, and Matthew M Churpek.
• Hawaii Permanente Medical Group, Honolulu, HI.
• Crit. Care Med. 2023 Dec 1; 51 (12): 169717051697-1705.

ObjectivesTo identify and validate novel COVID-19 subphenotypes with potential heterogenous treatment effects (HTEs) using electronic health record (EHR) data and 33 unique biomarkers.DesignRetrospective cohort study of adults presenting for acute care, with analysis of biomarkers from residual blood collected during routine clinical care. Latent profile analysis (LPA) of biomarker and EHR data identified subphenotypes of COVID-19 inpatients, which were validated using a separate cohort of patients. HTE for glucocorticoid use among subphenotypes was evaluated using both an adjusted logistic regression model and propensity matching analysis for in-hospital mortality.SettingEmergency departments from four medical centers.PatientsPatients diagnosed with COVID-19 based on International Classification of Diseases , 10th Revision codes and laboratory test results.InterventionsNone.Measurements And Main ResultsBiomarker levels generally paralleled illness severity, with higher levels among more severely ill patients. LPA of 522 COVID-19 inpatients from three sites identified two profiles: profile 1 ( n = 332), with higher levels of albumin and bicarbonate, and profile 2 ( n = 190), with higher inflammatory markers. Profile 2 patients had higher median length of stay (7.4 vs 4.1 d; p < 0.001) and in-hospital mortality compared with profile 1 patients (25.8% vs 4.8%; p < 0.001). These were validated in a separate, single-site cohort ( n = 192), which demonstrated similar outcome differences. HTE was observed ( p = 0.03), with glucocorticoid treatment associated with increased mortality for profile 1 patients (odds ratio = 4.54).ConclusionsIn this multicenter study combining EHR data with research biomarker analysis of patients with COVID-19, we identified novel profiles with divergent clinical outcomes and differential treatment responses.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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