Hyperinflammatory Subphenotype and Code Status Changes in Acute Respiratory Failure
Author Information
Author(s): Moale Amanda C. MD, Nouraie S. Mehdi MD, PhD, Zia Haris MD, Schaefer Caitlin MPH, Barbash Ian J. MD, MS, White Douglas B. MD, MAS, McVerry Bryan J. MD, Kitsios Georgios D. MD, PhD
Primary Institution: University of Pittsburgh School of Medicine
Hypothesis
The hyperinflammatory subphenotype would be associated with code status de-escalation in patients with acute respiratory failure.
Conclusion
Patients with the hyperinflammatory subphenotype experienced earlier code status de-escalation and worse outcomes compared to those with the hypoinflammatory subphenotype.
Supporting Evidence
- Code status de-escalation occurred in 108 patients (26.7%) during the ICU course.
- Patients with the hyperinflammatory subphenotype showed a statistically significant association with code status de-escalation.
- Time to code status de-escalation was shorter for patients with the hyperinflammatory subphenotype.
- Patients who experienced code status de-escalation had a statistically significant association with 90-day mortality.
Takeaway
This study found that patients with a certain type of inflammation in their bodies had to change their treatment plans sooner and had worse survival rates.
Methodology
Data from mechanically ventilated adult patients with acute respiratory failure were analyzed using logistic regression models to assess associations between subphenotypes and code status de-escalation.
Potential Biases
Clinicians were unaware of subphenotype classifications, which may introduce bias in treatment decisions.
Limitations
The study is limited by its retrospective single-center design and sample size.
Participant Demographics
The cohort included 404 patients, predominantly white (91.6%), with a mean age of 57.1 years.
Statistical Information
P-Value
P = .010
Confidence Interval
95% CI, 1.14–3.16
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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