Evidence mapPaperPMID 42006609Full record

ArticleCHEST critical care2025

Testing the Transportability of Sepsis Subtypes to Patients With ARDS for Postdischarge Outcomes.

Robert J Flick, Thomas S Valley, Mari Armstrong-Hough, Theodore J Iwashyna

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Article in CHEST critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Robert J FlickDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
Thomas S ValleyDivision of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan.
Mari Armstrong-HoughDepartment of Epidemiology, New York University School of Global Public Health, New York, New York.
Theodore J IwashynaDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.

Funding

MULTIDISCIPLINARY TRAINING PROGRAM IN LUNG DISEASEST32HL007534 · NHLBI · JOHNS HOPKINS UNIVERSITY · 1985 to 2025
$8.7M
Effective Primary care practices that Enhance Recovery Trajectories after pneumonia (EXPERT)R01HL169533 · JOHNS HOPKINS UNIVERSITY · 2025 to 2025
$696k
Promoting Change in Practice for Respiratory Failure: the PRECIPICE StudyR01HL157361 · NEW YORK UNIVERSITY · 2025 to 2025
$648k
NHLBI NIH HHS R01 HL132232NHLBI NIH HHS R01 HL157361NHLBI NIH HHS R01 HL169533NHLBI NIH HHS T32 HL007534
6 · The paper itself

Abstract

Background: Survivors of ARDS experience significant morbidity and mortality after hospital discharge. A latent class analysis (LCA) proposed 5 sepsis survivor subtypes that may be of use for ARDS patients as well, but did not include an operationalization algorithm for assigning patients to subtypes. Research Question: Can the Taylor sepsis survivor subtypes be operationalized in an ARDS population, and does such operationalizations distinguish patients at varying risk of post-discharge mortality and readmission? Study Design and Methods: We conducted a secondary analysis of adults with acute respiratory distress syndromes requiring mechanical ventilation enrolled in the Reevaluation of Systemic Early Neuromuscular Blockade (ROSE) trial. We compared two methods of operationalizing subtype to develop an assignment rule: transported subtypes based on an algorithm developed using five variables from the previously published derivation cohort, and de novo subtypes derived from a new latent class analysis (LCA). Random-effect logit models were used to estimate the association between subtype and the primary outcome of mortality at 12 months. Results: 580 participants were assigned to five subtypes using the transported approach. In age-adjusted regression, transported subtype was significantly associated with mortality at 12 months (p=0.027) and readmission at 3 months (p=0.043). A de novo LCA identified 5 distinct subtypes as the optimal solution; subtypes were associated with mortality at 3, 6, and 12 months (p<0.001) and readmission at 3 months (p=0.008). Agreement between the two assignment methods was 48% (kappa 0.361), and concentrated in the lowest (134/145, 92.4%) and highest risk (44/44, 100%) groups. Interpretation: Sepsis survivor subtypes can be transported and operationalized in ARDS patients. Different approaches to operationalization yield similar but not identical subgroups classifications. Both approaches assign individuals to groups that are significantly associated with patient-important outcomes among ARDS survivors. Optimal strategies to transport externally derived subtypes, versus internal rederivation, may depend on the specific use case.

Indexed as

critical carepatient reported outcome measures

Identifiers

PMID42006609
PMCPMC13089912

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.