Temporal patterns of organ dysfunction in COVID-19 patients hospitalized in the intensive care unit: A group-based multitrajectory modeling analysis

Jiafei Yu; Kai Zhang; Tianqi Chen; Ronghai Lin; Qijiang Chen; Chensong Chen; Minfeng Tong; Jianping Chen; Jianhua Yu; Yuhang Lou; Panpan Xu; Chao Zhong; Qianfeng Chen; Kangwei Sun; Liyuan Liu; Lanxin Cao; Cheng Zheng; Ping Wang; Qitao Chen; Qianqian Yang; Weiting Chen; Xiaofang Wang; Zuxi Yan; Xuefeng Zhang; Wei Cui; Lin Chen; Zhongheng Zhang; Gensheng Zhang

doi:10.1016/j.ijid.2024.107045

Temporal patterns of organ dysfunction in COVID-19 patients hospitalized in the intensive care unit: A group-based multitrajectory modeling analysis

Int J Infect Dis. 2024 Apr 10:144:107045. doi: 10.1016/j.ijid.2024.107045. Online ahead of print.

Authors

Jiafei Yu¹, Kai Zhang², Tianqi Chen³, Ronghai Lin⁴, Qijiang Chen⁵, Chensong Chen⁶, Minfeng Tong⁷, Jianping Chen⁸, Jianhua Yu⁹, Yuhang Lou², Panpan Xu⁴, Chao Zhong¹⁰, Qianfeng Chen⁶, Kangwei Sun⁸, Liyuan Liu⁹, Lanxin Cao², Cheng Zheng⁴, Ping Wang⁵, Qitao Chen⁷, Qianqian Yang⁷, Weiting Chen¹¹, Xiaofang Wang¹², Zuxi Yan¹³, Xuefeng Zhang¹⁴, Wei Cui², Lin Chen⁷, Zhongheng Zhang³, Gensheng Zhang¹⁵

Affiliations

¹ Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Department of Critical Care Medicine, Haiyan People's Hospital, Zhejiang 314300, China.
² Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
³ Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
⁴ Department of Critical Care Medicine, Taizhou Municipal Hospital, Zhejiang, 318000, China.
⁵ Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315600, China.
⁶ Intensive Care Unit, Xiangshan First People's Hospital Medical and Health Group, Zhejiang, 315700, China.
⁷ Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China.
⁸ Department of Emergency Medicine, Dongyang People' Hospital of Wenzhou Medical University, Zhejiang, 322100, China.
⁹ Department of Critical Care Medicine, Longquan People's Hospital, Zhejiang, 323700, China.
¹⁰ Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315600, China.
¹¹ Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Department of Emergency and Intensive Care Unit, The First People's Hospital of Linhai, Taizhou, Zhejiang 317000, China.
¹² Department of Cardiovascular Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
¹³ Department of Critical Care Medicine, Haiyan People's Hospital, Zhejiang 314300, China.
¹⁴ Department of Critical Care Medicine, Second Affiliated Hospital, Jiaxing College School of Medicine, Jiaxing 314031, China.
¹⁵ Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Key Laboratory of Multiple Organ Failure (Zhejiang University), Ministry of Education, Hangzhou 310009, China. Electronic address: genshengzhang@zju.edu.cn.

PMID: 38604470
DOI: 10.1016/j.ijid.2024.107045

Abstract

Background: The course of organ dysfunction (OD) in Corona Virus Disease 2019 (COVID-19) patients is unknown. Herein, we analyze the temporal patterns of OD in intensive care unit-admitted COVID-19 patients.

Methods: Sequential organ failure assessment scores were evaluated daily within 2 weeks of admission to determine the temporal trajectory of OD using group-based multitrajectory modeling (GBMTM).

Results: A total of 392 patients were enrolled with a 28-day mortality rate of 53.6%. GBMTM identified four distinct trajectories. Group 1 (mild OD, n = 64), with a median APACHE II score of 13 (IQR 9-21), had an early resolution of OD and a low mortality rate. Group 2 (moderate OD, n = 140), with a median APACHE II score of 18 (IQR 13-22), had a 28-day mortality rate of 30.0%. Group 3 (severe OD, n = 117), with a median APACHR II score of 20 (IQR 13-27), had a deterioration trend of respiratory dysfunction and a 28-day mortality rate of 69.2%. Group 4 (extremely severe OD, n = 71), with a median APACHE II score of 20 (IQR 17-27), had a significant and sustained OD affecting all organ systems and a 28-day mortality rate of 97.2%.

Conclusions: Four distinct trajectories of OD were identified, and respiratory dysfunction trajectory could predict nonpulmonary OD trajectories and patient prognosis.

Keywords: COVID-19; Group-based multitrajectory modeling; Intensive care unit; Multiple-organ dysfunction; Sequential organ failure assessment score.