RT Journal Article
SR Electronic
T1 Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00489-2021
DO 10.1183/23120541.00489-2021
VO 8
IS 1
A1 Esther Wittermans
A1 Philip A. van der Zee
A1 Hongchao Qi
A1 Ewoudt M.W. van de Garde
A1 Claudine A. Blum
A1 Mirjam Christ-Crain
A1 Diederik Gommers
A1 Jan C. Grutters
A1 G. Paul Voorn
A1 Willem Jan W. Bos
A1 Henrik Endeman
YR 2022
UL http://openres.ersjournals.com/content/8/1/00489-2021.abstract
AB Background Latent class analysis (LCA) has identified subgroups with meaningful treatment implications in acute respiratory distress syndrome. We performed a secondary analysis of three studies to assess whether LCA can identify clinically distinct subgroups in community-acquired pneumonia (CAP) and whether the treatment effect of adjunctive corticosteroids differs between subgroups.Methods LCA was performed on baseline clinical and biomarker data from the Ovidius trial (n=304) and the Steroids in Pneumonia (STEP) trial (n=727), both randomised controlled trials investigating adjunctive corticosteroid treatment in CAP, and the observational TripleP cohort (n=201). Analyses were conducted independently in two cohorts (Ovidius–TripleP combined and the STEP trial). In both cohorts, differences in clinical outcomes and response to adjunctive corticosteroid treatment were examined between subgroups identified through LCA.Results A two-class model fitted both cohorts best. Class 2 patients had more signs of systemic inflammation compared to class 1. In both cohorts, length of stay was longer and in-hospital mortality rate was higher in class 2. In the Ovidius trial, corticosteroids reduced the median length of stay in class 2 (6.5 versus 9.5 days) but not in class 1 (p-value for interaction=0.02). In the STEP trial, there was no significant interaction for length of stay. We found no significant interaction between class assignment and adjunctive corticosteroid treatment for secondary outcomes.Conclusions In two independent cohorts, LCA identified two classes of CAP patients with different clinical characteristics and outcomes. Given the different response to adjunctive corticosteroids in the Ovidius trial, LCA might provide a useful basis to improve patient selection for future trials.Latent class analysis of baseline clinical and biomarker data identified two distinct classes of patients with community-acquired pneumonia in two cohorts. In one cohort, the response to adjunctive corticosteroid treatment differed between classes. https://bit.ly/3ClR92L