key: cord-0835669-09zvrkiu
authors: Azoulay, Elie; Zafrani, Lara; Mirouse, Adrien; Lengliné, Etienne; Darmon, Michael; Chevret, Sylvie
title: Clinical phenotypes of critically ill COVID-19 patients
date: 2020-05-28
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06120-4
sha: 5fcd14424e7bec7459da749b0a28e542b29272d7
doc_id: 835669
cord_uid: 09zvrkiu

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predominance of females; 9 L/min oxygen at presentation; relatively low ferritin, D-dimers, and CRP levels but intermediate IL6 levels; 8% ICU mortality. Cluster 2 (N = 17, 20%, intermediate mortality) had younger patients; 88% males; no fever; criteria for acute kidney injury in 87% of cases; 6 L/min oxygen at presentation; low IL6 concentrations but intermediate ferritin, D-dimers, and CRP; 18% ICU mortality. Cluster 3 (N = 31, 36.5%, high mortality) was remarkable for the marked majority of men; older age than in the other two clusters; severe hypoxemia with 15 L/min oxygen at presentation; fever; intense inflammatory syndrome with high CRP, D-dimer, ferritin, and IL6 concentrations; 39% ICU mortality. Intubation rates were 41%, 33%, and 71% in clusters 1, 2, and 3, respectively.

By multivariable analysis (Cox proportional hazards model), factors associated with the need for intubation and mechanical ventilation were age > 65 years (HR 1-3.51) and oxygen flow at presentation (HR 1.02/l (1-1.04)). Determinants of ICU mortality were age > 70 years (HR 1.41-17.92) and the number of comorbid conditions (HR 1.09-2.81).

This clustering approach correlates initial clinical features and outcomes in 85 critically ill hypoxemic COVID-19 patients. Awareness of these clusters may assist clinicians in making ICU admission decisions when beds are scarce. Moreover, the marked variations in inflammation markers across clusters suggest possible differences in the response to specific COVID-19 treatment [3, 4] . 

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