Abstract
BackgroundCoronavirus disease has heterogeneous clinical features; however, the reasons for the heterogeneity are poorly understood. This study aimed to identify clinical phenotypes according to patients’ temperature trajectory.MethodA retrospective review was conducted in five tertiary hospitals in Hubei Province from November 2019 to March 2020. We explored potential temperature-based trajectory phenotypes and assessed patients’ clinical outcomes, inflammatory response, and response to immunotherapy according to phenotypes.ResultsA total of 1580 patients were included. Four temperature-based trajectory phenotypes were identified: normothermic (Phenotype 1); fever, rapid defervescence (Phenotype 2); gradual fever onset (Phenotype 3); and fever, slow defervescence (Phenotype 4). Compared with Phenotypes 1 and 2, Phenotypes 3 and 4 had a significantly higher C-reactive protein level and neutrophil count and a significantly lower lymphocyte count. After adjusting for confounders, Phenotypes 3 and 4 had higher in-hospital mortality (adjusted odds ratio and 95% confidence interval 2.1, 1.1–4.0; and 3.3, 1.4–8.2, respectively), while Phenotype 2 had similar mortality, compared with Phenotype 1. Corticosteroid use was associated with significantly higher in-hospital mortality in Phenotypes 1 and 2, but not in Phenotypes 3 or 4 (p for interaction < 0.01). A similar trend was observed for gamma-globulin.ConclusionsPatients with different temperature-trajectory phenotypes had different inflammatory responses, clinical outcomes, and responses to corticosteroid therapy.
Highlights
Coronavirus disease has heterogeneous clinical features; the reasons for the heterogeneity are poorly understood
Corticosteroid use was associated with significantly higher in-hospital mortality in Phenotypes 1 and 2, but not in Phenotypes 3 or 4 (p for interaction < 0.01)
Outcome definition This study aimed to investigate the heterogeneous features of temperature-trajectory phenotypes from three perspectives: the clinical outcome, inflammatory response, and response to immunotherapy
Summary
Coronavirus disease has heterogeneous clinical features; the reasons for the heterogeneity are poorly understood. This study aimed to identify clinical phenotypes according to patients’ temperature trajectory. Coronavirus disease (COVID-19) is a global health threat that has caused more than one million deaths worldwide. Concerted efforts have been made to evaluate effective therapies, such as use of corticosteroids [1, 2] and statins [3, 4]. The effectiveness of various therapies is unclear. Evidence has indicated that COVID-19 is a heterogeneous disease [5, 6] characterized by different inflammatory responses. Despite the heterogeneity within COVID-19 cases, most clinical trials have focused on a one-size-fits-all treatment approach, which may partly explain the inconsistencies in the results between studies. Identification of different clinical phenotypes may contribute to improving medical interventions and prognosis [8, 9]
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