Clinical Phenotypes of Patients Hospitalized for an Asthma Exacerbation: Prognostic Implications

Xin Zhang; Li Zhang; Gang Wang; Min Feng; Rui Liang; Vanessa M McDonald; Hong Ping Zhang; He Yu; Zong An Liang; Lei Wang; Guy B Marks; Wei Min Li; Gang Wang; Peter Gerard Gibson

doi:10.1016/j.jaip.2020.09.031

Clinical Phenotypes of Patients Hospitalized for an Asthma Exacerbation: Prognostic Implications

J Allergy Clin Immunol Pract. 2021 Feb;9(2):830-841.e14. doi: 10.1016/j.jaip.2020.09.031. Epub 2020 Oct 1.

Authors

Xin Zhang¹, Li Zhang², Gang Wang³, Min Feng², Rui Liang², Vanessa M McDonald⁴, Hong Ping Zhang², He Yu⁵, Zong An Liang⁵, Lei Wang², Guy B Marks⁶, Wei Min Li⁵, Gang Wang⁷, Peter Gerard Gibson⁴

Affiliations

¹ Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China; Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, PR China.
² Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China.
³ Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China; West China School of Medicine, Sichuan University, Chengdu, PR China.
⁴ Priority Research Centre for Healthy Lungs and Centre of Excellence in Severe Asthma, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
⁵ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China.
⁶ The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
⁷ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, PR China. Electronic address: wcums-respiration@hotmail.com.

PMID: 33011298
DOI: 10.1016/j.jaip.2020.09.031

Abstract

Background: Hospitalization due to acute asthma exacerbation (AE) is a highly detrimental situation requiring critical management to prevent further deterioration, including mechanical ventilation, intensive care unit (ICU) admission, and death. However, patients hospitalized for AEs are highly heterogeneous and remain largely unexplored.

Objective: To identify clinical and inflammatory phenotypes of AE requiring hospitalization associated with in-hospital outcomes.

Methods: We performed a hierarchical cluster analysis of 825 consecutively recruited patients hospitalized for AEs. Logistic regressions were conducted to quantify the independent associations of the identified phenotypes with in-hospital outcomes. Decision tree analysis was developed to predict cluster assignment.

Results: We identified 3 clusters of patients, which had significantly different characteristics associated with in-hospital adverse outcomes. Cluster 1 (n = 526, 63.8%) was a late-onset phenotype, cluster 2 (n = 97, 11.8%) was an early-onset phenotype, and cluster 3 (n = 202, 24.5%) was a phenotype with fewer eosinophils and more comorbidities. Clusters 2 and 3 had an elevated risk of death (relative ratio [RR_adj], 18.10 and 19.17, respectively) and mechanical ventilation (RR_adj, 2.56 and 5.71, respectively) than did cluster 1. Individuals in cluster 3 had an extended length of hospital stay (11 days), increased hospitalization direct costs (13,481.57 Chinese Yuan), and a higher risk of ICU admission (RR_adj, 2.14) than individuals in clusters 1 and 2. The decision tree assigned 90.8% of the participants correctly.

Conclusions: We identified 3 phenotypes with differential clinical and inflammatory characteristics associated with in-hospital adverse outcomes. These new phenotypes might have important and clinically relevant implications for the management of patients hospitalized for AEs.

Keywords: Asthma; Cluster analysis; Exacerbations; Phenotypes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asthma* / diagnosis
Asthma* / epidemiology
Hospitalization
Humans
Length of Stay
Phenotype
Prognosis