Journal
BMC INFECTIOUS DISEASES
Volume 22, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s12879-022-07701-y
Keywords
COVID-19; Pneumonia; Phenotype; Cluster analysis; Japan
Categories
Funding
- AMED [JP20nk0101612, JP20fk0108415, JP21jk0210034, JP21km0405211, JP21km0405217]
- JST CREST [JPMJCR20H2]
- Takeda Science Foundation
- Mitsubishi Foundation
- Bioinformatics Initiative of Osaka University Graduate School of Medicine, Osaka University
- Precursory Research for Embryonic Science and Technology [JPMJPR21R7]
- MHLW [20CA2054]
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This study used cluster analysis to phenotype COVID-19 patients in Japan and identified four distinct clusters. Patients in the middle-aged obese and elderly clusters had a higher prevalence of shortness of breath and higher levels of serum biomarkers. The middle-aged obese cluster had worse outcomes but a lower mortality rate.
Background The clinical course of coronavirus disease (COVID-19) is diverse, and the usefulness of phenotyping in predicting the severity or prognosis of the disease has been demonstrated overseas. This study aimed to investigate clinically meaningful phenotypes in Japanese COVID-19 patients using cluster analysis. Methods From April 2020 to May 2021, data from inpatients aged >= 18 years diagnosed with COVID-19 and who agreed to participate in the study were collected. A total of 1322 Japanese patients were included. Hierarchical cluster analysis was performed using variables reported to be associated with COVID-19 severity or prognosis, namely, age, sex, obesity, smoking history, hypertension, diabetes mellitus, malignancy, chronic obstructive pulmonary disease, hyperuricemia, cardiovascular disease, chronic liver disease, and chronic kidney disease. Results Participants were divided into four clusters: Cluster 1, young healthy (n = 266, 20.1%); Cluster 2, middle-aged (n = 245, 18.5%); Cluster 3, middle-aged obese (n = 435, 32.9%); and Cluster 4, elderly (n = 376, 28.4%). In Clusters 3 and 4, sore throat, dysosmia, and dysgeusia tended to be less frequent, while shortness of breath was more frequent. Serum lactate dehydrogenase, ferritin, KL-6, d-dimer, and C-reactive protein levels tended to be higher in Clusters 3 and 4. Although Cluster 3 had a similar age as Cluster 2, it tended to have poorer outcomes. Both Clusters 3 and 4 tended to exhibit higher rates of oxygen supplementation, intensive care unit admission, and mechanical ventilation, but the mortality rate tended to be lower in Cluster 3. Conclusions We have successfully performed the first phenotyping of COVID-19 patients in Japan, which is clinically useful in predicting important outcomes, despite the simplicity of the cluster analysis method that does not use complex variables.
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