Sub-phenotyping in critical care
A valuable strategy or methodologically fragile path?
J. M. Smit (TU Delft - Pattern Recognition and Bioinformatics, Radboud Universiteit Nijmegen, Erasmus MC)
Annemijn H. Jonkman (Erasmus MC)
JH Krijthe (TU Delft - Pattern Recognition and Bioinformatics)
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Abstract
In her pioneering work, Calfee et al. [1] addressed the clinical and biological heterogeneity of acute respiratory distress syndrome (ARDS), a factor likely contributing to the poor track record of randomized trials (RCTs) in this patient population. Using latent class (or profile) analysis (LCA), a method for identifying unobserved subgroups from observed data, they identified two distinct ARDS sub-phenotypes (hypo- and hyperinflammatory), which showed association with clinical outcomes and, crucially, heterogeneity of treatment effect (HTE) [2], demonstrating different responses to higher vs. lower PEEP regimes. [...]
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