Latent class analysis-based subgroups and response to corticosteroids in hospitalised community-acquired pneumonia patients: a validation study

ERJ Open Research, vol. 9, pp. 00577–2022

Abstract

Latent class analysis (LCA), a statistical method to identify ‘hidden’ subgroups within a population, has identified clinically distinct subgroups with treatment implications in acute respiratory distress syndrome and COVID-19 [1–3]. We recently showed that LCA could also identify two clinically distinct subgroups in community-acquired pneumonia (CAP) [4]. In two independent cohorts [5, 6], LCA identified a subgroup with more excessive systemic inflammation and worse prognosis (Class 2), and a subgroup with less systemic inflammation and better prognosis (Class 1). In one of the two cohorts, the Ovidius cohort, we also observed a greater effect of adjunctive dexamethasone on length of stay (LOS) in Class 2 compared to Class 1. The aim of the present study was to validate the existence of LCA defined subgroups in a third, more recent CAP cohort. And if subgroups prove robust, to validate the finding from the Ovidius cohort that subgroups respond differently to adjunctive corticosteroids. Footnotes This manuscript has recently been accepted for publication in the ERJ Open Research . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article. Conflict of interest: Dr. Wittermans has nothing to disclose. Conflict of interest: Dr. van der Zee has nothing to disclose. Conflict of interest: Mr. Qi has nothing to disclose. Conflict of interest: Dr. Grutters has nothing to disclose. Conflict of interest: Dr. Voorn has nothing to disclose. Conflict of interest: Dr. Bos reports grants from Zilveren Kruis Insurance, outside the submitted work. Conflict of interest: Dr. van de Garde has nothing to disclose. Conflict of interest: Dr. Endeman has nothing to disclose.

Authors 8

1. Esther Wittermans Aachen Department of Internal Medicine

   Leiden University · Leiden University Medical Center · St. Antonius Ziekenhuis

   Affiliation as printed

   Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands

   Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands

   These authors contributed equally

   Both authors contributed equally

2. Philip A. van der Zee

   Erasmus MC

   Affiliation as printed

   Department of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands

   These authors contributed equally

   Both authors contributed equally

3. Hongchao Qi

   Erasmus MC

   Affiliation as printed

   Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands

4. Jan C. Grutters

   Utrecht University · University Medical Center Utrecht · St. Antonius Ziekenhuis

   Affiliation as printed

   Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands

   Division of Heart and Lungs, Utrecht University Medical Centre, Utrecht, The Netherlands

5. G. Paul Voorn

   St. Antonius Ziekenhuis

   Affiliation as printed

   Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands

6. Willem Jan W. Bos Aachen Department of Internal Medicine

   Leiden University · Leiden University Medical Center · St. Antonius Ziekenhuis

   Affiliation as printed

   Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands

   Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands

7. Ewoudt M.W. van de Garde

   Utrecht University · St. Antonius Ziekenhuis

   Affiliation as printed

   Department of Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands

   Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands

8. Henrik Endeman

   Erasmus MC

   Affiliation as printed

   Department of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands