Identification of Phenotypes Among COVID-19 Patients in the United States Using Latent Class Analysis

Abstract

Catherine Teng,1 Unnikrishna Thampy,1 Ju Young Bae,1 Peng Cai,2 Richard AF Dixon,3 Qi Liu,3 Pengyang Li4 1Department of Medicine, Yale New Haven Health – Greenwich Hospital, Greenwich, CT, USA; 2Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA; 3Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA; 4Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USACorrespondence: Pengyang LiPauley Heart Center, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23219, USATel [phone]Fax [phone]Email [email protected] LiuTexas Heart Institute, 6770 Bertner Avenue, MC 2-255, Houston, TX, 77030, USATel [phone]Fax [phone]Email [email protected]: Coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) is a heterogeneous disorder with a complex pathogenesis. Recent studies from Spain and France have indicated that underlying phenotypes may exist among patients admitted to the hospital with COVID-19. Whether those same phenotypes exist in the United States (US) remains unclear. Using latent class analysis (LCA), we sought to determine whether clinical phenotypes exist among patients admitted for COVID-19.Methods: We reviewed the charts of adult patients who were hospitalized primarily for COVID-19 at Greenwich Hospital and performed LCA using variables based on patient demographics and comorbidities. To further examine the reliability and replicability of the clustering results, we repeated LCA on the cohort of patients who died during hospitalization for COVID-19.Results: Two phenotypes were identified in patients admitted for COVID-19 (N = 483). According to phenotype, patients were designated as cluster 1 (C1) or cluster 2 (C2). C1 (n = 193) consisted of older individuals with more comorbidities and a higher mortality rate (25.4% vs 8.97%, p < 0.001) than patients in C2. C2 (n = 290) consisted of younger individuals who were more likely to be obese, male, and nonwhite, with higher levels of the inflammatory markers C-reactive protein and alanine aminotransferase. When we performed LCA on the cohort of patients who died during hospitalization for COVID-19 (n = 75), we found that the distribution of patient baseline characteristics and comorbidities was similar to that of the entire cohort of patients admitted for COVID-19.Conclusion: Using LCA, we identified two clinical phenotypes of patients who were admitted to our hospital for COVID-19. These findings may reflect different pathophysiologic processes that lead to moderate to severe COVID-19 and may be useful for identifying treatment targets and selecting patients with severe COVID-19 disease for future clinical trials.Keywords: COVID-19 (United States), hospitalization, death, phenotypes, latent class analysis, comorbidities

Keywords

• covid-19 (united states)
• hospitalization
• death
• phenotypes
• latent class analysis
• comorbidities