Latent transition analysis of cardiac arrest patients treated in the intensive care unit.

Abstract

Post-cardiac arrest (CA) syndrome is heterogenous in their clinical presentations and outcomes. This study aimed to explore the transition and stability of subphenotypes (profiles) of CA treated in the intensive care unit (ICU). Clinical features of CA patients on day 1 and 3 after ICU admission were modeled by latent transition analysis (LTA) to explore the transition between subphenotypes over time. The association between different transition patterns and mortality outcome was explored using multivariable logistic regression. We identified 848 eligible patients from the database. The LPA identified three distinct subphenotypes: Profile 1 accounted for the largest proportion (73%) and was considered as the baseline subphenotype. Profile 2 (13%) was characterized by brain injury and profile 3 (14%) was characterized by multiple organ dysfunctions. The same three subphenotypes were identified on day 3. The LTA showed consistent subphenotypes. A majority of patients in profile 2 (72%) and 3 (82%) on day 1 switched to profile 1 on day 3. In the logistic regression model, patients in profile 1 on day 1 transitioned to profile 3 had worse survival outcome than those continue to remain in profile 1 (OR: 20.64; 95% CI: 6.01 to 70.94; p < 0.001) and transitioned to profile 2 (OR: 8.42; 95% CI: 2.22 to 31.97; p = 0.002) on day 3. The study identified three subphenotypes of CA, which was consistent on day 1 and 3 after ICU admission. Patients who transitioned to profile 3 on day 3 had significantly worse survival outcome than those remained in profile 1 or 2.