Abstract Rationale COVID-19 remains a morbid condition with prominent inflammation and endothelial dysfunction. Prior studies identified phenotypes of COVID-19 based on clinical and laboratory characteristics including BMI, comorbidities, and inflammatory markers, with implications for treatment response and mortality. Phenotyping improves population resource utilization and may customize individual treatments. We seek to further characterize presentations of COVID-19 using clinical, laboratory, and CT findings. Methods Patients hospitalized January 2021 to December 2021 with positive COVID-19 nasopharyngeal PCR and subsequent CT chest were retrospectively reviewed. Clinical and laboratory data were collected from time of admission. Chest imaging was quantitatively analyzed using VIDATM software. Latent class analysis (LCA) was performed using clinical and laboratory data to identify two phenotypes. Cluster analysis utilizing quantitative CT imaging identified further subgroups. Results 340 patients were examined. LCA identified two phenotypes based on clinical and laboratory characteristics. Group 1 was older men with lower BMI and higher oxygen requirements (p ≤ 0.001). They had greater end-organ dysfunction (creatinine and liver function tests) and inflammatory markers (WBC count, CRP, LDH, d-dimer, and fibrinogen) (p ≤ 0.002). Group 2 was younger women with higher BMI and lower oxygen requirements. There was no difference in race, cardiac comorbidities, or COPD. Cluster analysis using quantitative CT imaging revealed further subgroups. Group 1B was predominantly younger with a higher BMI and oxygen requirements (p ≤ 0.038). This group had a higher percentage of ground glass opacities (GGO) and consolidations relative to total lung mass with lower BV5% (p ≤ 0.008). A similar phenotype was found in group 2B with a higher BMI and higher percentage of GGOs and consolidation with a lower BV5% (p ≤ 0.0002). However, there was no difference in oxygen requirement (p = 0.16). In-hospital mortality did not differ between the subgroups (p = 0.34). Conclusion We identified two phenotypes of COVID-19 illness based on clinical and laboratory characteristics: a hyperinflammatory group with end-organ dysfunction and a hypoinflammatory group with preserved end organ function. Further cluster analysis utilizing CT imaging identified two distinct subgroups with higher BMI and greater degree of GGO, consolidation, and lower BV5% within the hyper and hypoinflammatory groups. Our data suggests that BMI may be associated with more severe radiographical presentations of COVID-19 illness. Additionally, the lower BV5% may be indicative of greater microcirculatory dysfunction. Our study highlights the utility of CT imaging in further phenotyping patients with COVID-19. Future studies should examine further outcomes after discharge such as oxygen requirements on discharge or 90-day mortality. This abstract is funded by: None
Sundlof et al. (Fri,) studied this question.