Novel phenotypes of coronavirus disease: a temperature-based trajectory model

• DOI: 10.1186/s13613-021-00907-4
• Publication Date: 2021-08-13T05:33:08Z
• Authors: Yanfei Shen; Dechang Chen; Xinmei Huang; Guolong Cai; Qianghong Xu; Caibao Hu; Jing Yan; Jiao Liu
• Keywords: 0301 basic medicine; 03 medical and health sciences; RC86-88.9; Research; Temperature; COVID-19; Inflammatory response; Corticosteroids; Medical emergencies. Critical care. Intensive care. First aid; Mortality; 3. Good health

Abstract Background Coronavirus disease has heterogeneous clinical features; however, the reasons for the heterogeneity are poorly understood. This study aimed to identify clinical phenotypes according to patients’ temperature trajectory.

Method A retrospective review was conducted in five tertiary hospitals in Hubei Province from November 2019 to March 2020. We explored potential temperature-based trajectory phenotypes and assessed patients’ clinical outcomes, inflammatory response, and response to immunotherapy according to phenotypes.

Results A total of 1580 patients were included. Four temperature-based trajectory phenotypes were identified: normothermic (Phenotype 1); fever, rapid defervescence (Phenotype 2); gradual fever onset (Phenotype 3); and fever, slow defervescence (Phenotype 4). Compared with Phenotypes 1 and 2, Phenotypes 3 and 4 had a significantly higher C-reactive protein level and neutrophil count and a significantly lower lymphocyte count. After adjusting for confounders, Phenotypes 3 and 4 had higher in-hospital mortality (adjusted odds ratio and 95% confidence interval 2.1, 1.1–4.0; and 3.3, 1.4–8.2, respectively), while Phenotype 2 had similar mortality, compared with Phenotype 1. Corticosteroid use was associated with significantly higher in-hospital mortality in Phenotypes 1 and 2, but not in Phenotypes 3 or 4 (p for interaction < 0.01). A similar trend was observed for gamma-globulin.

Conclusions Patients with different temperature-trajectory phenotypes had different inflammatory responses, clinical outcomes, and responses to corticosteroid therapy.