Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in context
Summary: Background: Subphenotypes of infected patients have been reported in Europe and North America, but few studies have investigated populations in Southeast Asia. We sought to identify and differentiate subphenotypes of patients hospitalized with suspected infection in rural Thailand using bi...
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| Language: | English |
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Elsevier
2025-02-01
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| Series: | The Lancet Regional Health - Southeast Asia |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772368225000071 |
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| author | Prapassorn Poolchanuan Taylor D. Coston Viriya Hantrakun Parinya Chamnan Gumphol Wongsuvan Pavan K. Bhatraju Narisara Chantratita Direk Limmathurotsakul T. Eoin West Shelton W. Wright |
| author_facet | Prapassorn Poolchanuan Taylor D. Coston Viriya Hantrakun Parinya Chamnan Gumphol Wongsuvan Pavan K. Bhatraju Narisara Chantratita Direk Limmathurotsakul T. Eoin West Shelton W. Wright |
| author_sort | Prapassorn Poolchanuan |
| collection | DOAJ |
| description | Summary: Background: Subphenotypes of infected patients have been reported in Europe and North America, but few studies have investigated populations in Southeast Asia. We sought to identify and differentiate subphenotypes of patients hospitalized with suspected infection in rural Thailand using biological markers implicated in the dysregulated host response. Methods: In a cohort of prospectively enrolled patients hospitalized with suspected infection in northeastern Thailand, we measured 15 circulating biomarkers from a random selection of 585 subjects and developed latent profile models to identify subphenotypes. Patient characteristics were compared after subphenotype assignment, and a parsimonious model was developed to identify patient subphenotypes. Findings: We identified and assigned 585 patients to three subphenotypes termed latent biological profile (LBP)-1 (52%), LBP-2 (39%) and LBP-3 (9%). Patients assigned to LBP-3 had a higher risk of 28-day mortality compared to those in LBP-1 and LBP-2 (adjusted relative risk 1.8, 95% confidence interval [CI] 1.1–2.9, P = 0.02). Patient clinical characteristics and biomarker concentrations also differed by subphenotype assignment. A parsimonious three-biomarker model identified subphenotypes in an internal validation cohort (LBP-1: area under the receiver operating curve [AUC] 0.96, 95% CI: 0.94–0.98; LBP-2: AUC 0.77, 95% CI 0.71–0.83; LBP-3: AUC 0.99, 95% CI 0.98–1.00). Interpretation: We identified three biological subphenotypes of patients with suspected infection in rural Thailand, where the burden of infection is high but understudied. Patient subphenotype assignment was characterized by distinct clinical outcomes and biological profiles which could inform contextualized future study design. Funding: The US National Institutes of Health, the Wellcome Trust, and the Firland Foundation. |
| format | Article |
| id | doaj-art-605ded0ec898429596bf1c655e1f2284 |
| institution | Kabale University |
| issn | 2772-3682 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health - Southeast Asia |
| spelling | doaj-art-605ded0ec898429596bf1c655e1f22842025-02-11T04:35:39ZengElsevierThe Lancet Regional Health - Southeast Asia2772-36822025-02-0133100536Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in contextPrapassorn Poolchanuan0Taylor D. Coston1Viriya Hantrakun2Parinya Chamnan3Gumphol Wongsuvan4Pavan K. Bhatraju5Narisara Chantratita6Direk Limmathurotsakul7T. Eoin West8Shelton W. Wright9Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USAMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandCardiometabolic Research Group, Department of Social Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, ThailandMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USADepartment of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, USADivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA; Corresponding author. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Box 359640, 300 9th Ave, Seattle, WA, 98104, USA.Summary: Background: Subphenotypes of infected patients have been reported in Europe and North America, but few studies have investigated populations in Southeast Asia. We sought to identify and differentiate subphenotypes of patients hospitalized with suspected infection in rural Thailand using biological markers implicated in the dysregulated host response. Methods: In a cohort of prospectively enrolled patients hospitalized with suspected infection in northeastern Thailand, we measured 15 circulating biomarkers from a random selection of 585 subjects and developed latent profile models to identify subphenotypes. Patient characteristics were compared after subphenotype assignment, and a parsimonious model was developed to identify patient subphenotypes. Findings: We identified and assigned 585 patients to three subphenotypes termed latent biological profile (LBP)-1 (52%), LBP-2 (39%) and LBP-3 (9%). Patients assigned to LBP-3 had a higher risk of 28-day mortality compared to those in LBP-1 and LBP-2 (adjusted relative risk 1.8, 95% confidence interval [CI] 1.1–2.9, P = 0.02). Patient clinical characteristics and biomarker concentrations also differed by subphenotype assignment. A parsimonious three-biomarker model identified subphenotypes in an internal validation cohort (LBP-1: area under the receiver operating curve [AUC] 0.96, 95% CI: 0.94–0.98; LBP-2: AUC 0.77, 95% CI 0.71–0.83; LBP-3: AUC 0.99, 95% CI 0.98–1.00). Interpretation: We identified three biological subphenotypes of patients with suspected infection in rural Thailand, where the burden of infection is high but understudied. Patient subphenotype assignment was characterized by distinct clinical outcomes and biological profiles which could inform contextualized future study design. Funding: The US National Institutes of Health, the Wellcome Trust, and the Firland Foundation.http://www.sciencedirect.com/science/article/pii/S2772368225000071Global infectionSubphenotypesLatent class analysisResource-limitedTropical infection |
| spellingShingle | Prapassorn Poolchanuan Taylor D. Coston Viriya Hantrakun Parinya Chamnan Gumphol Wongsuvan Pavan K. Bhatraju Narisara Chantratita Direk Limmathurotsakul T. Eoin West Shelton W. Wright Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in context The Lancet Regional Health - Southeast Asia Global infection Subphenotypes Latent class analysis Resource-limited Tropical infection |
| title | Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in context |
| title_full | Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in context |
| title_fullStr | Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in context |
| title_full_unstemmed | Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in context |
| title_short | Biological subphenotypes in patients hospitalized with suspected infection in Thailand: a secondary analysis of a prospective observational studyResearch in context |
| title_sort | biological subphenotypes in patients hospitalized with suspected infection in thailand a secondary analysis of a prospective observational studyresearch in context |
| topic | Global infection Subphenotypes Latent class analysis Resource-limited Tropical infection |
| url | http://www.sciencedirect.com/science/article/pii/S2772368225000071 |
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