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Phenotypic clusters within sepsis-associated multiple organ dysfunction syndrome.

Daniel B Knox1, Michael J Lanspa, Kathryn G Kuttler

  • 1Pulmonary and Critical Care, Intermountain Medical Center, Salt Lake City, USA, danknoxmd@gmail.com.

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Researchers identified four distinct patient clusters in severe sepsis or septic shock, revealing varied mortality risks. These sepsis subtypes may guide personalized treatment and research for better patient outcomes.

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Area of Science:

  • Critical Care Medicine
  • Medical Informatics
  • Pathophysiology

Background:

  • Sepsis is often treated as a monolithic condition, potentially hindering research and patient care.
  • Identifying distinct patient subgroups within severe sepsis or septic shock is crucial for advancing treatment and prognostication.
  • This study aimed to define clinically meaningful clusters in patients with severe sepsis or septic shock.

Purpose of the Study:

  • To identify and characterize distinct patient clusters within severe sepsis or septic shock.
  • To explore potential pathophysiological differences reflected by these clusters.
  • To provide a basis for tailored treatments and directed research in sepsis management.

Main Methods:

  • Retrospective analysis of 2533 patients with severe sepsis or septic shock admitted to ICUs between 2006-2013.
  • Utilized self-organizing maps (SOMs) for multidimensional data representation.
  • Defined clusters based on age and Sequential Organ Failure Assessment (SOFA) subscores.

Main Results:

  • Four distinct clusters were identified: (1) shock with elevated creatinine, (2) minimal multi-organ dysfunction syndrome (MODS), (3) shock with hypoxemia and altered mental status, and (4) hepatic disease.
  • Mortality rates varied significantly across clusters: 11% (elevated creatinine), 12% (minimal MODS), 28% (hypoxemia/altered mental status), and 21% (hepatic disease).
  • Cluster identification influenced the association between clinical outcomes and predictors like APACHE II score.

Conclusions:

  • Four distinct clusters of multi-organ dysfunction syndrome (MODS) were identified in severe sepsis or septic shock patients.
  • These clusters may represent underlying pathophysiological variations.
  • The identified clusters offer potential for developing tailored treatments and guiding future research in sepsis.