Presenting hemodynamic phenotypes in ED patients with confirmed sepsis

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Emergency Medicine

Background:

• Sepsis is a life-threatening condition requiring prompt recognition and management.
• Hemodynamic monitoring is crucial for assessing circulatory function in sepsis.
• Current sepsis management often relies on generalized protocols, potentially missing patient-specific needs.

Purpose of the Study:

• To classify emergency department (ED) patients with sepsis into distinct groups using noninvasive hemodynamic (HD) data.
• To identify clinical parameters that can differentiate these hemodynamic sepsis clusters.
• To explore the potential for tailored therapeutic interventions based on HD phenotypes.

Main Methods:

• A prospective, observational study involving 127 adult patients with confirmed sepsis.
• Noninvasive HD parameters, including cardiac index (CI) and systemic vascular resistance index (SVRI), were measured using Nexfin.
• K-means clustering was applied to identify distinct patient subgroups based on normalized HD parameters.

Main Results:

• Three distinct sepsis patient clusters were identified based on CI and SVRI.
• Cluster 1 (high CI, normal SVRI) exhibited the lowest 30-day mortality.
• Age, heart rate, and temperature differed significantly across the three clusters, suggesting potential clinical identifiers.

Conclusions:

• Emergency department sepsis patients demonstrate three unique hemodynamic profiles identifiable through noninvasive CI and SVRI measurements.
• These findings support the concept of hemodynamic phenotyping in sepsis for potential personalized treatment.
• Further research is warranted to evaluate the impact of cluster-specific interventions on patient outcomes.