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Updated: May 22, 2025
A Data-Driven Approach to Quantifying Immune States in Sepsis
Published on: February 7, 2025
Identification of distinct clinical profiles of sepsis risk in paediatric emergency department patients using
Patricia Gilholm1, Sainath Raman2,3, Adam Irwin3,4
1Children's Intensive Care Research Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia p.gilholm@uq.edu.au.
Insights
Researchers identified seven distinct clinical profiles for pediatric sepsis risk in the emergency department (ED). Two high-risk profiles, characterized by severe illness indicators and elevated lactate, were strongly associated with adverse outcomes, aiding early sepsis identification.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Infectious Diseases
Background:
- Sepsis affects millions of children annually, posing significant mortality risks.
- Early sepsis detection in children is challenging due to varied symptoms and overlap with other conditions.
- Current sepsis screening methods often evaluate criteria individually, missing complex patterns.
Purpose of the Study:
- To identify distinct clinical profiles of suspected sepsis in children presenting to the emergency department (ED).
- To explore associations between patterns of sepsis screening criteria and sepsis risk.
- To better understand the clinical heterogeneity of suspected sepsis in pediatric patients.
Main Methods:
- Secondary analysis of 3473 children screened for sepsis in 12 Queensland EDs.
- Utilized Bayesian profile regression to construct data-driven clinical profiles from sepsis screening criteria.
- Validated profiles against suspected sepsis, septic shock, organ dysfunction, and infection sources.
Main Results:
- Identified seven distinct clinical profiles, with two classified as high risk for suspected sepsis.
- High-risk profiles (n=22 and n=150) showed high probabilities of suspected sepsis (Pr 0.73 and 0.69).
- High-risk profiles were associated with severe illness indicators, elevated lactate, and strong links to adverse clinical outcomes.
Conclusions:
- Seven distinct clinical profiles for pediatric sepsis risk were identified, varying in risk and associated outcomes.
- These profiles can help characterize clinical heterogeneity in suspected sepsis.
- Further validation in diverse populations and research into targeted interventions for specific profiles are necessary.
Background:
Sepsis affects 25 million children and neonates annually, causing significant mortality and morbidity. Early identification and treatment are crucial for improving outcomes. Identifying children at risk is challenging due to clinical heterogeneity and overlap with other conditions. Current evaluations of sepsis criteria adopt a variable-centred approach, evaluating each criterion independently. The objective of this study was to explore associations between patterns of sepsis screening criteria and sepsis risk in children screened in the emergency department (ED) to identify distinct profiles that describe the clinical heterogeneity of suspected sepsis.
Methods:
This secondary analysis involved 3473 children screened for sepsis across 12 EDs in Queensland, Australia. Bayesian profile regression was used to construct data-driven clinical profiles derived from sepsis screening criteria and their association with suspected sepsis, defined as senior medical officer diagnosis and antibiotic administration in the ED. Posterior risk probabilities (Prs) with 95% credible intervals (CIs) were calculated for each profile. Profiles were internally validated by assessing their association with sepsis, septic shock, organ dysfunction and infection sources, in both adjusted and unadjusted models.
Results:
Seven distinct clinical profiles were identified. Two profiles were labelled as high risk of suspected sepsis (profile 1, n=22: Pr 0.73, 95% CI 0.55, 0.89; profile 2, n=150: Pr 0.69, 95% CI 0.59, 0.80), four as moderate risk and one as low risk. High-risk profiles were characterised by severe illness indicators and elevated lactate levels. Moderate-risk profiles included criteria such as altered behaviour, young age (<3 months) and respiratory distress. High-risk profiles had strong associations with all clinical outcomes.
Conclusions:
Seven clinical profiles were identified that varied in their risk of suspected sepsis and associated outcomes. Validation of these profiles in diverse populations and identification of which profiles are likely to benefit from certain interventions is needed.
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