[Sepsis phenotypes and individualized fluid therapy in patients with chronic diseases]

Sepsis is a clinical syndrome caused by a dysregulated host response to infection, often resulting in life-threatening organ dysfunction. Patients with chronic diseases are more susceptible to sepsis and have a higher risk of mortality due to impaired organ reserve and immune imbalance. Fluid resuscitation remains a cornerstone of sepsis management. However, a "one-size-fits-all" approach may not be suitable for patients with chronic diseases. In recent years, with the development of machine learning, researchers have proposed phenotype-based classification to identify the heterogeneity of sepsis and guide individualized fluid therapy. Evidence indicates that sepsis phenotypes derived from single or multidimensional clinical indicators, as well as single-omics or multi-omics approaches, are closely associated with fluid responsiveness and patient outcomes. Notably, in patients with chronic heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), or cirrhosis, different phenotypes show distinct responses to fluid strategies. Although existing findings suggest that phenotype-directed fluid management shows significant promise, several major challenges persist, such as phenotype overlap, dynamic phenotypic shifts, and the lack of high-quality prospective clinical trials. Future research should integrate large-scale, multimodal data to establish dynamic and reproducible phenotyping systems, and validate phenotype-specific fluid strategies through clinical trials, thereby advancing sepsis treatment from empirical management toward precision medicine.