In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 8 ( 2021-8-4), p. e0252793-
Abstract:
Heterogeneity in sepsis expression is multidimensional, including highly disparate data such as the underlying disorders, infection source, causative micro-organismsand organ failures. The aim of the study is to identify clusters of patients based on clinical and biological characteristic available at patients’ admission. Methods All patients included in a national prospective multicenter ICU cohort OUTCOMEREA and admitted for sepsis or septic shock (Sepsis 3.0 definition) were retrospectively analyzed. A hierarchical clustering was performed in a training set of patients to build clusters based on a comprehensive set of clinical and biological characteristics available at ICU admission. Clusters were described, and the 28-day, 90-day, and one-year mortality were compared with log-rank rates. Risks of mortality were also compared after adjustment on SOFA score and year of ICU admission. Results Of the 6,046 patients with sepsis in the cohort, 4,050 (67%) were randomly allocated to the training set. Six distinct clusters were identified: young patients without any comorbidities, admitted in ICU for community-acquired pneumonia (n = 1,603 (40%)); young patients without any comorbidities, admitted in ICU for meningitis or encephalitis (n = 149 (4%)); elderly patients with COPD, admitted in ICU for bronchial infection with few organ failures (n = 243 (6%)); elderly patients, with several comorbidities and organ failures (n = 1,094 (27%)); patients admitted after surgery, with a nosocomial infection (n = 623 (15%)); young patients with immunosuppressive conditions (e.g., AIDS, chronic steroid therapy or hematological malignancy) (n = 338 (8%)). Clusters differed significantly in early or late mortality (p 〈 .001), even after adjustment on severity of organ dysfunctions (SOFA) and year of ICU admission. Conclusions Clinical and biological features commonly available at ICU admission of patients with sepsis or septic shock enabled to set up six clusters of patients, with very distinct outcomes. Considering these clusters may improve the care management and the homogeneity of patients in future studies.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0252793
DOI:
10.1371/journal.pone.0252793.g001
DOI:
10.1371/journal.pone.0252793.g002
DOI:
10.1371/journal.pone.0252793.g003
DOI:
10.1371/journal.pone.0252793.t001
DOI:
10.1371/journal.pone.0252793.t002
DOI:
10.1371/journal.pone.0252793.t003
DOI:
10.1371/journal.pone.0252793.t004
DOI:
10.1371/journal.pone.0252793.s001
DOI:
10.1371/journal.pone.0252793.s002
DOI:
10.1371/journal.pone.0252793.s003
DOI:
10.1371/journal.pone.0252793.s004
DOI:
10.1371/journal.pone.0252793.s005
DOI:
10.1371/journal.pone.0252793.s006
DOI:
10.1371/journal.pone.0252793.s007
DOI:
10.1371/journal.pone.0252793.s008
DOI:
10.1371/journal.pone.0252793.s009
DOI:
10.1371/journal.pone.0252793.s010
DOI:
10.1371/journal.pone.0252793.s011
DOI:
10.1371/journal.pone.0252793.s012
DOI:
10.1371/journal.pone.0252793.s013
DOI:
10.1371/journal.pone.0252793.s014
DOI:
10.1371/journal.pone.0252793.s015
DOI:
10.1371/journal.pone.0252793.s016
DOI:
10.1371/journal.pone.0252793.s017
DOI:
10.1371/journal.pone.0252793.s018
DOI:
10.1371/journal.pone.0252793.s019
DOI:
10.1371/journal.pone.0252793.s020
DOI:
10.1371/journal.pone.0252793.s021
DOI:
10.1371/journal.pone.0252793.r001
DOI:
10.1371/journal.pone.0252793.r002
DOI:
10.1371/journal.pone.0252793.r003
DOI:
10.1371/journal.pone.0252793.r004
DOI:
10.1371/journal.pone.0252793.r005
DOI:
10.1371/journal.pone.0252793.r006
DOI:
10.1371/journal.pone.0252793.r007
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2267670-3
Permalink