Li Han, Markal Asena, Balch Jeremy A, Loftus Tyler J, Efron Philip A, Ozrazgat-Baslanti Tezcan, Bihorac Azra
Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida College of Medicine, Gainesville, FL.
University of Florida College of Medicine, Gainesville, FL.
Crit Care Explor. 2022 Mar 30;4(4):e0672. doi: 10.1097/CCE.0000000000000672. eCollection 2022 Apr.
Despite its heterogeneous phenotypes, sepsis or life-threatening dysfunction in response to infection is often treated empirically. Identifying patient subgroups with unique pathophysiology and treatment response is critical to the advancement of sepsis care. However, phenotyping methods and results are as heterogeneous as the disease itself. This scoping review evaluates the prognostic capabilities and treatment implications of adult sepsis and septic shock phenotyping methods.
Medline and Embase.
We included clinical studies that described sepsis or septic shock and used any clustering method to identify sepsis phenotypes. We excluded conference abstracts, literature reviews, comments, letters to the editor, and in vitro studies. We assessed study quality using a validated risk of bias tool for observational cohort and cross-sectional studies.
We extracted population, methodology, validation, and phenotyping characteristics from 17 studies.
Sepsis phenotyping methods most frequently grouped patients based on the degree of inflammatory response and coagulopathy using clinical, nongenomic variables. Five articles clustered patients based on genomic or transcriptomic data. Seven articles generated patient subgroups with differential response to sepsis treatments. Cluster clinical characteristics and their associations with mortality and treatment response were heterogeneous across studies, and validity was evaluated in nine of 17 articles, hindering pooled analysis of results and derivation of universal truths regarding sepsis phenotypes, their prognostic capabilities, and their associations with treatment response.
Sepsis phenotyping methods can identify high-risk patients and those with high probability of responding well to targeted treatments. Research quality was fair, but achieving generalizability and clinical impact of sepsis phenotyping will require external validation and direct comparison with alternative approaches.
尽管脓毒症存在异质性表型，但针对感染引起的脓毒症或危及生命的功能障碍通常采用经验性治疗。识别具有独特病理生理学和治疗反应的患者亚组对于脓毒症治疗的进展至关重要。然而，表型分析方法和结果与疾病本身一样具有异质性。本综述评估了成人脓毒症和脓毒性休克表型分析方法的预后能力和治疗意义。
Medline和Embase。
我们纳入了描述脓毒症或脓毒性休克并使用任何聚类方法识别脓毒症表型的临床研究。我们排除了会议摘要、文献综述、评论、给编辑的信和体外研究。我们使用经过验证的观察性队列和横断面研究偏倚风险工具评估研究质量。
我们从17项研究中提取了人群、方法、验证和表型特征。
脓毒症表型分析方法最常使用临床非基因组变量根据炎症反应程度和凝血病对患者进行分组。五篇文章根据基因组或转录组数据对患者进行聚类。七篇文章生成了对脓毒症治疗反应不同的患者亚组。各研究中聚类的临床特征及其与死亡率和治疗反应的关联存在异质性，17篇文章中有9篇评估了有效性，这阻碍了对结果的汇总分析以及关于脓毒症表型、其预后能力及其与治疗反应关联的普遍真理的推导。
脓毒症表型分析方法可以识别高危患者以及对靶向治疗反应良好可能性高的患者。研究质量尚可，但要实现脓毒症表型分析的普遍性和临床影响，需要外部验证并与替代方法进行直接比较。
