运用无监督聚类分析识别受益于红细胞输注的脓毒症表型。

Clin Lab. 2022 May 1;68(5). doi: 10.7754/Clin.Lab.2021.210619.

BACKGROUND

Sepsis is a heterogeneous syndrome. Previous studies have shown controversial results of the effects of red blood cell transfusion (RBC) on the clinical outcomes of septic patients. This study aimed to identify the phenotypes of sepsis that will benefit from RBC transfusion.

METHODS

Clinical data were extracted from the Medical Information Mart for Intensive Care III database. The study population included adult (age ≥ 18 years) septic patients with moderate non-bleeding anemia (hemoglobin ≤ 10 g/dL) within 24 hours after admission to the intensive care unit (ICU) between 2001 and 2012. After data preprocessing, partitioning around medoids function was used for unsupervised cluster analysis. We used Kaplan-Meier survival analysis and multivariable Cox proportional hazard models to explore the relationship between RBC transfusion and mortality.

RESULTS

In total, 6,821 septic patients with moderate non-bleeding anemia within 24 hours after ICU admission, and 3,874 patients (56.8%) received RBC transfusion during their stay in the ICU. Using unsupervised cluster analysis, we identified three phenotypes of septic patients with moderate non-bleeding anemia: cluster A (n = 1,835) was characterized by advanced age and heart issues; cluster B (n = 3,043) was characterized by mild disease and relatively high hemoglobin levels; and cluster C (n = 1,943) was characterized by severe disease, low mean arterial pressure, bloodstream infection, coagulopathy, high lactate levels, and high mortality. Only for patients in cluster C, RBC transfusion exhibited protective effects in terms of the 14-day [hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.41 - 0.61; p < 0.001], 28-day (HR, 0.61; 95% CI, 0.51 - 0.72; p < 0.001), and 90-day (HR, 0.67; 95% CI, 0.58 - 0.78; p < 0.001) mortality after adjusting the confounding variables.

CONCLUSIONS

Utilizing unsupervised cluster analysis, we identified three phenotypes of septic patients with moderate non-bleeding anemia who had different responses to RBC transfusion. In the future, randomized controlled trials about prognostic outcomes of RBC transfusions can focus on the specific phenotype of sepsis.

背景

脓毒症是一种异质性综合征。先前的研究表明，红细胞输注（RBC）对脓毒症患者临床结局的影响存在争议。本研究旨在确定从 RBC 输血中获益的脓毒症表型。

方法

从医疗信息集市重症监护 III 数据库中提取临床数据。研究人群包括 2001 年至 2012 年入住 ICU 后 24 小时内患有中度非出血性贫血（血红蛋白≤10g/dL）的成年（年龄≥18 岁）脓毒症患者。在数据预处理后，使用中位数分区函数进行无监督聚类分析。我们使用 Kaplan-Meier 生存分析和多变量 Cox 比例风险模型来探讨 RBC 输血与死亡率之间的关系。

结果

共有 6821 例脓毒症患者在 ICU 入住后 24 小时内患有中度非出血性贫血，其中 3874 例（56.8%）在 ICU 住院期间接受了 RBC 输血。使用无监督聚类分析，我们确定了三种患有中度非出血性贫血的脓毒症患者表型：A 型（n=1835）表现为高龄和心脏问题；B 型（n=3043）表现为轻度疾病和相对较高的血红蛋白水平；C 型（n=1943）表现为严重疾病、低平均动脉压、血流感染、凝血障碍、高乳酸水平和高死亡率。仅对于 C 型患者，RBC 输血在 14 天（风险比[HR]，0.50；95%置信区间[CI]，0.41-0.61；p<0.001）、28 天（HR，0.61；95%CI，0.51-0.72；p<0.001）和 90 天（HR，0.67；95%CI，0.58-0.78；p<0.001）死亡率方面具有保护作用，调整混杂变量后。