Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Crit Care. 2024 Sep 3;28(1):290. doi: 10.1186/s13054-024-05071-2.
Sepsis is a heterogeneous syndrome. This study aimed to identify new sepsis sub-phenotypes using plasma cortisol trajectory.
This retrospective study included patients with sepsis admitted to the intensive care unit of Zhongshan Hospital Fudan University between March 2020 and July 2022. A group-based cortisol trajectory model was used to classify septic patients into different sub-phenotypes. The clinical characteristics, biomarkers, and outcomes were compared between sub-phenotypes.
A total of 258 patients with sepsis were included, of whom 186 were male. Patients were divided into two trajectory groups: the lower-cortisol group (n = 217) exhibited consistently low and slowly declining cortisol levels, while the higher-cortisol group (n = 41) showed relatively higher levels in comparison. The 28-day mortality (65.9% vs.16.1%, P < 0.001) and 90-day mortality (65.9% vs. 19.8%, P < 0.001) of the higher-cortisol group were significantly higher than the lower-cortisol group. Multivariable Cox regression analysis showed that the trajectory sub-phenotype (HR = 5.292; 95% CI 2.218-12.626; P < 0.001), APACHE II (HR = 1.109; 95% CI 1.030-1.193; P = 0.006), SOFA (HR = 1.161; 95% CI 1.045-1.291; P = 0.006), and IL-1β (HR = 1.001; 95% CI 1.000-1.002; P = 0.007) were independent risk factors for 28-day mortality. Besides, the trajectory sub-phenotype (HR = 4.571; 95% CI 1.980-10.551; P < 0.001), APACHE II (HR = 1.108; 95% CI 1.043-1.177; P = 0.001), SOFA (HR = 1.270; 95% CI 1.130-1.428; P < 0.001), and IL-1β (HR = 1.001; 95% CI 1.000-1.001; P = 0.015) were also independent risk factors for 90-day mortality.
This study identified two novel cortisol trajectory sub-phenotypes in patients with sepsis. The trajectories were associated with mortality, providing new insights into sepsis classification.
脓毒症是一种异质性综合征。本研究旨在使用血浆皮质醇轨迹来鉴定新的脓毒症亚表型。
本回顾性研究纳入了 2020 年 3 月至 2022 年 7 月期间复旦大学中山医院重症监护病房收治的脓毒症患者。使用基于群组的皮质醇轨迹模型将脓毒症患者分为不同的亚表型。比较了亚表型之间的临床特征、生物标志物和结局。
共纳入 258 例脓毒症患者，其中 186 例为男性。患者被分为两组轨迹：低皮质醇组（n=217）表现为持续低水平且缓慢下降的皮质醇水平，而高皮质醇组（n=41）表现为相对较高的皮质醇水平。高皮质醇组的 28 天死亡率（65.9%比 16.1%，P<0.001）和 90 天死亡率（65.9%比 19.8%，P<0.001）明显高于低皮质醇组。多变量 Cox 回归分析显示，轨迹亚表型（HR=5.292；95%CI 2.218-12.626；P<0.001）、APACHE II（HR=1.109；95%CI 1.030-1.193；P=0.006）、SOFA（HR=1.161；95%CI 1.045-1.291；P=0.006）和 IL-1β（HR=1.001；95%CI 1.000-1.002；P=0.007）是 28 天死亡率的独立危险因素。此外，轨迹亚表型（HR=4.571；95%CI 1.980-10.551；P<0.001）、APACHE II（HR=1.108；95%CI 1.043-1.177；P=0.001）、SOFA（HR=1.270；95%CI 1.130-1.428；P<0.001）和 IL-1β（HR=1.001；95%CI 1.000-1.001；P=0.015）也是 90 天死亡率的独立危险因素。
本研究在脓毒症患者中确定了两种新的皮质醇轨迹亚表型。这些轨迹与死亡率相关，为脓毒症分类提供了新的见解。
