Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort
Abstract Background Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsuperv...
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-03972-8 |
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| author | Sabri Soussi Divya Sharma Peter Jüni Gerald Lebovic Laurent Brochard John C. Marshall Patrick R. Lawler Margaret Herridge Niall Ferguson Lorenzo Del Sorbo Elodie Feliot Alexandre Mebazaa Erica Acton Jason N. Kennedy Wei Xu Etienne Gayat Claudia C. Dos Santos the FROG-ICU CCCTBG trans-trial group study for InFACT - the International Forum for Acute Care Trialists |
| author_facet | Sabri Soussi Divya Sharma Peter Jüni Gerald Lebovic Laurent Brochard John C. Marshall Patrick R. Lawler Margaret Herridge Niall Ferguson Lorenzo Del Sorbo Elodie Feliot Alexandre Mebazaa Erica Acton Jason N. Kennedy Wei Xu Etienne Gayat Claudia C. Dos Santos the FROG-ICU CCCTBG trans-trial group study for InFACT - the International Forum for Acute Care Trialists |
| author_sort | Sabri Soussi |
| collection | DOAJ |
| description | Abstract Background Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis. Methods In the original FROG-ICU prospective, observational, multicenter study, intensive care unit (ICU) patients with sepsis on admission (Sepsis-3) were identified (N = 655). Among them, 467 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct sepsis-survivors clinical classes using readily available data at ICU discharge. The primary endpoint was one-year mortality after ICU discharge. Results At ICU discharge, two distinct subtypes were identified (A and B) using 15 readily available clinical and biological variables. Patients assigned to subtype B (48% of the studied population) had more impaired cardiovascular and kidney functions, hematological disorders and inflammation at ICU discharge than subtype A. Sepsis-survivors in subtype B had significantly higher one-year mortality compared to subtype A (respectively, 34% vs 16%, p < 0.001). When adjusted for standard long-term risk factors (e.g., age, comorbidities, severity of illness, renal function and duration of ICU stay), subtype B was independently associated with increased one-year mortality (adjusted hazard ratio (HR) = 1.74 (95% CI 1.16–2.60); p = 0.006). Conclusions A subtype with sustained organ failure and inflammation at ICU discharge can be identified from routine clinical and laboratory data and is independently associated with poor long-term outcome in sepsis-survivors. Trial registration NCT01367093; https://clinicaltrials.gov/ct2/show/NCT01367093 . Graphical Abstract |
| first_indexed | 2024-12-12T23:26:36Z |
| format | Article |
| id | doaj.art-50e52d67b88a420497ecf9e469cf3324 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-12T23:26:36Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-50e52d67b88a420497ecf9e469cf33242022-12-22T00:08:03ZengBMCCritical Care1364-85352022-04-0126111210.1186/s13054-022-03972-8Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohortSabri Soussi0Divya Sharma1Peter Jüni2Gerald Lebovic3Laurent Brochard4John C. Marshall5Patrick R. Lawler6Margaret Herridge7Niall Ferguson8Lorenzo Del Sorbo9Elodie Feliot10Alexandre Mebazaa11Erica Acton12Jason N. Kennedy13Wei Xu14Etienne Gayat15Claudia C. Dos Santos16the FROG-ICUCCCTBG trans-trial group study for InFACT - the International Forum for Acute Care TrialistsInterdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of TorontoDepartment of Biostatistics, Princess Margaret Cancer Centre, University of TorontoApplied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s HospitalApplied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s HospitalInterdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of TorontoInterdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of TorontoPeter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of TorontoDepartment of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of TorontoDepartment of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of TorontoDepartment of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of TorontoDepartment of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of ParisDepartment of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of ParisInterdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of TorontoDepartment of Critical Care Medicine, School of Medicine, University of PittsburghDepartment of Biostatistics, Princess Margaret Cancer Centre, University of TorontoDepartment of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of ParisInterdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of TorontoAbstract Background Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis. Methods In the original FROG-ICU prospective, observational, multicenter study, intensive care unit (ICU) patients with sepsis on admission (Sepsis-3) were identified (N = 655). Among them, 467 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct sepsis-survivors clinical classes using readily available data at ICU discharge. The primary endpoint was one-year mortality after ICU discharge. Results At ICU discharge, two distinct subtypes were identified (A and B) using 15 readily available clinical and biological variables. Patients assigned to subtype B (48% of the studied population) had more impaired cardiovascular and kidney functions, hematological disorders and inflammation at ICU discharge than subtype A. Sepsis-survivors in subtype B had significantly higher one-year mortality compared to subtype A (respectively, 34% vs 16%, p < 0.001). When adjusted for standard long-term risk factors (e.g., age, comorbidities, severity of illness, renal function and duration of ICU stay), subtype B was independently associated with increased one-year mortality (adjusted hazard ratio (HR) = 1.74 (95% CI 1.16–2.60); p = 0.006). Conclusions A subtype with sustained organ failure and inflammation at ICU discharge can be identified from routine clinical and laboratory data and is independently associated with poor long-term outcome in sepsis-survivors. Trial registration NCT01367093; https://clinicaltrials.gov/ct2/show/NCT01367093 . Graphical Abstracthttps://doi.org/10.1186/s13054-022-03972-8SepsisPost-intensive care syndrome (PICS)BiomarkersLatent profile analysisMixture modelingPrognostic enrichment |
| spellingShingle | Sabri Soussi Divya Sharma Peter Jüni Gerald Lebovic Laurent Brochard John C. Marshall Patrick R. Lawler Margaret Herridge Niall Ferguson Lorenzo Del Sorbo Elodie Feliot Alexandre Mebazaa Erica Acton Jason N. Kennedy Wei Xu Etienne Gayat Claudia C. Dos Santos the FROG-ICU CCCTBG trans-trial group study for InFACT - the International Forum for Acute Care Trialists Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort Critical Care Sepsis Post-intensive care syndrome (PICS) Biomarkers Latent profile analysis Mixture modeling Prognostic enrichment |
| title | Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort |
| title_full | Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort |
| title_fullStr | Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort |
| title_full_unstemmed | Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort |
| title_short | Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort |
| title_sort | identifying clinical subtypes in sepsis survivors with different one year outcomes a secondary latent class analysis of the frog icu cohort |
| topic | Sepsis Post-intensive care syndrome (PICS) Biomarkers Latent profile analysis Mixture modeling Prognostic enrichment |
| url | https://doi.org/10.1186/s13054-022-03972-8 |
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