A New Proposed Approach to Categorize Sepsis Sub-phenotypes Based on Combined Trajectories of Perfusion Index and Central Venous Oxygen Saturation.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE

SHOCK Pub Date : 2026-09-01 Epub Date: 2025-12-26 DOI:10.1097/SHK.0000000000002764

Xinchen Wang, Xiaoting Wang, Yan Kang, Xiang Zhou, Yun Long, Wei Du

{"title":"A New Proposed Approach to Categorize Sepsis Sub-phenotypes Based on Combined Trajectories of Perfusion Index and Central Venous Oxygen Saturation.","authors":"Xinchen Wang, Xiaoting Wang, Yan Kang, Xiang Zhou, Yun Long, Wei Du","doi":"10.1097/SHK.0000000000002764","DOIUrl":null,"url":null,"abstract":"Background: Circulatory disturbances in sepsis are heterogeneous but may manifest as a mismatch between peripheral perfusion and tissue oxygenation. Peripheral perfusion index (PI) and central venous oxygen saturation (ScvO 2 ) have been independently validated as prognostic markers in sepsis; however, their combined utility remains unexplored.Methods: This retrospective cohort study included patients admitted to three intensive care units between January 1, 2015, and December 31, 2021. A novel index, PISO = (PI - 1.1) × ScvO 2 , was calculated every 6 hours during the first 72 hours following sepsis onset. Dynamic time warping and hierarchical agglomerative clustering were applied to PISO trajectories to identify sub-phenotypes, with internal validation and sensitivity analysis. Machine learning algorithms were used to predict the sub-phenotypes using clinical features. Survival was assessed using Kaplan-Meier analysis, with particular focus on the association with 12-hour cumulative fluid balance.Results: Among 12,975 patients, 5,205 (40.1%) developed sepsis; 720 patients with complete PI and ScvO 2 data were included. Three distinct PISO sub-phenotypes were identified. Phenotype 3 (n = 190, 33.0%), characterized by a persistently declining trajectory from negative, was associated with the poorest clinical outcomes. Random forest classifier demonstrated the best performance and identified key early clinical features differentiating each sub-phenotype. Kaplan-Meier analysis revealed that a 12-hour cumulative fluid balance ≤0 mL was significantly associated with improved 28-day survival in phenotype 1 ( P = 0.038) and phenotype 2 ( P = 0.033).Conclusions: A persistently negative and declining PISO index within the first 72 hours of sepsis onset identifies a high-risk sub-phenotype. A nonpositive 12-hour cumulative fluid balance is associated with improved survival in select sub-phenotypic groups.","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"628-637"},"PeriodicalIF":2.7000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456544/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"SHOCK","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SHK.0000000000002764","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/26 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Circulatory disturbances in sepsis are heterogeneous but may manifest as a mismatch between peripheral perfusion and tissue oxygenation. Peripheral perfusion index (PI) and central venous oxygen saturation (ScvO 2 ) have been independently validated as prognostic markers in sepsis; however, their combined utility remains unexplored.

Methods: This retrospective cohort study included patients admitted to three intensive care units between January 1, 2015, and December 31, 2021. A novel index, PISO = (PI - 1.1) × ScvO 2 , was calculated every 6 hours during the first 72 hours following sepsis onset. Dynamic time warping and hierarchical agglomerative clustering were applied to PISO trajectories to identify sub-phenotypes, with internal validation and sensitivity analysis. Machine learning algorithms were used to predict the sub-phenotypes using clinical features. Survival was assessed using Kaplan-Meier analysis, with particular focus on the association with 12-hour cumulative fluid balance.

Results: Among 12,975 patients, 5,205 (40.1%) developed sepsis; 720 patients with complete PI and ScvO 2 data were included. Three distinct PISO sub-phenotypes were identified. Phenotype 3 (n = 190, 33.0%), characterized by a persistently declining trajectory from negative, was associated with the poorest clinical outcomes. Random forest classifier demonstrated the best performance and identified key early clinical features differentiating each sub-phenotype. Kaplan-Meier analysis revealed that a 12-hour cumulative fluid balance ≤0 mL was significantly associated with improved 28-day survival in phenotype 1 ( P = 0.038) and phenotype 2 ( P = 0.033).

Conclusions: A persistently negative and declining PISO index within the first 72 hours of sepsis onset identifies a high-risk sub-phenotype. A nonpositive 12-hour cumulative fluid balance is associated with improved survival in select sub-phenotypic groups.

查看原文本刊更多论文

一种基于灌注指数和中心静脉氧饱和度联合轨迹分类脓毒症亚表型的新方法。

背景：脓毒症的循环障碍是异质性的，但在临床上经常表现为外周灌注和组织氧合的不匹配。外周灌注指数（PI）和中心静脉氧饱和度（ScvO 2）已被独立验证为脓毒症的预后指标；然而，它们的综合效用尚未得到系统的探讨。方法：本回顾性队列研究纳入2015年1月1日至2021年12月31日期间入住三间重症监护病房（icu）的患者。在脓毒症发作后的前72小时内，每6小时计算一次新的指数PISO = (PI - 1.1) × ScvO 2。动态时间翘曲和分层聚集聚类应用于72小时PISO轨迹来识别亚表型，并进行内部验证和敏感性分析。使用机器学习算法根据早期临床特征预测亚表型。使用Kaplan-Meier分析和log-rank检验评估生存结果，特别关注12小时累积体液平衡与28天住院生存之间的关系。结果：12975例患者中，5205例（40.1%）发生败血症。其中，720例患者有完整的6小时PI和ScvO 2数据。确定了三种不同的PISO亚表型。表型3 （n = 190, 33.0%）的特征是从负基线持续下降，与最差的临床结果相关。随机森林分类器表现出最好的性能，并识别出区分每个亚表型的关键早期临床特征。Kaplan-Meier分析显示，在表型1 （p = 0.038）和表型2 （p = 0.033）患者中，12小时累积体液平衡≤0 mL与28天生存率显著相关。结论：在脓毒症发病的前72小时内，PISO指数持续呈阴性且不断下降，表明存在与不良结局相关的潜在风险亚表型。此外，在某些表型亚组中，脓毒症发病后12小时累积体液平衡非阳性与生存率的提高有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.