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Войти в исследования Frontiers in medicine · 2026
Identification and validation of early vital sign trajectory subphenotypes for risk stratification in sepsis-associated liver injury: a multicenter retrospective cohort study.
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Wang Weihang, Ma Jing, Wang Bingqing, Wang Jiayang, Zang Zexi, Liu Qiyao, Gao Zhi, Chen Wei, Deng Yuxin, Zhang Zhiqing, Jiang Yongfang
Аннотация
BACKGROUND: Sepsis-associated liver injury (SALI) is a serious clinical syndrome with heterogeneity in outcome among affected individuals. Physiological changes that are critical to outcome prediction are not considered in the existing system of stratification based on single-point observations. This could compromise the effectiveness of individualized treatment.
OBJECTIVE: To develop and validate dynamic clinical subphenotypes of SALI using early vital sign trajectories.
METHODS: This retrospective cohort study included 1,159 patients from MIMIC-IV as the derivation cohort and 168 patients from the Second Xiangya Hospital as the external validation cohort. Early vital sign trajectories within 12 h of ICU admission were summarized as trajectory-derived features and clustered using K-means. Candidate solutions (k = 2-6) were assessed using internal clustering metrics and bootstrap stability. A four-cluster solution was retained as an exploratory partition, considering trajectory interpretability and subgroup sizes. Clinical characteristics, organ support, and mortality outcomes were compared across the identified subphenotypes.
RESULTS: Four exploratory SALI subphenotypes with distinct early vital sign trajectories were identified, ranging from relatively stable profiles to marked hemodynamic and physiological stress. Subphenotype 3 exhibited the most stable vital signs and was associated with lower adjusted 28-day (HR 0.74, 95% CI 0.56-0.97) and 90-day mortality (HR 0.76, 95% CI 0.59-0.97) compared with the highest-risk Subphenotype 4. These prognostic differences were consistently replicated in the external cohort, supporting short- to intermediate-term prognostic generalizability.
CONCLUSION: Early vital sign trajectories identified exploratory SALI groups associated with differences in 28-day and 90-day mortality. Their reproducibility, incremental prognostic value, and clinical utility require further evaluation.
OBJECTIVE: To develop and validate dynamic clinical subphenotypes of SALI using early vital sign trajectories.
METHODS: This retrospective cohort study included 1,159 patients from MIMIC-IV as the derivation cohort and 168 patients from the Second Xiangya Hospital as the external validation cohort. Early vital sign trajectories within 12 h of ICU admission were summarized as trajectory-derived features and clustered using K-means. Candidate solutions (k = 2-6) were assessed using internal clustering metrics and bootstrap stability. A four-cluster solution was retained as an exploratory partition, considering trajectory interpretability and subgroup sizes. Clinical characteristics, organ support, and mortality outcomes were compared across the identified subphenotypes.
RESULTS: Four exploratory SALI subphenotypes with distinct early vital sign trajectories were identified, ranging from relatively stable profiles to marked hemodynamic and physiological stress. Subphenotype 3 exhibited the most stable vital signs and was associated with lower adjusted 28-day (HR 0.74, 95% CI 0.56-0.97) and 90-day mortality (HR 0.76, 95% CI 0.59-0.97) compared with the highest-risk Subphenotype 4. These prognostic differences were consistently replicated in the external cohort, supporting short- to intermediate-term prognostic generalizability.
CONCLUSION: Early vital sign trajectories identified exploratory SALI groups associated with differences in 28-day and 90-day mortality. Their reproducibility, incremental prognostic value, and clinical utility require further evaluation.