Researchers at the University of Pittsburgh analyzed clinical data from 63,858 sepsis patients across three hospital cohorts, using statistical clustering to see whether the condition actually splits into distinct patterns.
Four phenotypes emerged, labeled alpha through delta, differing in organ dysfunction and lab values, with 28-day mortality ranging from about 5 percent in the mildest group to about 40 percent in the most severe. Patients who looked clinically similar at admission could land in very different risk groups.
Computer simulations suggested some sepsis treatments tested in past trials might have helped one phenotype while harming another, which could explain why several sepsis drug trials showed no overall benefit despite mixed results within subgroups. The phenotypes have not yet been validated in a prospective trial that assigns treatment by type.
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One diagnosis turned out to hide four patient types.
Source
- Seymour, C. W., Kennedy, J. N., Wang, S., Chang, C.-C. H., Elliott, C. F., Xu, Z., Berry, S., Clermont, G., Cooper, G., Gomez, H., Huang, D. T., Kellum, J. A., Mi, Q., Opal, S. M., Talisa, V., van der Poll, T., Visweswaran, S., Vodovotz, Y., Weiss, J. C., . . . Angus, D. C. (2019). Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis. JAMA, 321(20), 2003–2017. https://doi.org/10.1001/jama.2019.5791