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Spectral clustering of risk score trajectories stratifies sepsis patients by clinical outcome and interventions received.


ABSTRACT: Sepsis is not a monolithic disease, but a loose collection of symptoms with diverse outcomes. Thus, stratification and subtyping of sepsis patients is of great importance. We examine the temporal evolution of patient state using our previously-published method for computing risk of transition from sepsis into septic shock. Risk trajectories diverge into four clusters following early prediction of septic shock, stratifying by outcome: the highest-risk and lowest-risk groups have a 76.5% and 10.4% prevalence of septic shock, and 43% and 18% mortality, respectively. These clusters differ also in treatments received and median time to shock onset. Analyses reveal the existence of a rapid (30-60 min) transition in risk at the time of threshold crossing. We hypothesize that this transition occurs as a result of the failure of compensatory biological systems to cope with infection, resulting in a bifurcation of low to high risk. Such a collapse, we believe, represents the true onset of septic shock. Thus, this rapid elevation in risk represents a potential new data-driven definition of septic shock.

SUBMITTER: Liu R 

PROVIDER: S-EPMC7508552 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Spectral clustering of risk score trajectories stratifies sepsis patients by clinical outcome and interventions received.

Liu Ran R   Greenstein Joseph L JL   Fackler James C JC   Bembea Melania M MM   Winslow Raimond L RL  

eLife 20200922


Sepsis is not a monolithic disease, but a loose collection of symptoms with diverse outcomes. Thus, stratification and subtyping of sepsis patients is of great importance. We examine the temporal evolution of patient state using our previously-published method for computing risk of transition from sepsis into septic shock. Risk trajectories diverge into four clusters following early prediction of septic shock, stratifying by outcome: the highest-risk and lowest-risk groups have a 76.5% and 10.4%  ...[more]

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