Observational studyCritical care medicine2018
Endotype Transitions During the Acute Phase of Pediatric Septic Shock Reflect Changing Risk and Treatment Response.
Observational study in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025Pooled it
- Relationship Between Phenotyping and Individualized Absolute Risk Differences in Sepsis: A Secondary Analysis of Two Approaches in Two Multicenter Trials.Critical care explorations · 2025Trial
- Development and validation of novel sepsis subphenotypes using trajectories of vital signs.Intensive care medicine · 2022Trial
- Lymphopenia and elevated NLR identify patients with septic shock who may benefit from corticosteroids: a target trial emulation study.Intensive care medicine experimental · 2026Article
- Precision medicine in pediatric sepsis-associated acute kidney injury: when systemic heterogeneity meets organ-level heterogeneity.World journal of pediatrics : WJP · 2026Article
- Pediatric sepsis-associated acute kidney injury: leveraging pathophysiology for risk stratification and identification of treatable traits.Pediatric nephrology (Berlin, Germany) · 2026Review
- Age-related differences and common pathways of lymphocyte subsets in sepsis: a comparative review of elderly and pediatric patients.Cell death & disease · 2026Review
- Pediatric Sepsis: Evolving Subphenotypes, Overlap Syndromes, and the Path to Precision Therapies.Clinics in chest medicine · 2026Review
- Multi-omic and computational approaches for biomarker discovery and clinical translation in pediatric sepsis.Frontiers in pharmacology · 2026Review
- Is "pre-sepsis" the new sepsis? A narrative review.PLoS pathogens · 2025Review
- A gene expression-based approach for the precision use of hydrocortisone in septic shock patients; a secondary analysis of the ADRENAL trial.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Article
- Immunomodulation in Pediatric Sepsis: A Narrative Review.Journal of clinical medicine · 2025Review
- AI-driven multi-omics profiling of sepsis immunity in the digestive system.Frontiers in immunology · 2025Review
- Novel cortisol trajectory sub-phenotypes in sepsis.Critical care (London, England) · 2024Article
- Pediatric Sepsis - Sailing the Unchartered Waters with Omics.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- Biological basis of critical illness subclasses: from the bedside to the bench and back again.Critical care (London, England) · 2024Review
- Glucocorticoid use in acute respiratory failure from pulmonary causes and association with early changes in the systemic host immune response.Intensive care medicine experimental · 2024Article
- Whole blood transcriptomics identifies subclasses of pediatric septic shock.Critical care (London, England) · 2023Article
- Defining critical illness using immunological endotypes in patients with and without sepsis: a cohort study.Critical care (London, England) · 2023Article
- Defining critical illness using immunological endotypes in patients with and without of sepsis: A cohort study.Research square · 2023Article
Corrections and comments
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Authors and funding
19 authors.
Funding
Abstract
objectiveWe previously identified septic shock endotypes A and B based on 100 genes reflecting adaptive immunity and glucocorticoid receptor signaling. The endotypes differ with respect to outcome and corticosteroid responsiveness. We determined whether endotypes change during the initial 3 days of illness, and whether changes are associated with outcomes.
designObservational cohort study including existing and newly enrolled participants.
settingMultiple PICUs. PATIENTS: Children with septic shock.
interventionsNone. MEASUREMENTS AND MAIN
resultsWe measured the 100 endotyping genes at day 1 and day 3 of illness in 375 patients. We determined if endotype assignment changes over time, and whether changing endotype is associated with corticosteroid response and outcomes. We used multivariable logistic regression to adjust for illness severity, age, and comorbidity burden. Among the 132 subjects assigned to endotype A on day 1, 56 (42%) transitioned to endotype B by day 3. Among 243 subjects assigned to endotype B on day 1, 77 (32%) transitioned to endotype A by day 3. Assignment to endotype A on day 1 was associated with increased odds of mortality. This risk was modified by the subsequent day 3 endotype assignment. Corticosteroids were associated with increased risk of mortality among subjects who persisted as endotype A.
conclusionsA substantial proportion of children with septic shock transition endotypes during the acute phase of illness. The risk of poor outcome and the response to corticosteroids change with changes in endotype assignment. Patients persisting as endotype A are at highest risk of poor outcomes.
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