ArticleCritical care (London, England)2021
Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen.
Article in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers.
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Who cites it
30 citing papers in PubMed, 53 citations in OpenAlex.
- Longitudinal phenotypes in patients with acute respiratory distress syndrome: a multi-database study.Critical care (London, England) · 2022Trial
- Optimal Dynamic Treatment Regimes for High-Dimensional Accelerated Failure Time Model.Statistics in medicine · 2026Article
- J-shaped association between serum bicarbonate and 28-day ICU mortality in adult patients with sepsis: A multicenter cohort analysis.Medicine · 2026Article
- Patient Benefits in the Context of Sepsis-Related AI-Based Clinical Decision Support Systems: Scoping Review.Journal of medical Internet research · 2026Article
- Sequential Versus Non-Sequential Polymyxin B Hemoperfusion in Severe Sepsis and Septic Shock: A Real-World Cohort Analysis of Survival in an Asian ICU.Diagnostics (Basel, Switzerland) · 2026Article
- Interpretable prediction of hospital mortality in bleeding critically ill patients based on machine learning and SHAP.BMC medical informatics and decision making · 2025Article
- Septic Cardiomyopathy: Difficult Definition, Challenging Diagnosis, Unclear Treatment.Journal of clinical medicine · 2025Review
- Hyper- and hypomagnesemia as an initial predictor of outcomes in septic pediatric patients in Egypt.Acute and critical care · 2025Article
- Extremely early initiation of vasopressors might not decrease short-term mortality for adults with septic shock: a systematic review and meta-analysis.Annals of intensive care · 2025Article
- Sepsis subphenotypes: bridging the gaps in sepsis treatment strategies.Frontiers in immunology · 2025Review
- Fluid therapy should be as short as possible.Critical care science · 2025Article
- A Multivariate Phenotypical Approach of Sepsis and Septic Shock-A Comprehensive Narrative Literature Review.Medicina (Kaunas, Lithuania) · 2024Review
- The mortality of patients with sepsis increases in the first month of a new academic year.Clinical and experimental emergency medicine · 2024Article
- Article
- Review
- Revisiting Post-ICU Admission Fluid Balance Across Pediatric Sepsis Mortality Risk Strata: A Secondary Analysis of a Prospective Observational Cohort Study.Critical care explorations · 2024Article
- Causal inference using observational intensive care unit data: a scoping review and recommendations for future practice.NPJ digital medicine · 2023Article
- Precision fluid and vasoactive drug therapy for critically ill patients.Pharmacotherapy · 2023Review
- Prognostic Value of Serum Glucose Level in Critically Ill Septic Patients on Admission to Pediatric Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
- Clinical Sepsis Phenotypes in Critically Ill Patients.Microorganisms · 2023Review
Corrections and comments
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Authors and funding
29 authors at 19 institutions in 1 country.
Funding
Abstract
backgroundSeptic shock comprises a heterogeneous population, and individualized resuscitation strategy is of vital importance. The study aimed to identify subclasses of septic shock with non-supervised learning algorithms, so as to tailor resuscitation strategy for each class.
methodsPatients with septic shock in 25 tertiary care teaching hospitals in China from January 2016 to December 2017 were enrolled in the study. Clinical and laboratory variables were collected on days 0, 1, 2, 3 and 7 after ICU admission. Subclasses of septic shock were identified by both finite mixture modeling and K-means clustering. Individualized fluid volume and norepinephrine dose were estimated using dynamic treatment regime (DTR) model to optimize the final mortality outcome. DTR models were validated in the eICU Collaborative Research Database (eICU-CRD) dataset.
resultsA total of 1437 patients with a mortality rate of 29% were included for analysis. The finite mixture modeling and K-means clustering robustly identified five classes of septic shock. Class 1 (baseline class) accounted for the majority of patients over all days; class 2 (critical class) had the highest severity of illness; class 3 (renal dysfunction) was characterized by renal dysfunction; class 4 (respiratory failure class) was characterized by respiratory failure; and class 5 (mild class) was characterized by the lowest mortality rate (21%). The optimal fluid infusion followed the resuscitation/de-resuscitation phases with initial large volume infusion and late restricted volume infusion. While class 1 transitioned to de-resuscitation phase on day 3, class 3 transitioned on day 1. Classes 1 and 3 might benefit from early use of norepinephrine, and class 2 can benefit from delayed use of norepinephrine while waiting for adequate fluid infusion.
conclusionsSeptic shock comprises a heterogeneous population that can be robustly classified into five phenotypes. These classes can be easily identified with routine clinical variables and can help to tailor resuscitation strategy in the context of precise medicine.
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