Evidence map›Paper›PMID 37474944›Full record

ArticleCritical care (London, England)2023

Defining critical illness using immunological endotypes in patients with and without sepsis: a cohort study.

Jeremy A Balch, Uan-I Chen, Oliver Liesenfeld, Petr Starostik, Tyler J Loftus, Philip A Efron, Scott C Brakenridge, Timothy E Sweeney, Lyle L Moldawer

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Jeremy A Balch *Sepsis and Critical Illness Research Center, Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, P. O. Box 100019, Gainesville, FL, 32610-0019, USA.
Uan-I Chen *Inflammatix, Inc., Sunnyvale, CA, 94085, USA.
Oliver LiesenfeldInflammatix, Inc., Sunnyvale, CA, 94085, USA.
Petr StarostikUF Health Medical Laboratory at Rocky Point, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
Tyler J LoftusSepsis and Critical Illness Research Center, Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, P. O. Box 100019, Gainesville, FL, 32610-0019, USA.
Philip A EfronSepsis and Critical Illness Research Center, Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, P. O. Box 100019, Gainesville, FL, 32610-0019, USA.
Scott C BrakenridgeSepsis and Critical Illness Research Center, Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, P. O. Box 100019, Gainesville, FL, 32610-0019, USA.
Timothy E SweeneyInflammatix, Inc., Sunnyvale, CA, 94085, USA.
Lyle L MoldawerSepsis and Critical Illness Research Center, Department of Surgery, Shands Hospital, University of Florida College of Medicine, Room 6116, 1600 SW Archer Road, P. O. Box 100019, Gainesville, FL, 32610-0019, USA. moldawer@surgery.ufl.edu.

Funding

Renewal: Dysfunctional Myelopoiesis and Myeloid-Derived Suppressor Cells in Sepsis PathobiologyRM1GM139690 · NIGMS · UNIVERSITY OF FLORIDA · PI Philip A Efron, Michael Paul Kladde · 2021 to 2026
$10.3M
Molecular Biology in Burns and TraumaT32GM008721 · NIGMS · UNIVERSITY OF FLORIDA · PI Philip A Efron · 1999 to 2026
$5.0M
NIGMS NIH HHS RM1 GM139690NIGMS NIH HHS RM1 GM139690-02NIGMS NIH HHS T32 GM008721NIGMS NIH HHS T32 GM008721-24
6 · The paper itself

Abstract

backgroundSepsis is a heterogenous syndrome with limited therapeutic options. Identifying immunological endotypes through gene expression patterns in septic patients may lead to targeted interventions. We investigated whether patients admitted to a surgical intensive care unit (ICU) with sepsis and with high risk of mortality express similar endotypes to non-septic, but still critically ill patients using two multiplex transcriptomic metrics obtained both on admission to a surgical ICU and at set intervals.

methodsWe analyzed transcriptomic data from 522 patients in two single-site, prospective, observational cohorts admitted to surgical ICUs over a 5-year period ending in July 2020. Using an FDA-cleared analytical platform (nCounter FLEX

resultsSepsis was associated with a significantly higher predicted and actual hospital mortality. At enrollment, the predominant endotype for both septic and non-septic patients was adaptive, though with significantly different distributions. Inflammopathic and coagulopathic septic patients, as well as inflammopathic non-septic patients, showed significantly higher frequencies of secondary infections compared to those with adaptive endotypes (p < 0.01). Endotypes changed during ICU hospitalization in 57.5% of patients. Patients who remained adaptive had overall better prognosis, while those who remained inflammopathic or coagulopathic had worse overall outcomes. For severity metrics, patients admitted with sepsis and a high predicted likelihood of mortality showed an inflammopathic (49.6%) endotype and had higher rates of cumulative adverse outcomes (67.4%). Patients at low mortality risk, whether septic or non-septic, almost uniformly presented with an adaptive endotype (100% and 93.4%, respectively).

conclusionCritically ill surgical patients express different and evolving immunological endotypes depending upon both their sepsis status and severity of their clinical course. Future studies will elucidate whether endotyping critically ill, septic patients can identify individuals for targeted therapeutic interventions to improve patient management and outcomes.

Indexed as

CoinfectionSepsisCohort StudiesCritical IllnessHospital MortalityHumansIntensive Care UnitsProspective StudiesRNA, MessengerRNA, MessengerBiomarkersICUOutcomesSepsisTranscriptomics

Identifiers

PMID37474944
PMCPMC10360294

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.