ArticleCritical care (London, England)2024
Novel cortisol trajectory sub-phenotypes in sepsis.
Article in Critical care (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed.
- Hemodynamic trajectory phenotypes may modify associations between corticosteroid timing and outcomes in septic shock.Journal of clinical monitoring and computing · 2026Article
- Blood biomarker trajectories in ICU-directed prediction models - A scoping review.The EPMA journal · 2026Review
- Persistent stress hyperglycemia trajectories predict mortality in sepsis: a machine learning-enhanced cohort study.BMC infectious diseases · 2026Article
- Data-driven spatial-temporal framework for exploring the heterogeneity and temporality of sepsis.Chinese medical journal · 2026Review
- Metabolic and post-translational modifications in sepsis-associated immune dysfunction: a conceptual framework.Frontiers in immunology · 2026Review
- The immunology of sepsis: translating new insights into clinical practice.Nature reviews. Nephrology · 2026Review
- Clinical subphenotypes and molecular endotypes in sepsis: toward an integrated and dynamic framework.Annals of intensive care · 2026Review
- Longitudinal serum chloride trajectories and their correlation with all-cause mortality in critically Ill sepsis patients: a retrospective cohort analysis.BMC infectious diseases · 2025Article
- Association between sodium level trajectories and clinical prognosis in patients with sepsis: A longitudinal retrospective cohort study.Science progressArticle
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7 authors.
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Abstract
backgroundSepsis is a heterogeneous syndrome. This study aimed to identify new sepsis sub-phenotypes using plasma cortisol trajectory.
methodsThis retrospective study included patients with sepsis admitted to the intensive care unit of Zhongshan Hospital Fudan University between March 2020 and July 2022. A group-based cortisol trajectory model was used to classify septic patients into different sub-phenotypes. The clinical characteristics, biomarkers, and outcomes were compared between sub-phenotypes.
resultsA total of 258 patients with sepsis were included, of whom 186 were male. Patients were divided into two trajectory groups: the lower-cortisol group (n = 217) exhibited consistently low and slowly declining cortisol levels, while the higher-cortisol group (n = 41) showed relatively higher levels in comparison. The 28-day mortality (65.9% vs.16.1%, P < 0.001) and 90-day mortality (65.9% vs. 19.8%, P < 0.001) of the higher-cortisol group were significantly higher than the lower-cortisol group. Multivariable Cox regression analysis showed that the trajectory sub-phenotype (HR = 5.292; 95% CI 2.218-12.626; P < 0.001), APACHE II (HR = 1.109; 95% CI 1.030-1.193; P = 0.006), SOFA (HR = 1.161; 95% CI 1.045-1.291; P = 0.006), and IL-1β (HR = 1.001; 95% CI 1.000-1.002; P = 0.007) were independent risk factors for 28-day mortality. Besides, the trajectory sub-phenotype (HR = 4.571; 95% CI 1.980-10.551; P < 0.001), APACHE II (HR = 1.108; 95% CI 1.043-1.177; P = 0.001), SOFA (HR = 1.270; 95% CI 1.130-1.428; P < 0.001), and IL-1β (HR = 1.001; 95% CI 1.000-1.001; P = 0.015) were also independent risk factors for 90-day mortality.
conclusionThis study identified two novel cortisol trajectory sub-phenotypes in patients with sepsis. The trajectories were associated with mortality, providing new insights into sepsis classification.
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