ArticleInternal and emergency medicine2025
Bundle compliance patterns in septic shock and their association with patient outcomes: an unsupervised cluster analysis.
Article in Internal and emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Continuation of direct oral anticoagulants versus warfarin during critical illness: bleeding and clinical outcomes in a multicenter ICU cohort.Journal of thrombosis and thrombolysis · 2026Article
- Article
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Authors and funding
5 authors.
Funding
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Abstract
Adhering to bundle-based care recommendations within stringent time constraints presents a profound challenge. Elements within these bundles hold varying degrees of significance. We aimed to evaluate the Surviving Sepsis Campaign (SSC) hour-one bundle compliance patterns and their association with patient outcomes. Utilizing the Medical Information Mart for Intensive Care-IV 1.0 dataset, this retrospective cohort study evaluated patients with sepsis who developed shock and were admitted to the intensive care unit between 2008 and 2019. The execution of five hour-one bundle interventions were assessed. Patients with similar treatment profiles were categorized into clusters using unsupervised machine learning. Primary outcomes included in-hospital and 1-year mortality. Four clusters were identified: C#0 (n = 4716) had the poorest bundle compliance. C#1 (n = 1117) had perfect antibiotic adherence with modest fluid and serum lactate measurement adherence. C#2 (n = 850) exhibited full adherence to lactate measurement and low adherence to fluid administration, blood culture, and vasopressors, while C#3 (n = 381) achieved complete adherence to fluid administration and the highest adherence to vasopressor requirements in the entire cohort. Adjusting for covariates, C#1 and C#3 were associated with reduced odds of in-hospital mortality compared to C#0 (adjusted odds ratio [aOR] = 0·83; 95% confidence interval [CI] 0·7-0·97 and aOR = 0·7; 95% CI 0·53-0·91, respectively). C#1 exhibited significantly better 1-year survival (adjusted hazard ratio [aHR] = 0·9; 95%CI 0·81-0·99). We were able to identify distinct clusters of SSC hour-one bundle adherence patterns using unsupervised machine learning techniques, which were associated with patient outcomes.
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