Evidence map›Paper›PMID 40390062›Full record

ArticleCritical care (London, England)2025

Identifying a unique signature of sepsis in patients with pre-existing cirrhosis.

Anushka Dasgupta, Tiffanie K Jones, Heather Giannini, Rachel Bennett, Gulus Emre, Caroline A G Ittner, Alexandra Turner, Mika Esperanza, Kaitlyn Housel, Todd Miano and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–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

7 citing papers in PubMed.

  1. SOFA-2 Score and Mortality in Suspected Infection Stratified by Cirrhosis Status: A Multi-Institutional Observational Cohort Study.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Anushka DasguptaCollege of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.
Tiffanie K JonesDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Heather GianniniDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Rachel BennettDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Gulus EmreDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Caroline A G IttnerDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Alexandra TurnerDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Mika EsperanzaDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Kaitlyn HouselDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Todd MianoCenter for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Matthew ErlichDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Brian J AndersonDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Michael G S ShashatyDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Nuala J MeyerDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
John P ReillyDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, 5042 Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA. John.Reilly@pennmedicine.upenn.edu.

Funding

Investigating Individual Susceptibility and Host Response in Acute Respiratory Distress SyndromeR35HL161196 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI Nuala Jennings Meyer · 2022 to 2026
$4.8M
An ABO Blood Type Defined ARDS Endotype in SepsisR01HL155159 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI REILLY, JOHN PATRICK · 2021 to 2025
$2.7M
MESO QuikPlex SQ 120 for the multiplex quantification of proteins in human biospecimensS10OD025172 · OD · UNIVERSITY OF PENNSYLVANIA · PI MEYER, NUALA JENNINGS · 2018 to 2018
$50k
NHLBI NIH HHS R01 HL155159NHLBI NIH HHS R01-HL155159NHLBI NIH HHS R35 HL161196NHLBI NIH HHS R35-HL161196NIH HHS S10 OD025172ODCDC CDC HHS S10 OD025172
6 · The paper itself

Abstract

backgroundThe pre-existing diagnosis of cirrhosis is a complicating factor in the progression and prognosis of sepsis; however, the unique epidemiology, sepsis characteristics, and underlying mechanisms of immune dysregulation in sepsis among patients with cirrhosis remain incompletely understood. Our primary objective was to identify clinical outcomes and biological characteristics that differ between patients with and without cirrhosis among critically ill patients with sepsis.

methodsWe analyzed data from a prospective cohort of critically ill patients presenting to single center with sepsis. Subjects were followed for 6 days for the development of acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), and 30 days for mortality. Inflammatory, endothelial, and coagulopathic proteins were measured in plasma collected at ICU admission in a subset of patients. We determined associations of cirrhosis with outcomes using multivariable logistic regression adjusting for pre-specified confounders. We tested differences in plasma protein levels by cirrhosis diagnosis using the Wilcoxon Rank-sum test.

resultsWe enrolled 2962 subjects, 371 (13%) of whom had a pre-existing diagnosis of cirrhosis. Patients with cirrhosis had higher severity of illness scores, were more likely to have an abdominal source of sepsis, and had more significant clinically measured coagulation abnormalities relative to patients without cirrhosis. In multivariate analysis, cirrhosis was associated with higher AKI risk (adjusted OR 1.65; 95% CI 1.21 to 2.26; P = 0.002), and 30-day mortality (adjusted OR 1.38; 95% CI 1.05 to 1.82; P = 0.022). There was no significant difference in risk for ARDS (adjusted OR 1.02; 95% CI 0.69 to 1.50; P = 0.92). Cirrhosis was associated with higher plasma levels of angiopoietin-2 (P < 0.001), von Willebrand factor (P < 0.001), and soluble thrombomodulin (P < 0.001), as well as lower levels of interleukin (IL)-10 (P < 0.001), IL-1β (P = 0.008), and IL-1RA (P = 0.036). There were no significant differences in levels of IL-6 (P = 0.30).

conclusionsWe identified associations between pre-existing cirrhosis and endothelial injury, AKI, and mortality in sepsis. Patients with pre-existing cirrhosis who develop sepsis may display a unique phenotype of endothelial dysfunction that requires unique targeted approaches.

Indexed as

Liver CirrhosisSepsisAcute Kidney InjuryAgedBiomarkersCohort StudiesCritical IllnessFemaleHumansIntensive Care UnitsLogistic ModelsMaleMiddle AgedProspective StudiesRespiratory Distress SyndromeBiomarkersAcute kidney injuryAcute respiratory distress syndromeCirrhosisEndothelial dysfunctionSepsis

Identifiers

PMID40390062
PMCPMC12090594

What OpenQuestion holds

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LicenceCC BY-NC-ND
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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.