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Septic Shock: Phenotypes and Outcomes

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Abstract

Introduction

Sepsis is a heterogeneous syndrome that results in life-threatening organ dysfunction. Our goal was to determine the relevant variables and patient phenotypes to use in predicting sepsis outcomes.

Methods

We performed an ancillary study concerning 119 patients with septic shock at intensive care unit (ICU) admittance (T0). We defined clinical worsening as having an increased sequential organ failure assessment (SOFA) score of ≥ 1, 48 h after admission (ΔSOFA ≥ 1). We performed univariate and multivariate analyses based on the 28-day mortality rate and ΔSOFA ≥ 1 and determined three patient phenotypes: safe, intermediate and unsafe. The persistence of the intermediate and unsafe phenotypes after T0 was defined as a poor outcome.

Results

At T0, the multivariate analysis showed two variables associated with 28-day mortality rate: norepinephrine dose and serum lactate concentration. Regarding ΔSOFA ≥ 1, we identified three variables at T0: norepinephrine dose, lactate concentration and venous-to-arterial carbon dioxide difference (P(v-a)CO2). At T0, the three phenotypes (safe, intermediate and unsafe) were found in 28 (24%), 70 (59%) and 21 (18%) patients, respectively. We thus suggested using an algorithm featuring norepinephrine dose, lactate concentration and P(v-a)CO2 to predict patient outcomes and obtained an area under the curve (AUC) of 74% (63–85%).

Conclusion

Our findings highlight the fact that identifying relevant variables and phenotypes may help physicians predict patient outcomes.

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Acknowledgements

The authors are indebted to the nursing staff of the polyvalent intensive care units for providing the best care to their patients. We thank all the participants of the study.

Funding

No funding or sponsorship was received for this study or publication of this article.

Author Contributions

Alexandre Cereuil: Concept, design and drafting the manuscript. Romain Ronflé: Concept, design and drafting the manuscript. Aurélien Culver: Reviewing. Mohamed Boucekine: statistical analysis. Laurent Papazian: Reviewing. Laurent Lefebvre: Reviewing. Marc Leone: Concept, design and reviewing the manuscript.

Compliance with Ethics Guidelines

The initial study was approved by the ethics committee of Nice University Hospital, France (Agreement number 2016-A00533-48). The ancillary study was also approved by the ethics committee of the French Society of Anaesthesia, Critical Care and Perioperative Medicine (SFAR), (Agreement number IRB 00010254-2022-078) and their opinion covers multiple hospitals. The requirement for written informed consent was waived because of this study’s strict observational design, according to French law [29]. However, we obtained the patient’s or relatives’ consent to use these data.

Disclosures

All the authors have nothing to disclose.

Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Réanimation et Surveillance Continue Médico-Chirurgicales Polyvalentes, Hôpital Nord, Service d’Anesthésie et de Réanimation, Aix Marseille Université, APHM, Avenue des tamaris, 13100, Marseille, Aix-en-Provence, France

    Alexandre Cereuil & Marc Leone

  2. Réanimation et Surveillance Continue Médico-Chirurgicales Polyvalentes, Centre Hospitalier du Pays d’Aix, Marseille, Aix-en-Provence, France

    Romain Ronflé, Aurélien Culver & Laurent Lefebvre

  3. Hôpital Nord, Médecine Intensive – Réanimation, Aix Marseille Université, APHM, Marseille, France

    Laurent Papazian

  4. EA 3279 CEReSS, School of Medicine – La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, APHM, Marseille, France

    Mohamed Boucekine

  5. Centre d’Investigation Clinique, Hôpital Nord, Aix Marseille Université, APHM, Marseille, France

    Marc Leone

Authors
  1. Alexandre Cereuil
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  2. Romain Ronflé
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  5. Laurent Papazian
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Corresponding author

Correspondence to Romain Ronflé.

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Cereuil, A., Ronflé, R., Culver, A. et al. Septic Shock: Phenotypes and Outcomes. Adv Ther 39, 5058–5071 (2022). https://doi.org/10.1007/s12325-022-02280-5

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