Spectral clustering of risk score trajectories stratifies sepsis patients by clinical outcome and interventions received.
Spectral clustering of risk score trajectories stratifies sepsis patients by clinical outcome and interventions received.
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DOI：
10.7554/elife.58142
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发表时间：
2020-09-22
期刊：
影响因子：
7.7
通讯作者：
Winslow RL
中科院分区：
文献类型：
--
作者：
Liu R;Greenstein JL;Fackler JC;Bembea MM;Winslow RL
脓毒症不是一种单一的疾病，而是一种具有不同结果的症状的松散集合。因此，对脓毒症患者进行分层和分型具有重要意义。我们使用我们之前发表的计算从败血症过渡到感染性休克风险的方法来检查患者状态的时间演变。在脓毒性休克的早期预测后，风险轨迹分为四类，按结果分层：最高风险组和最低风险组的脓毒性休克患病率分别为76.5%和10.4%，死亡率分别为43%和18%。这些组在接受的治疗和休克发作的中位时间上也有所不同。分析表明，在跨越阈值时，存在一个快速（30-60分钟）的风险转移。我们假设这种转变是代偿性生物系统应对感染失败的结果，导致低风险到高风险的分岔。我们认为，这样的崩溃代表了脓毒性休克的真正开始。因此，这种风险的快速上升代表了一种潜在的新的数据驱动的感染性休克定义。
Sepsis is not a monolithic disease, but a loose collection of symptoms with diverse outcomes. Thus, stratification and subtyping of sepsis patients is of great importance. We examine the temporal evolution of patient state using our previously-published method for computing risk of transition from sepsis into septic shock. Risk trajectories diverge into four clusters following early prediction of septic shock, stratifying by outcome: the highest-risk and lowest-risk groups have a 76.5% and 10.4% prevalence of septic shock, and 43% and 18% mortality, respectively. These clusters differ also in treatments received and median time to shock onset. Analyses reveal the existence of a rapid (30–60 min) transition in risk at the time of threshold crossing. We hypothesize that this transition occurs as a result of the failure of compensatory biological systems to cope with infection, resulting in a bifurcation of low to high risk. Such a collapse, we believe, represents the true onset of septic shock. Thus, this rapid elevation in risk represents a potential new data-driven definition of septic shock.