Sepsis Subclasses: A Framework for Development and Interpretation.
Sepsis Subclasses: A Framework for Development and Interpretation.
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DOI：
10.1097/ccm.0000000000004842
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发表时间：
2021-05-01
影响因子：
8.8
通讯作者：
Seymour CW
中科院分区：
文献类型：
--
作者：
DeMerle KM;Angus DC;Baillie JK;Brant E;Calfee CS;Carcillo J;Chang CH;Dickson R;Evans I;Gordon AC;Kennedy J;Knight JC;Lindsell CJ;Liu V;Marshall JC;Randolph AG;Scicluna BP;Shankar-Hari M;Shapiro NI;Sweeney TE;Talisa VB;Tang B;Thompson BT;Tsalik EL;van der Poll T;van Vught LA;Wong HR;Yende S;Zhao H;Seymour CW
脓毒症被定义为一种失调的宿主对感染的反应，导致危及生命的急性器官功能障碍。它每年困扰着全世界约5000万人，即使及时应用循证指南，也往往是致命的。在过去的20年里，许多随机试验测试了脓毒症的治疗方法，但大多数都没有证明是有益的。这可能是因为脓毒症是一种异质性综合征，其特征在于大量的临床和生物学特征。然而，这些特征的组合可能会识别出以前未被识别的群体，或对给定治疗具有不同结局和反应风险的"亚类"。随着确定败血症亚类的努力变得越来越普遍，出现了许多未回答的问题和挑战。其中包括：1）败血症亚类的语义基础，2）亚类的概念目标，3）关于研究设计、数据源和统计方法的考虑，4）新兴数据类型的作用，以及5）如何确定亚类是否代表"真理"。我们讨论了这些挑战，并提出了一个框架，更广泛的研究败血症亚类。该框架旨在帮助理解和解释脓毒症亚类，提供一种解释不同方法学方法产生的亚类的机制，并指导临床医生如何在床边护理中考虑亚类。
Sepsis is defined as a dysregulated host response to infection that leads to life-threatening acute organ dysfunction. It afflicts approximately 50 million people worldwide annually and is often deadly, even when evidence-based guidelines are applied promptly. Many randomized trials tested therapies for sepsis over the past 2 decades, but most have not proven beneficial. This may be because sepsis is a heterogeneous syndrome, characterized by a vast set of clinical and biologic features. Combinations of these features, however, may identify previously unrecognized groups, or “subclasses” with different risks of outcome and response to a given treatment. As efforts to identify sepsis subclasses become more common, many unanswered questions and challenges arise. These include: 1) the semantic underpinning of sepsis subclasses, 2) the conceptual goal of subclasses, 3) considerations about study design, data sources, and statistical methods, 4) the role of emerging data types, and 5) how to determine whether subclasses represent “truth.” We discuss these challenges and present a framework for the broader study of sepsis subclasses. This framework is intended to aid in the understanding and interpretation of sepsis subclasses, provide a mechanism for explaining subclasses generated by different methodologic approaches, and guide clinicians in how to consider subclasses in bedside care.