Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort
Sabri Soussi,
Divya Sharma,
Peter Jüni,
Gerald Lebovic,
Laurent Brochard,
John C. Marshall,
Patrick R. Lawler,
Margaret Herridge,
Niall Ferguson,
Lorenzo Del Sorbo,
Elodie Feliot,
Alexandre Mebazaa,
Erica Acton,
Jason N. Kennedy,
Wei Xu,
Etienne Gayat,
Claudia C. Dos Santos,
the FROG-ICU,
CCCTBG trans-trial group study for InFACT - the International Forum for Acute Care Trialists
Affiliations
Sabri Soussi
Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto
Divya Sharma
Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto
Peter Jüni
Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital
Gerald Lebovic
Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital
Laurent Brochard
Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto
John C. Marshall
Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto
Patrick R. Lawler
Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto
Margaret Herridge
Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto
Niall Ferguson
Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto
Lorenzo Del Sorbo
Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto
Elodie Feliot
Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris
Alexandre Mebazaa
Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris
Erica Acton
Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto
Jason N. Kennedy
Department of Critical Care Medicine, School of Medicine, University of Pittsburgh
Wei Xu
Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto
Etienne Gayat
Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris
Claudia C. Dos Santos
Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto
the FROG-ICU
CCCTBG trans-trial group study for InFACT - the International Forum for Acute Care Trialists
Abstract Background Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis. Methods In the original FROG-ICU prospective, observational, multicenter study, intensive care unit (ICU) patients with sepsis on admission (Sepsis-3) were identified (N = 655). Among them, 467 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct sepsis-survivors clinical classes using readily available data at ICU discharge. The primary endpoint was one-year mortality after ICU discharge. Results At ICU discharge, two distinct subtypes were identified (A and B) using 15 readily available clinical and biological variables. Patients assigned to subtype B (48% of the studied population) had more impaired cardiovascular and kidney functions, hematological disorders and inflammation at ICU discharge than subtype A. Sepsis-survivors in subtype B had significantly higher one-year mortality compared to subtype A (respectively, 34% vs 16%, p < 0.001). When adjusted for standard long-term risk factors (e.g., age, comorbidities, severity of illness, renal function and duration of ICU stay), subtype B was independently associated with increased one-year mortality (adjusted hazard ratio (HR) = 1.74 (95% CI 1.16–2.60); p = 0.006). Conclusions A subtype with sustained organ failure and inflammation at ICU discharge can be identified from routine clinical and laboratory data and is independently associated with poor long-term outcome in sepsis-survivors. Trial registration NCT01367093; https://clinicaltrials.gov/ct2/show/NCT01367093 . Graphical Abstract
