Four Clinical Phenotypes Identified for Sepsis

Four distinct clinical phenotypes have been identified among patients with sepsis, according to a study published in the Journal of the American Medical Association to coincide with the American Thoracic Society 2019 International Conference, held from May 17 to 22 in Dallas.

Christopher W. Seymour, M.D., from the University of Pittsburgh, and colleagues conducted a retrospective analysis to derive sepsis phenotypes from clinical data for 20,189 total patients (16,552 unique patients) who met Sepsis-3 criteria. Reproducibility was examined in a second database with 43,086 total patients and 31,160 unique patients.

The researchers found that of the four derived phenotypes, the most common phenotype was α (33 percent), which included patients with the lowest vasopressor administration; β phenotype (27 percent) included older patients with more chronic illness and renal dysfunction; γ phenotype (27 percent) included patients with more inflammation and pulmonary dysfunction; and δ phenotype (13 percent) included patients with more liver dysfunction and septic shock. In the validation cohort, the phenotypic distributions were similar. Consistent differences were seen in biomarker patterns by phenotype. In the derivation cohort, cumulative 28-day mortality was 5, 13, 24, and 40 percent for α, β, γ, and δ phenotypes, respectively.

"By seeing sepsis as several distinct conditions with varying clinical characteristics, we can discover and test therapies precisely tailored to the type of sepsis each patient has," Seymour said in a statement.

Several authors disclosed financial ties to the biopharmaceutical industry; the GenIMS Study, which supplied some of the data, was partially funded by GlaxoSmithKline.

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