{"id":17313,"date":"2019-07-22T03:23:26","date_gmt":"2019-07-21T19:23:26","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17313"},"modified":"2019-08-06T11:23:18","modified_gmt":"2019-08-06T03:23:18","slug":"icu-management-practice-%e8%84%93%e6%af%92%e7%97%87%e6%96%b0%e4%b8%b4%e5%ba%8a%e5%88%86%e5%9e%8b%e7%9a%84%e6%b2%bb%e7%96%97%e6%84%8f%e4%b9%89","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17313","title":{"rendered":"[ICU Management & Practice]: \u8113\u6bd2\u75c7\u65b0\u4e34\u5e8a\u5206\u578b\u7684\u6cbb\u7597\u610f\u4e49"},"content":{"rendered":"\n

Treatment implications of novel clinical phenotypes for sepsis<\/h1>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Sepsis affects millions of individuals every year. It carries a high risk of death, even if prompt care is provided.\u00a0It has been decades, and no new therapies for sepsis have been discovered. A major barrier to progress in this area has been the overly broad definition for this syndrome. Sepsis has a vast array of clinical and biological features, and these features can be clustered in different combinations into different subsets or phenotypes. So far, efforts to identify these phenotypes have\u00a0been quite limited, and most of the focus has remained on patients in the intensive care unit.\u00a0<\/p>\n\n\n\n

The National Institutes of Health-funded Sepsis Endotyping in Emergency Care (SENACA) project was designed to develop and evaluate sepsis phenotypes. The primary goal of this project was to determine whether routine clinical information could be mathematically reduced to discrete, reproducible sepsis phenotypes. The secondary goal was to understand whether these different phenotypes were associated with patterns among biomarkers and clinical outcomes.\u00a0<\/p>\n\n\n\n

The investigators derived 4 clinical phenotypes of sepsis using routine clinical data at the time of hospital presentation. These phenotypes differed in demographics, laboratory abnormalities, and patterns of organ dysfunction. Phenotypes were derived among 20,189 patients who presented with sepsis within 6 hours of hospital presentation.Of the\u00a0four phenotypes that were \u00a0derived (\u03b1, \u03b2, \u03b3, and \u03b4),\u00a0the \u03b1 was the most common.\u00a0The \u03b2 phenotype was observed more in older patients with more chronic illness and renal dysfunction; the \u03b3 phenotype was found in patients with more inflammation and pulmonary dysfunction, and patients with the \u03b4 phenotype had more liver dysfunction and septic shock.<\/p>\n\n\n\n

The \u03b4 phenotype was found to be strongly correlated with abnormal values of host-response biomarkers and was associated with cardiovascular and liver dysfunction. The \u03b4 phenotype also had the greatest proportion of intraabdominal infections. The \u03b1 phenotype had fewer abnormalities and less septic shock.\u00a0<\/p>\n\n\n\n

By using these phenotypes, it is possible to identify subsets of patients that are most likely to benefit from particular immunomodulation strategies. These findings show that sepsis is a heterogeneous syndrome and that the identification of specific clinical phenotypes could allow more precise therapy and improved care for patients with sepsis.\u00a0 It is thus important to characterise the heterogeneity of sepsis when determining actions to treat it.<\/p>\n\n\n\n

Source:\u00a0JAMA<\/a>Image Credit: iStock<\/p>\n\n\n\n

References:<\/h4>\n\n\n\n

Seymour CW, Kennedy JN, Wang, S et al. (2019) Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis<\/a>. JAMA. doi:10.1001\/jama.2019.5791<\/p>\n","protected":false},"excerpt":{"rendered":"

Treatment implications of novel clinical phenotypes for […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17313"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17313"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17313\/revisions"}],"predecessor-version":[{"id":17314,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17313\/revisions\/17314"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17313"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17313"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17313"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}