Identification of Clinically Significant Cytokine Signature Clusters in Patients With Septic Shock
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved..
OBJECTIVES: To identify cytokine signature clusters in patients with septic shock.
DESIGN: Prospective observational cohort study.
SETTING: Single academic center in the United States.
PATIENTS: Adult (≥ 18 yr old) patients admitted to the medical ICU with septic shock requiring vasoactive medication support.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: One hundred fourteen patients with septic shock completed cytokine measurement at time of enrollment (t 1 ) and 24 hours later (t 2 ). Unsupervised random forest analysis of the change in cytokines over time, defined as delta (t 2 -t 1 ), identified three clusters with distinct cytokine profiles. Patients in cluster 1 had the lowest initial levels of circulating cytokines that decreased over time. Patients in cluster 2 and cluster 3 had higher initial levels that decreased over time in cluster 2 and increased in cluster 3. Patients in clusters 2 and 3 had higher mortality compared with cluster 1 (clusters 1-3: 11% vs 31%; odds ratio [OR], 3.56 [1.10-14.23] vs 54% OR, 9.23 [2.89-37.22]). Cluster 3 was independently associated with in-hospital mortality (hazard ratio, 5.24; p = 0.005) in multivariable analysis. There were no significant differences in initial clinical severity scoring or steroid use between the clusters. Analysis of either t 1 or t 2 cytokine measurements alone or in combination did not reveal clusters with clear clinical significance.
CONCLUSIONS: Longitudinal measurement of cytokine profiles at initiation of vasoactive medications and 24 hours later revealed three distinct cytokine signature clusters that correlated with clinical outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:51 |
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| Enthalten in: |
Critical care medicine - 51(2023), 12 vom: 01. Dez., Seite e253-e263 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhao, Jack O [VerfasserIn] |
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| Links: |
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| Themen: |
Cytokines |
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| Anmerkungen: |
Date Completed 17.11.2023 Date Revised 27.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/CCM.0000000000006032 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM361758308 |
|---|
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| 100 | 1 | |a Zhao, Jack O |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Identification of Clinically Significant Cytokine Signature Clusters in Patients With Septic Shock |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 17.11.2023 | ||
| 500 | |a Date Revised 27.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. | ||
| 520 | |a OBJECTIVES: To identify cytokine signature clusters in patients with septic shock | ||
| 520 | |a DESIGN: Prospective observational cohort study | ||
| 520 | |a SETTING: Single academic center in the United States | ||
| 520 | |a PATIENTS: Adult (≥ 18 yr old) patients admitted to the medical ICU with septic shock requiring vasoactive medication support | ||
| 520 | |a INTERVENTIONS: None | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: One hundred fourteen patients with septic shock completed cytokine measurement at time of enrollment (t 1 ) and 24 hours later (t 2 ). Unsupervised random forest analysis of the change in cytokines over time, defined as delta (t 2 -t 1 ), identified three clusters with distinct cytokine profiles. Patients in cluster 1 had the lowest initial levels of circulating cytokines that decreased over time. Patients in cluster 2 and cluster 3 had higher initial levels that decreased over time in cluster 2 and increased in cluster 3. Patients in clusters 2 and 3 had higher mortality compared with cluster 1 (clusters 1-3: 11% vs 31%; odds ratio [OR], 3.56 [1.10-14.23] vs 54% OR, 9.23 [2.89-37.22]). Cluster 3 was independently associated with in-hospital mortality (hazard ratio, 5.24; p = 0.005) in multivariable analysis. There were no significant differences in initial clinical severity scoring or steroid use between the clusters. Analysis of either t 1 or t 2 cytokine measurements alone or in combination did not reveal clusters with clear clinical significance | ||
| 520 | |a CONCLUSIONS: Longitudinal measurement of cytokine profiles at initiation of vasoactive medications and 24 hours later revealed three distinct cytokine signature clusters that correlated with clinical outcomes | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 7 | |a Cytokines |2 NLM | |
| 700 | 1 | |a Patel, Bhakti K |e verfasserin |4 aut | |
| 700 | 1 | |a Krishack, Paulette |e verfasserin |4 aut | |
| 700 | 1 | |a Stutz, Matthew R |e verfasserin |4 aut | |
| 700 | 1 | |a Pearson, Steven D |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Julie |e verfasserin |4 aut | |
| 700 | 1 | |a Lecompte-Osorio, Paola A |e verfasserin |4 aut | |
| 700 | 1 | |a Dugan, Karen C |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Seoyoen |e verfasserin |4 aut | |
| 700 | 1 | |a Gras, Nicole |e verfasserin |4 aut | |
| 700 | 1 | |a Pohlman, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Kress, John P |e verfasserin |4 aut | |
| 700 | 1 | |a Hall, Jesse B |e verfasserin |4 aut | |
| 700 | 1 | |a Sperling, Anne I |e verfasserin |4 aut | |
| 700 | 1 | |a Adegunsoye, Ayodeji |e verfasserin |4 aut | |
| 700 | 1 | |a Verhoef, Philip A |e verfasserin |4 aut | |
| 700 | 1 | |a Wolfe, Krysta S |e verfasserin |4 aut | |
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