Blood pressure response index trajectories identify distinct hemodynamic phenotypes and predict mortality in septic shock: a two-database retrospective cohort study
Authors' conclusion
BPRI trajectory analysis identifies six hemodynamic phenotypes in septic shock that are validated in an independent external database, are independently associated with mortality, and capture temporal hemodynamic response patterns missed by static assessments.
Study context
- Population
- Septic shock patients on vasopressor therapy, MIMIC-IV (development) and eICU-CRD (validation)1,240 eICU-CRD validation
- Participants
- 4,389 patients
- Exposure
- BPRI trajectory phenotypes and ICU mortality
- Outcome
- ICU mortality by BPRI trajectory phenotype (first 48 h of vasopressor therapy)
Methodological detailstwo-database, latent class mixed models, external validation (parameter transport)
- Two-database
- Latent class mixed models
- External validation (parameter transport)
Main finding
As reported in the abstract
ICU mortality
Odds ratio (95% CI)
C2
3.67(2.76–4.86)
C1
2.68(2.08–3.46)
Observational data: associations, not effects.
Further findings
| Outcome | ΔAUC | P value |
|---|---|---|
| Incremental discrimination beyond severity scoresSeverity scores + trajectory classification vs Severity scores · static BPRI added no further information | + 0.020 | P < 0.001 |
External validation (eICU-CRD)
- Preserved class separation and prognostic gradient; average posterior probability
- 0.960
Restricted mean survival time, adjusted loss for C2 · τ = 14 days
- Largest adjusted loss, C2 (minimal attenuation from unadjusted)
- - 2.56 days
Original publication
Blood pressure response index trajectories identify distinct hemodynamic phenotypes and predict mortality in septic shock: a two-database retrospective cohort study. Crit Care. Published 29 April 2026. doi:10.
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