Hemodynamic trajectory phenotypes may modify associations between corticosteroid timing and outcomes in septic shock
Authors' conclusion
Hemodynamic trajectory phenotypes identified clinically meaningful variation in the relationship between corticosteroid timing and outcomes in septic shock. In the Deteriorated phenotype, delayed corticosteroid initiation was associated with lower 28-day mortality and shorter recovery, whereas the Improved phenotype showed no mortality advantage from delayed treatment. These findings support incorporating dynamic hemodynamic trajectories into future studies of corticosteroid timing in septic shock.
Study context
- Population
- Adult patients with septic shock receiving vasopressors, in three ICU cohorts
- Exposure
- Late (> 6 h) vs early (≤ 6 h) corticosteroids after sepsis onset, within each hemodynamic trajectory phenotype
- Deterioratedn = 2,082
- Improvedn = 3,361
- Outcome
- Hemodynamic phenotypes identified in MIMIC-IV
Methodological detailsderivation cohort (MIMIC-IV) and validation cohorts (eICU-CRD and PINES), dynamic time warping clustering of Blood Pressure-Vasopressor Index (BPRI) trajectories, inverse probability of treatment weighting with cause-specific Cox regression, random-effects meta-analysis with I2
- Derivation cohort (MIMIC-IV) and validation cohorts (eICU-CRD and PINES)
- Dynamic time warping clustering of Blood Pressure-Vasopressor Index (BPRI) trajectories
- Inverse probability of treatment weighting with cause-specific Cox regression
- Random-effects meta-analysis with I2
Main finding
As reported in the abstract
Deteriorated (MIMIC-IV)
N=2,082, 38%
Improved (MIMIC-IV)
N=3,361, 62%
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | |
|---|---|---|
| 28-day mortality, Deteriorated phenotype (MIMIC-IV) · 28 daysLate vs Early · lower 28-day mortality with late corticosteroids · not consistently replicated in validation cohorts | 0.88 (0.78–0.98) | |
| Ventilation duration, Deteriorated phenotype (MIMIC-IV)Late vs Early · shorter ventilation duration with late corticosteroids · association observed in PINES Deteriorated patients | 0.65 (0.58–0.73) | |
| 0.512Hazard ratio (log scale) |
Mortality and hospital length of stay, Improved phenotype
- Late steroids showed no consistent mortality or hospital length-of-stay association
Hemodynamic response (BPRI slope), Deteriorated phenotype
- More favorable BPRI slope for late versus early steroids
- Exploratory
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →