Six subphenotypes in septic shock: Latent class analysis of the PROWESS Shock study

J Crit Care. 2018 Oct:47:70-79. doi: 10.1016/j.jcrc.2018.06.012. Epub 2018 Jun 8.

Abstract

Purpose: Septic shock is a highly heterogeneous condition which is part of the challenge in its diagnosis and treatment. In this study we aim to identify clinically relevant subphenotypes of septic shock using a novel statistic al approach.

Methods: Baseline patient data from a large global clinical trial of septic shock (n = 1696) was analysed using latent class analysis (LCA). This approach allowed investigators to identify subgroups in a heterogeneous population by estimating a categorical latent variable that detects relatively homogeneous subgroups within a complex phenomenon.

Results: LCA identified six different, clinically meaningful subphenotypes of septic shock each with a typical profile: (1) "Uncomplicated Septic Shock, (2) "Pneumonia with adult respiratory distress syndrome (ARDS)", (3) "Postoperative Abdominal", (4) "Severe Septic Shock", (5): "Pneumonia with ARDS and multiple organ dysfunction syndrome (MODS)", (6) "Late Septic Shock". The 6-class solution showed high entropy approaching 1 (i.e., 0.92), indicating there was excellent separation between estimated classes.

Conclusions: LCA appears to be an applicable statistical tool in analysing a heterogenous clinical cohort of septic shock. The results may lead to a better understanding of septic shock complexity and form a basis for considering targeted therapies and selecting patients for future clinical trials.

Keywords: Critical illness; Intensive care; Latent class analysis; Sepsis; Septic shock; Subphenotypes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Data Interpretation, Statistical
  • Female
  • Hemodynamics
  • Humans
  • Kaplan-Meier Estimate
  • Latent Class Analysis*
  • Male
  • Middle Aged
  • Multiple Organ Failure / classification
  • Multiple Organ Failure / diagnosis*
  • Multiple Organ Failure / therapy
  • Phenotype
  • Pneumonia / classification
  • Pneumonia / diagnosis*
  • Pneumonia / therapy
  • Respiratory Distress Syndrome / classification
  • Respiratory Distress Syndrome / diagnosis*
  • Respiratory Distress Syndrome / therapy
  • Sepsis / therapy
  • Shock, Septic / classification
  • Shock, Septic / diagnosis*
  • Shock, Septic / therapy