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


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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.HighlightsLatent class analysis (LCA) can be used to identify subphenotypes within a complex phenomenon like septic shockLCA identified six distinctive subphenotypes of septic shock with a high degree of separationEach subphenotype has its specific, clinically relevant, characteristics

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