Clustering ICU patients with sepsis based on the patterns of their circulating biomarkers: A secondary analysis of the CAPTAIN prospective multicenter cohort study.
[en] ("[en] BACKGROUND: Although sepsis is a life-threatening condition, its heterogeneous presentation likely explains the negative results of most trials on adjunctive therapy. This study in patients with sepsis aimed to identify subgroups with similar immune profiles and their clinical and outcome correlates.
METHODS: A secondary analysis used data of a prospective multicenter cohort that included patients with early assessment of sepsis. They were described using Predisposition, Insult, Response, Organ failure sepsis (PIRO) staging system. Thirty-eight circulating biomarkers (27 proteins, 11 mRNAs) were assessed at sepsis diagnosis, and their patterns were determined through principal component analysis (PCA). Hierarchical clustering was used to group the patients and k-means algorithm was applied to assess the internal validity of the clusters.
RESULTS: Two hundred and three patients were assessed, of median age 64.5 [52.0-77.0] years and SAPS2 score 55 [49-61] points. Five main patterns of biomarkers and six clusters of patients (including 42%, 21%, 17%, 9%, 5% and 5% of the patients) were evidenced. Clusters were distinguished according to the certainty of the causal infection, inflammation, use of organ support, pro- and anti-inflammatory activity, and adaptive profile markers.
CONCLUSIONS: In this cohort of patients with suspected sepsis, we individualized clusters which may be described with criteria used to stage sepsis. As these clusters are based on the patterns of circulating biomarkers, whether they might help to predict treatment responsiveness should be addressed in further studies.
TRIAL REGISTRATION: The CAPTAIN study was registered on clinicaltrials.gov on June 22, 2011, # NCT01378169.","[en] ","")
Disciplines :
Anesthesia & intensive care
Author, co-author :
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Philippart, François ; Service de Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France ; Unité Endotoxines, Structures et Réponse de l'Hôte, Département de Microbiologie, Institut de Biologie Intégrative de la Cellule, Paris Saclay, Saclay, France
Fitting, Catherine; Unit Cytokines & Inflammation, Institut Pasteur, Paris, France
Bedos, Jean-Pierre; Service de Réanimation, Hôpital André Mignot, Versailles, France
Diehl, Jean-Luc; Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France ; INSERM UMR S1140, Université Paris Descartes, Paris Sorbonne Cité, Paris, France
Hamzaoui, Olfa; Service de Réanimation, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
Annane, Djillali ; Service de Réanimation, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France ; Université Versailles Saint-Quentin, Versailles, France
Journois, Didier; Service de Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
Parlato, Marianna; Unit Cytokines & Inflammation, Institut Pasteur, Paris, France
Moucadel, Virginie; BioMérieux SA, Lyon, France
Cavaillon, Jean-Marc; Unit Cytokines & Inflammation, Institut Pasteur, Paris, France
Coste, Joël; Unité de Biostatistiques et d'Epidémiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France ; Université de Paris, Paris, France
Clustering ICU patients with sepsis based on the patterns of their circulating biomarkers: A secondary analysis of the CAPTAIN prospective multicenter cohort study.
Grant from the Programme Hospitalier de Recherche Clinique of the French Ministry of Health (PHRC AOM 09143) and from the Institut Mérieux-Institut Pasteur collaborative research partnership. The study was sponsored by the Département de la Recherche Clinique et du Développement de l’Assistance Publique-Hôpitaux de Paris. This project was part of Advanced Diagnostics for New Therapeutic Approaches, a program dedicated to personalized medicine, coordinated by Mérieux Alliance and supported by the French public agency, OSEO. These funding sources had no role in the design of this study, analyses, interpretation of the data, or decision to submit the results.
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