Work

Hemodynamic subphenotypes in septic shock and their different responses to fluid balance in relation to ICU mortality

Year: 2025

Type: article

Abstract: BACKGROUND: Hemodynamically unstable septic patients often require aggressive fluid resuscitation, but limited evidence exists on which hemodynamic subphenotypes benefit most. METHODS: The retrospective cohort study conducted in a tertiary hospital of China. Patients with septic shock who underwent pulse index continuous cardiac output (PiCCO) monitoring within 24 h were included from November 2013 to January 2024. We applied latent profile modelling to identify subphenotypes using all hemodynamic parameters monitored via PiCCO. We then tested the association of 48-h fluid balance with ICU mortality in different subphenotypes using logistic regression. RESULT: A total of 691 patients were included. Latent profile models indicated that a four-profile model was the best fit. Hyperdynamic subphenotype (phenotype1) was characterized by highest cardiac output and lowest systemic vascular resistance index (SVRI); high preload subphenotype (phenotype 2) was characterized by highest preload; hypodynamic subphenotype (phenotype 3) was characterised by lowest cardiac output, highest SVRI, lung function, as well as inotropic score; preserved subphenotype (phenotype 4) was presented with relative normal hemodynamic parameters. No significant difference was observed in 24- and 48-hour fluid balance among subphenotypes, and overall, no significant correlation was found between 48-hour fluid balance and ICU mortality. However, a significant interaction existed between 48-hour fluid balance and phenotype 4; in this group, higher fluid balance at 48 h was associated with increased ICU mortality (OR 1.24, 95% CI 1.05 to 1.46; p = 0.011). CONCLUSION: Four hemodynamic subphenotypes in septic shock was identified. The impact of 48-hour fluid balance on ICU mortality varied by subphenotype, with increased mortality observed only in the preserved hemodynamic group.

Source: BMC Anesthesiology

DOI: 10.1186/s12871-025-03495-z