(1624) Clinical Phenotype and Outcomes of Dynamic Trajectory of Diastolic Arterial Pressure in Septic Shock

Introduction: Hemodynamic resuscitation in septic shock is a dynamic process with a high degree of heterogeneity. Diastolic arterial pressure (DAP), a marker of response to the vascular tone, is involved in this process. This study aimed to identify the clinical phenotype of septic shock using early DAP dynamic trajectories to determine the value of DAP in managing septic shock.

Methods: In this retrospective study, we phenotypically derived the dynamic trajectories of DAP in patients with septic shock during the first 72 h after intensive care unit (ICU) admission using the K-means unsupervised clustering algorithm. Subsequently, we validated them in internal versus external datasets. Data from the five electronic medical record datasets used in this study covered geographically diverse populations (the US, Europe, and China). The primary outcome indicator was 28-day mortality. Secondary outcome indicators included the length of ICU stay, ICU mortality, 7-day mortality, 90-day mortality, and 1-year mortality. In addition, we explored the heterogeneity in organ injury, infection site, and responsiveness to vasopressors between phenotypes.

Results: A total of 15,991 patients with septic shock were included in this study. Among the training set of 3,244 septic shock patients, we identified three clinical phenotypes with different characteristics based on the DAP dynamic trajectory, named phenotypes α, β, and γ. We found that patients with phenotype β were the oldest, had more underlying disease, were the least responsive to vasoactive drug therapy, required the highest dose, and were the sickest. Patients with phenotype γ tended to be younger, had the least positive fluid balance, had the lowest kidney injury, lower incidence of renal injury and were more responsive to vasoactive drug therapy. Phenotype β had the worst short- and long-term prognosis, while phenotype γ had the best prognosis, and phenotype α had a clinical prognosis between phenotypes β and γ. Similar clinical outcomes were obtained in the other validation sets.

Conclusions: Patients with septic shock were classified into three phenotypes with different characteristics and clinical outcomes, based on the dynamic trajectory of DAP during the first 72 h after ICU admission. Focusing on early DAP trends facilitates the management of septic shock.