A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review
Despite medical advances, sepsis and septic shock remain some of the leading causes of mortality worldwide, with a high inter-individual variability in prognosis, clinical manifestations and response to treatment. Evidence suggests that pulmonary sepsis is one of the most severe forms of sepsis, whi...
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MDPI AG
2024-10-01
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| author | Alina Tita Sebastian Isac Teodora Isac Cristina Martac Geani-Danut Teodorescu Lavinia Jipa Cristian Cobilinschi Bogdan Pavel Maria Daniela Tanasescu Liliana Elena Mirea Gabriela Droc |
| author_facet | Alina Tita Sebastian Isac Teodora Isac Cristina Martac Geani-Danut Teodorescu Lavinia Jipa Cristian Cobilinschi Bogdan Pavel Maria Daniela Tanasescu Liliana Elena Mirea Gabriela Droc |
| author_sort | Alina Tita |
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| description | Despite medical advances, sepsis and septic shock remain some of the leading causes of mortality worldwide, with a high inter-individual variability in prognosis, clinical manifestations and response to treatment. Evidence suggests that pulmonary sepsis is one of the most severe forms of sepsis, while liver dysfunction, left ventricular dysfunction, and coagulopathy impact the prognostic. Sepsis-related hypothermia and a hypoinflammatory state are related to a poor outcome. Given the heterogeneity of sepsis and recent technological progress amongst machine learning analysis techniques, a new, personalized approach to sepsis is being intensively studied. Despite the difficulties when tailoring a targeted approach, with the use of artificial intelligence-based pattern recognition, more and more publications are becoming available, highlighting novel factors that may intervene in the high heterogenicity of sepsis. This has led to the devise of a phenotypical approach in sepsis, further dividing patients based on host and trigger-related factors, clinical manifestations and progression towards organ deficiencies, dynamic prognosis algorithms, and patient trajectory in the Intensive Care Unit (ICU). Host and trigger-related factors refer to patients’ comorbidities, body mass index, age, temperature, immune response, type of bacteria and infection site. The progression to organ deficiencies refers to the individual particularities of sepsis-related multi-organ failure. Finally, the patient’s trajectory in the ICU points out the need for a better understanding of interindividual responses to various supportive therapies. This review aims to identify the main sources of variability in clustering septic patients in various clinical phenotypes as a useful clinical tool for a precision-based approach in sepsis and septic shock. |
| format | Article |
| id | doaj-art-69854a403a1e4db18d3ec450fb05fca8 |
| institution | OA Journals |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-69854a403a1e4db18d3ec450fb05fca82025-08-20T01:54:02ZengMDPI AGMedicina1010-660X1648-91442024-10-016011174010.3390/medicina60111740A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature ReviewAlina Tita0Sebastian Isac1Teodora Isac2Cristina Martac3Geani-Danut Teodorescu4Lavinia Jipa5Cristian Cobilinschi6Bogdan Pavel7Maria Daniela Tanasescu8Liliana Elena Mirea9Gabriela Droc10Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, RomaniaDepartment of Internal Medicine II, Faculty of Medicine, Carol Davila University of Medicine and Pharmcy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care II, Faculty of Medicine, Carol Davila University of Medicine and Pharmcy, 020021 Bucharest, RomaniaDepartment of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmcy, 020021 Bucharest, RomaniaDepartment of Medical Semiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmcy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care II, Faculty of Medicine, Carol Davila University of Medicine and Pharmcy, 020021 Bucharest, RomaniaDepartment of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, RomaniaDespite medical advances, sepsis and septic shock remain some of the leading causes of mortality worldwide, with a high inter-individual variability in prognosis, clinical manifestations and response to treatment. Evidence suggests that pulmonary sepsis is one of the most severe forms of sepsis, while liver dysfunction, left ventricular dysfunction, and coagulopathy impact the prognostic. Sepsis-related hypothermia and a hypoinflammatory state are related to a poor outcome. Given the heterogeneity of sepsis and recent technological progress amongst machine learning analysis techniques, a new, personalized approach to sepsis is being intensively studied. Despite the difficulties when tailoring a targeted approach, with the use of artificial intelligence-based pattern recognition, more and more publications are becoming available, highlighting novel factors that may intervene in the high heterogenicity of sepsis. This has led to the devise of a phenotypical approach in sepsis, further dividing patients based on host and trigger-related factors, clinical manifestations and progression towards organ deficiencies, dynamic prognosis algorithms, and patient trajectory in the Intensive Care Unit (ICU). Host and trigger-related factors refer to patients’ comorbidities, body mass index, age, temperature, immune response, type of bacteria and infection site. The progression to organ deficiencies refers to the individual particularities of sepsis-related multi-organ failure. Finally, the patient’s trajectory in the ICU points out the need for a better understanding of interindividual responses to various supportive therapies. This review aims to identify the main sources of variability in clustering septic patients in various clinical phenotypes as a useful clinical tool for a precision-based approach in sepsis and septic shock.https://www.mdpi.com/1648-9144/60/11/1740sepsisseptic shockomicsphenotypeprecision medicinemulti-organ dysfunction |
| spellingShingle | Alina Tita Sebastian Isac Teodora Isac Cristina Martac Geani-Danut Teodorescu Lavinia Jipa Cristian Cobilinschi Bogdan Pavel Maria Daniela Tanasescu Liliana Elena Mirea Gabriela Droc A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review Medicina sepsis septic shock omics phenotype precision medicine multi-organ dysfunction |
| title | A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review |
| title_full | A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review |
| title_fullStr | A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review |
| title_full_unstemmed | A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review |
| title_short | A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review |
| title_sort | multivariate phenotypical approach of sepsis and septic shock a comprehensive narrative literature review |
| topic | sepsis septic shock omics phenotype precision medicine multi-organ dysfunction |
| url | https://www.mdpi.com/1648-9144/60/11/1740 |
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