• Sabri Soussi, Divya Sharma, Peter Jüni, Gerald Lebovic, Laurent Brochard, John C Marshall, Patrick R Lawler, Margaret Herridge, Niall Ferguson, Lorenzo Del Sorbo, Elodie Feliot, Alexandre Mebazaa, Erica Acton, Jason N Kennedy, Wei Xu, Etienne Gayat, Claudia C Dos Santos, FROG-ICU, and CCCTBG trans-trial group study for InFACT - the International Forum for Acute Care Trialists.
• Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada. sabri.soussi@uhn.ca.
• Crit Care. 2022 Apr 21; 26 (1): 114.

BackgroundLate mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis.MethodsIn the original FROG-ICU prospective, observational, multicenter study, intensive care unit (ICU) patients with sepsis on admission (Sepsis-3) were identified (N = 655). Among them, 467 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct sepsis-survivors clinical classes using readily available data at ICU discharge. The primary endpoint was one-year mortality after ICU discharge.ResultsAt ICU discharge, two distinct subtypes were identified (A and B) using 15 readily available clinical and biological variables. Patients assigned to subtype B (48% of the studied population) had more impaired cardiovascular and kidney functions, hematological disorders and inflammation at ICU discharge than subtype A. Sepsis-survivors in subtype B had significantly higher one-year mortality compared to subtype A (respectively, 34% vs 16%, p < 0.001). When adjusted for standard long-term risk factors (e.g., age, comorbidities, severity of illness, renal function and duration of ICU stay), subtype B was independently associated with increased one-year mortality (adjusted hazard ratio (HR) = 1.74 (95% CI 1.16-2.60); p = 0.006).ConclusionsA subtype with sustained organ failure and inflammation at ICU discharge can be identified from routine clinical and laboratory data and is independently associated with poor long-term outcome in sepsis-survivors. Trial registration NCT01367093; https://clinicaltrials.gov/ct2/show/NCT01367093 .© 2022. The Author(s).

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