Sepsis is not a monolithic disease, but a loose collection of symptoms with diverse outcomes. Thus, stratification and subtyping of sepsis patients is of great importance. We examine the temporal evolution of patient state using our previously-published method for computing risk of transition from sepsis into septic shock. Risk trajectories diverge into four clusters following early prediction of septic shock, stratifying by outcome: the highest-risk and lowest-risk groups have a 76.5% and 10.4% prevalence of septic shock, and 43% and 18% mortality, respectively. These clusters differ also in treatments received and median time to shock onset. Analyses reveal the existence of a rapid (30–60 min) transition in risk at the time of threshold crossing. We hypothesize that this transition occurs as a result of the failure of compensatory biological systems to cope with infection, resulting in a bifurcation of low to high risk. Such a collapse, we believe, represents the true onset of septic shock. Thus, this rapid elevation in risk represents a potential new data-driven definition of septic shock.

中文翻译：

---

风险评分轨迹的谱聚类按临床结果和接受的干预对脓毒症患者进行分层

脓毒症不是一种单一的疾病，而是一系列具有不同结果的松散症状。因此，脓毒症患者的分层和亚型非常重要。我们使用我们之前发布的计算从败血症转变为败血症休克风险的方法来检查患者状态的时间演变。根据感染性休克的早期预测，风险轨迹分为四个集群，按结果分层：最高风险和最低风险组的感染性休克患病率分别为 76.5% 和 10.4%，死亡率分别为 43% 和 18%。这些集群在接受的治疗和休克发作的中位时间方面也有所不同。分析表明，在跨越阈值时存在风险的快速（30-60 分钟）转变。我们假设这种转变的发生是由于补偿性生物系统无法应对感染，导致低风险到高风险的分叉。我们认为，这种崩溃代表了感染性休克的真正发作。因此，这种风险的快速升高代表了感染性休克的潜在新数据驱动定义。