TY - JOUR TI - Spectral clustering of risk score trajectories stratifies sepsis patients by clinical outcome and interventions received AU - Liu, Ran AU - Greenstein, Joseph L AU - Fackler, James C AU - Bembea, Melania M AU - Winslow, Raimond L A2 - Molnár, Zsolt A2 - Franco, Eduardo A2 - Szakmany, Tamas VL - 9 PY - 2020 DA - 2020/09/22 SP - e58142 C1 - eLife 2020;9:e58142 DO - 10.7554/eLife.58142 UR - https://doi.org/10.7554/eLife.58142 AB - 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. KW - sepsis KW - septic shock KW - stratification JF - eLife SN - 2050-084X PB - eLife Sciences Publications, Ltd ER -