Identification of new subtypes of sepsis by cortisol level trajectory analysis

Objective To explore the identification of new subtypes of sepsis by longitudinal plasma cortisol level trajectories.

Methods 96 adult patients with sepsis who were hospitalized in the department of critical care medicine of Zhongshan Hospital, Fudan University from March 2019 to August 2021 were retrospectively selected. The blood of the patients was collected at 8:00 a.m. on the first, second and third day and 4:00 p.m. on the first and second day after enrollment, and the cortisol concentration change trajectory was analyzed. The patients were divided into groups according to the potential categories of cortisol level trajectories, and the basic conditions, disease severity, laboratory tests and clinical outcomes (hospitalization time, mortality, etc.) of different groups were compared.

Results Among the 96 patients with sepsis, the majority were male (68.8%), with a median age of 68 years. Among the primary deseases inducing sepsis, abdominal infection was main (83.3%), while most of the complications were tumors (61.5%), especially intestinal tumors. According to the analysis result of cortisol level trajectories, the patients were divided into two groups: the cortisol level gradually decreased from a higher concentration (falling group, n=33) and the group with normal range and relatively stable fluctuation (stable group, n=63). The patients in the falling group were more serious when they were enrolled. The sequential organ failure assessment (SOFA) score (8 6, 11 vs 6 4, 8) and APACHE Ⅱ score (20 15, 23 vs 15 11, 18) were higher than those in the stable group (P < 0.01). The mortality rate at 28 day (42.4% vs 17.4%) and at 90 day (45.5% vs22.2%) in the falling group were significantly higher than those in the stable group (P < 0.05).

Conclusion According to plasma cortisol level trajectory, a new subtype of sepsis can be established, in further to assist diagnosis and treatment.