ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1534706
This article is part of the Research TopicInfections in the Intensive Care Unit - Volume IIIView all 10 articles
Influence of age-adjusted shock index trajectories on 30-day mortality for critical patients with septic shock
Provisionally accepted
- Affiliated Hospital of Guangdong Medical College Hospital, Zhanjiang, Guangdong Province, China
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Background: Septic shock poses a high mortality risk in critically ill patients, necessitating precise hemodynamic monitoring. While the age-adjusted shock index (ASI) reflects hemodynamic stability, the prognostic value of its dynamic trajectory remains unexplored. This study evaluates whether dynamic 24-hour ASI trajectories predict 30-day mortality in septic shock patients.Methods: This retrospective cohort study extracted data from the MIMIC-Ⅳ (derivation cohort, n = 2559) and eICU-CRD (validation cohort, n = 2177) databases. The latent category trajectory model (LCTM) classified ASI changes within 24 hours of intensive care unit (ICU) admission. The association between ASI trajectory categories and 30-day mortality was evaluated using Kaplan-Meier (KM) method and Cox proportional-hazard models, reported as hazard ratios (HRs) and 95% confidence intervals (CIs).Result: Three distinct ASI trajectories were explored: persistently low (Classes 1), initial high ASI sharply decreasing followed by instability (Classes 2), and steady ASI increase (Classes 3). KM curve revealed significantly higher 30-day mortality in Class 2 (32.1%) and Class 3 (38.7%) than Class 1 (12.3%) (P < 0.001). After fully adjusting for covariates, Class 2 (HR = 1.68, 95% CI: 1.25–2.25, P = 0.001) and Class 3 (HR = 1.87, 95% CI: 1.26–2.77, P = 0.002) showed elevated mortality risks in the derivation cohort. Validation cohort results were consistent (Class 2: HR = 1.92, 95% CI: 1.38–2.68, P = 0.001) and (Class 3: HR = 1.66, 95% CI: 1.09–2.54, P = 0.019). Triple-robust analyses and subgroup analyses confirmed the reliability of the results. Conclusion: Dynamic 24-hour ASI trajectories independently predict 30-day mortality in patients with septic shock, with unstable or rising patterns signaling high-risk subgroups. This underscores the clinical utility of real-time ASI monitoring for early risk stratification and tailored intervention.
Keywords: septic shock, age-adjusted shock index, latent category trajectory model, Critical care patients, mortality risk
Received: 26 Nov 2024; Accepted: 22 Apr 2025.
Copyright: © 2025 Yue, Hou, Wang, Xu, Li, Wang, Ye and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiayuan Wu, Affiliated Hospital of Guangdong Medical College Hospital, Zhanjiang, Guangdong Province, China
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