ORIGINAL RESEARCH article
Front. Public Health
Sec. Disaster and Emergency Medicine
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1610220
Lactate trajectories and outcomes in patients with sepsis in the intensive care unit: Group-based trajectory modeling
Provisionally accepted
- 1Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
- 2Emergency Department of Yangzhou University Affiliated Hospital, China 225000, China, Yangzhou, China
- 3Emergency Intensive Care Unit (EICU), The Affiliated Hospital of Yangzhou University, 225000, China, yangzhou, China
- 4School of Nursing and School of Public Health, Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
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Background: Sepsis is highly heterogeneous. Therefore, identifying biomarkers that can stratify patients with sepsis into more homogeneous cohorts to develop individualized treatment and care measures for patients and carry out early intervention to reduce the risk of death and improve the prognosis of patients has become a current research hotspot.Methods: Using the MIMIC-IV database, we analyzed data from 1575 adult patients with sepsis.Serum lactate levels were measured once daily for five consecutive days after admission. The GBTM model was used to stratify the risk of sepsis and explore the relationships between different lactate trajectories and 28-day mortality in septic patients.Results: We report a new method for identifying subphenotypes of sepsis patients on the basis of lactate trajectories. Through group-based trajectory modeling, we identified and validated five groups of sepsis patients with different lactate trajectories, namely, "Low-stable group", "low-slowly declining group", "high-rapidly decline group", "Moderate-slow declining group", and "high-slow decline group".The relationships between sepsis patients with different lactate trajectories and 28-day mortality were explored. Among them, patients with a "Low-stable group" had the lowest in-hospital 28-day mortality.Patients with a "high-slow decline group" had the the highest 28-day mortality.Conclusions: In this study, different subtypes of sepsis were successfully identified by analyzing lactate trajectories. Combined with the dynamic changes in lactate levels, the GBTM model was used to stratify patients according to their risk of sepsis. This model provides a theoretical basis for clinicians to evaluate the prognosis of patients using the lactate change trajectory.
Keywords: Sepsis, Lactate, Group-based trajectory modeling, survival analysis, Subphenotype
Received: 11 Apr 2025; Accepted: 30 May 2025.
Copyright: © 2025 Wei, Zhuang, Wang, Wang, Zhang, Li and Leng. 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: Junling Leng, Emergency Department of Yangzhou University Affiliated Hospital, China 225000, China, Yangzhou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.