{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T12:34:12Z","timestamp":1793622852135,"version":"4.5.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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-h ASI trajectories predict 30-day mortality in septic shock patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study extracted data from the MIMIC-IV (derivation cohort, <jats:italic>n<\/jats:italic> = 2,559) and eICU-CRD (validation cohort, <jats:italic>n<\/jats:italic> = 2,177) databases. The latent category trajectory model (LCTM) classified ASI changes within 24 h 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>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%) (<jats:italic>P<\/jats:italic> &amp;lt; 0.001). After fully adjusting for covariates, Class 2 (HR = 1.68, 95% CI: 1.25\u20132.25, <jats:italic>P<\/jats:italic> = 0.001) and Class 3 (HR = 1.87, 95% CI: 1.26\u20132.77, <jats:italic>P<\/jats:italic> = 0.002) showed elevated mortality risks in the derivation cohort. Validation cohort results were consistent (Class 2: HR = 1.92, 95% CI: 1.38\u20132.68, <jats:italic>P<\/jats:italic> = 0.001) and (Class 3: HR = 1.66, 95% CI: 1.09\u20132.54, <jats:italic>P<\/jats:italic> = 0.019). Triple-robust analyses and subgroup analyses confirmed the reliability of the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dynamic 24-h 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1534706","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T05:34:11Z","timestamp":1746768851000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Influence of age-adjusted shock index trajectories on 30-day mortality for critical patients with septic shock"],"prefix":"10.3389","volume":"12","author":[{"given":"Suru","family":"Yue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefei","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingbai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shicai","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayuan","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3188","DOI":"10.3390\/jcm12093188","article-title":"2023 update on sepsis and septic shock in adult patients: management in the emergency department","volume":"12","author":"Guarino","year":"2023","journal-title":"J Clin Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1186\/s12879-022-07543-8","article-title":"Frequency and mortality of sepsis and septic shock in China: a systematic review and meta-analysis","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s13054-019-2478-6","article-title":"Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis","volume":"23","author":"Vincent","year":"2019","journal-title":"Crit Care."},{"key":"B5","doi-asserted-by":"publisher","first-page":"22129","DOI":"10.1038\/s41598-020-79142-z","article-title":"Dynamic survival prediction in intensive care units from heterogeneous time series without the need for variable selection or curation","volume":"10","author":"Deasy","year":"2020","journal-title":"Sci Rep."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1016\/j.ajem.2016.07.017","article-title":"Shock index, modified shock index, and age shock index for prediction of mortality in Emergency Severity Index level 3","volume":"34","author":"Torabi","year":"2016","journal-title":"Am J Emerg Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.ajem.2020.11.014","article-title":"Shock index is better than conventional vital signs for assessing higher level of care and mortality in severe sepsis or shock","volume":"46","author":"Gupta","year":"2021","journal-title":"Am J Emerg Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"101309","DOI":"10.1016\/j.cpcardiol.2022.101309","article-title":"Shock index, modified shock index, and age-adjusted shock index as predictors of in-hospital death in acute heart failure. 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