{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:50:19Z","timestamp":1791521419883,"version":"4.3.4"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis-associated liver injury (SALI) is a serious clinical syndrome with heterogeneity in outcome among affected individuals. Physiological changes that are critical to outcome prediction are not considered in the existing system of stratification based on single-point observations. This could compromise the effectiveness of individualized treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and validate dynamic clinical subphenotypes of SALI using early vital sign trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 1,159 patients from MIMIC-IV as the derivation cohort and 168 patients from the Second Xiangya Hospital as the external validation cohort. Early vital sign trajectories within 12\u2005h of ICU admission were summarized as trajectory-derived features and clustered using K-means. Candidate solutions (k\u2009=\u20092\u20136) were assessed using internal clustering metrics and bootstrap stability. A four-cluster solution was retained as an exploratory partition, considering trajectory interpretability and subgroup sizes. Clinical characteristics, organ support, and mortality outcomes were compared across the identified subphenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four exploratory SALI subphenotypes with distinct early vital sign trajectories were identified, ranging from relatively stable profiles to marked hemodynamic and physiological stress. Subphenotype 3 exhibited the most stable vital signs and was associated with lower adjusted 28-day (HR 0.74, 95% CI 0.56\u20130.97) and 90-day mortality (HR 0.76, 95% CI 0.59\u20130.97) compared with the highest-risk Subphenotype 4. These prognostic differences were consistently replicated in the external cohort, supporting short- to intermediate-term prognostic generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early vital sign trajectories identified exploratory SALI groups associated with differences in 28-day and 90-day mortality. Their reproducibility, incremental prognostic value, and clinical utility require further evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1835574","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:25:46Z","timestamp":1791519946000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Identification and validation of early vital sign trajectory subphenotypes for risk stratification in sepsis-associated liver injury: a multicenter retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Weihang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Affiliated Hospital of Nantong University, Nantong University","place":["NanTong, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zexi","family":"Zang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island","place":["Providence, RI, United 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