{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:04:52Z","timestamp":1789538692743,"version":"build-2803163510"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"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 is a highly heterogeneous syndrome. Providing personalized treatment for the various clinical phenotypes of sepsis has been a major challenge for critical care physicians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was a secondary analysis of data derived from a multicenter, prospective, observational study of sepsis patients. Based on relevance to sepsis onset or outcome, 25 parameters were selected by the derived cohort to derive sepsis phenotypes. Clustered phenotypes were derived via k-means clustering and examined in a sensitivity analysis using divisive hierarchical clustering. Then, the relationship between fluid resuscitation therapy and survival outcomes was assessed for each clustered phenotype using generalized estimating equations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with sepsis were categorized into Cluster A, B and C. Kaplan\u2013Meier analysis showed Cluster A patients had the highest 28-day mortality (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.029 by Log-rank test). In Cluster A, septic patients who received fluid resuscitation had a association than those who did not, with an adjusted RD for 28-day mortality of 16.2% (95% CI, 1.4 to 31.0%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.032). Sensitivity analyses adjusted for APACHE II and infection site confirmed these findings, with an adjusted RD for 28-day mortality of 6.3% (95% CI, 0.3 to 12.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.040). Hierarchical clustering methods yielded consistent conclusions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The association between fluid resuscitation and clinical outcomes varied across sepsis phenotypes, suggesting potential heterogeneity in treatment response that requires further prospective validation.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial registration:<\/jats:bold>\n                      The primary study was registered in the China Clinical Registry on February 1, 2022, with the registration number ChiCTR2200056179.\n                    <\/jats:p>\n                  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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhuSheng","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]},{"name":"Department of Biostatistics, Anhui Provincial Cancer Institute, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoChun","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Information Center, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Big Data and Population Health of IHM, Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nian","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First 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