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2026, Number 1

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Med Crit 2026; 40 (1)

Prediction of sepsis phenotypes obtained through unsupervised machine learning in patient records in internal medicine and intensive care

Cárdenas CHE, Ramírez HJP, Mandujano SIJ, Merlos RJI, Sosa MMÁ

Language: Spanish
References: 42
Page: 14-24
PDF size: 690.63 Kb.


ABSTRACT

Introduction: sepsis is a complex disorder, understood as a syndrome rather than a disease, which has presented a challenge from the very moment of its definition. Therefore, clinical trials addressing its diagnosis, prognosis, and especially its treatment have been extremely challenging and have often resulted in failures, despite having a robust theoretical foundation. Thus, it is evident that the definition of sepsis is very common and broad, applicable to a heterogeneous group of patients who do not necessarily have the same disorder. Objective: to describe the prognosis of different sepsis phenotypes using unsupervised machine learning and clinical and biochemical variables obtained during the first 12 hours of hospitalization from the medical records of patients admitted to the Internal Medicine and Intensive Care units of the "Dr. Manuel Gea González" Hospital, during the period from January 1, 2022, to December 31, 2023. Material and methods: this was an observational, analytical, retrospective, cross-sectional, and retrospective study of 387 patient records of individuals admitted to the hospital with sepsis, according to the SEPSIS-3 consensus. Clinical and biochemical variables at admission were analyzed using unsupervised machine learning to distinguish different sepsis phenotypes. Results: of the 389 records included, 188 were categorized as cluster 1 and 201 as cluster 2, with a robustness of 0.0696 according to the silhouette index and 0.1002459 according to Dunn's index. Acute kidney injury was documented in 77% (n = 144) of patients in cluster 1 and in 55% (n = 111) in cluster 2 (χ² = 19.649, p = 0.0004998). Renal replacement therapy was recorded in 20% (n = 37) of cases in cluster 1 and in 4% (n = 8) in cluster 2 (χ² = 23.408, p = 0.0004998). Conclusion: in the medical records of patients diagnosed with sepsis, the analysis of clinical and biochemical variables available during the first 12 hours results in a new sepsis categorization with prognostic utility regarding kidney injury and the need for renal replacement therapy.


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