Unsupervised Clustering Analysis Based on MODS Severity Identifies Four Distinct Organ Dysfunction Patterns in Severely Injured Blunt Trauma Patients

Frontiers in Medicine

article

Dongmei Liu¹  Rami A. Namas³  Yoram Vodovotz²  Andrew B. Peitzman²  Richard L. Simmons²  Hong Yuan¹  Qi Mi⁴  Timothy R. Billiar² 

[1] Department of Cardiology, Third Xiangya Hospital of Central South University;Department of Surgery, University of Pittsburgh, United States;Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, United States;Department of Sports Medicine and Nutrition, University of Pittsburgh, United States

关键词: multiple organ dysfunction;    intensive care unit;    blunt trauma;    biomarkers;    fuzzy C-means clustering;    dynamic network analysis;   

DOI  :  10.3389/fmed.2020.00046

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Purpose: We sought to identify a MODS score parameter that highly correlates with adverse outcomes and then use this parameter to test the hypothesis that multiple severity-based MODS clusters could be identified after blunt trauma. Methods: MOD score across days (D) 2–5 was subjected to Fuzzy C-means Clustering Analysis (FCM) followed by eight Clustering Validity Indices (CVI) to derive organ dysfunction patterns among 376 blunt trauma patients admitted to the intensive care unit (ICU) who survived to discharge. Thirty-one inflammation biomarkers were assayed (Luminex™) in serial blood samples (3 samples within the first 24 h and then daily up to D 5) and were analyzed using Two-Way ANOVA and Dynamic Network analysis (DyNA). Results: The FCM followed by CVI suggested four distinct clusters based on MOD score magnitude between D2 and D5. Distinct patterns of organ dysfunction emerged in each of the four clusters and exhibited statistically significant differences with regards to in-hospital outcomes. Interleukin (IL)-6, MCP-1, IL-10, IL-8, IP-10, sST2, and MIG were elevated differentially over time across the four clusters. DyNA identified remarkable differences in inflammatory network interconnectivity. Conclusion: These results suggest the existence of four distinct organ failure patterns based on MOD score magnitude in blunt trauma patients admitted to the ICU who survive to discharge.

【 授权许可】

CC BY