# Predictive Model of Dynamic Subphenotypes for 30-Day Mortality in Emergency Department Patients with Suspected Infection Using the Vital Signs of the First 24 Hours: An Analytical Cohort Study in a Tertiary Care Clinic

## TL;DR

This study identifies four subgroups of emergency patients with suspected infection based on vital signs and finds that those with more altered signs have higher mortality.

## Contribution

A novel cluster trajectory model using early vital signs to predict 30-day mortality in emergency patients with suspected infection.

## Key findings

- Patients in group A (all vital signs altered) had the highest mortality rate (8.33-fold increased risk).
- Group A patients were more likely to have pneumonia, CNS infections, and require mechanical ventilation.
- Early interventions for group A patients could reduce mortality in emergency departments.

## Abstract

Background/Objectives: To determine and validate the cluster trajectory model by dynamic subphenotypes of vital signs in infecti ons and prediction of 30-day mortality. Methods: We conducted a prospective study in the emergency department of Clínica Colombia with patients with suspected infection. Clinical data, vital signs, and 30-day mortality were collected. Vital signs were measured within the first 24 h of admission, and patients were classified according to a vital signs trajectory model into four groups: A, B, C, and D. Results: The final cohort consisted of 625 patients, and the subphenotypes, according to the vital signs, were as follows: A—2.66% (all vital signs altered), B—9.2% (at least one alteration, predominantly hypertension), C—19% (minimal or no alteration, control), D—69.2% (only arterial hypotension). The primary outcome was mortality. Overall mortality was 8.6%, being higher in group A followed by D, B and C (p = 0.009). The risk increased progressively in groups B (OR = 2.87, CI 95%: 0.62–13.25), D (OR = 4.77, CI 95%: 1.46–15.58), and A (OR = 8.33, CI 95%: 1.54–45.05). Group A presented more frequently with pneumonia (p = 0.002), CNS infections (p = 0.021), mechanical ventilation (p < 0.001), and vasopressor support (p < 0.001). Significant differences among groups were found in leukocytosis (B vs. C p = 0.026), neutrophilia (B vs. C p = 0.001 and B vs. D p = 0.042), lymphocytosis (B vs. D p = 0.002), neutrophil/lymphocyte ratio (A vs. C p = 0. 010), lactate (C vs. D p = 0.044), anemia (B vs. D p = 0.013 and C vs. D p = 0.001), and CRP (A vs. C p = 0.004, B vs. C p < 0.001 and C vs. D p < 0.001). Conclusions: Patients with suspected infection and more altered vital signs have higher mortality (group A) and benefit from earlier interventions by sepsis teams in the emergency department.