In the Literature

Summary of "Identifying septic shock subgroups to tailor fluid strategies through multi-omics integration"

Summary published April 6, 2026

Summary by John "J.W." Beard, MD

Nature Communications | October 2024

Zhang Z, Chen L, Sun B, Ruan Z, Pan P, Zhang W, Jiang X, Zheng S, Cheng S, Xian L, Wang B, Yang J, Zhang B, Xu P, Zhong Z, Cheng L, Ni H; Chinese Multi-omics Advances In Sepsis (CMAISE) Consortium; Hong Y. Identifying septic shock subgroups to tailor fluid strategies through multi-omics integration. Nat Commun. 2024 Oct 19;15(1):9028. doi: 10.1038/s41467-024-53239-9. PMID: 39424794; PMCID: PMC11489719.

doi: https://doi.org/10.1038/s41467-024-53239-9

  • Patients have variable responses to different resuscitation strategies for septic shock. For example, while aggressive fluid administration is a mainstay of treatment for septic shock, in some patients this may lead to unwanted side-effects including dilutional coagulopathy, volume overload, and tissue edema.
  • Recent advances in the fields of genomics, transcriptomics, proteomics, metabolomics, etc. (collectively referred to as “multi-omics”) have begun to provide valuable insights into how and why different patients respond to a particular therapy.
  • The authors of this multicenter, observational cohort study used a multi-omics approach to identify septic shock subgroups with differential responses to restrictive versus liberal fluid strategies.
  • The investigators integrated transcriptomic data from 494 patients (from 35 hospitals) with septic shock to develop a “benefit score” to predict which patients would benefit from a restrictive fluid strategy with less fluid and earlier vasopressors.
  • The study found that adherence to the recommended fluid strategy based on the benefit score was associated with improved survival (hazard ratio 0.82, 95% CI 0.64–0.92), and possible reduction of in-hospital mortality from 16% to 13%. The model predicted benefit from a restrictive strategy with an AUC of 0.80 (95% CI 0.75–0.85).
  • Due to the technical challenges of measuring RNA levels, the authors also developed a six-protein plasma signature to facilitate clinical application.
  • The findings suggest that a subset of septic patients may benefit from a restrictive fluid approach, and that a rapid protein-based test could help identify these individuals.
  • For anesthesia professionals, these results emphasize the opportunity for personalized therapy when managing fluids in septic shock. Implementation of such strategies could improve outcomes and reduce complications associated with fluid overload or under-resuscitation.
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