High cardiac and respiratory drive state at an early stage increases the all-cause mortality of ICU sepsis patients, based on the MIMIC-IV database

Background: High cardiac and respiratory drive are significant manifestations of uncontrolled, unregulated response, potentially leading to vital organ injury and dysfunction during the early stages of sepsis. Objectives: We aim to evaluate the relationship between the early stage of high cardiac and respiratory drive state and the prognosis of the intensive care unit (ICU) sepsis patients. Methods: This retrospective cohort study utilized data from the publicly accessible Medical Information Mart for Intensive Care IV database. ICU patients who met sepsis 3.0 criteria were included in the analysis. Patients were categorized into four groups based on their heart rate and PaCO 2 levels within the first 24 hours: “normal drive,” “respiratory high drive,” “cardiac high drive,” and “dual high drive.” The primary outcome is the short-term survival rate in 30 and 90 days. Other outcomes include the length of hospitalization and ICU stay and the duration of mechanical ventilation and vasoactive drug use. Results: Patients with the “dual high drive” phenotype exhibited the lowest short-term survival rates (74.2% of 30-day survival and 67.9% of 90-day survival). In contrast, patients in the “normal drive” group demonstrated a higher survival rate (86.4% of 30-day survival and 81.3% of 90-day survival). Kaplan–Meier curves showed a significant difference in the 30- and 90-day survival among these groups. Additionally, the “dual high drive” group had significantly longer hospital stays, ICU stays, durations of mechanical ventilation, and durations of vasoactive drug use. Conclusions: This study introduces the concept of a “cardiac and respiratory dual high drive” phenotype, which appears to be associated with poor short-term survival rates, prolonged hospital stays, and increased utilization of medical resources in the early stages of sepsis. Identifying patients with this phenotype may prove valuable in predicting outcomes and guiding treatment decisions for critically ill patients.