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Original Articles

Critical Care

Machine Learning-Based Clusters of Vital Signs and Lactate Levels Predict Vasopressor Use in Sepsis
Daun Jeong, Minyoung Choi, Seung Jin Maeng, Hanbeom Yoon, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Tae Gun Shin, Sung Phil Chung, Tae Ho Lim, on behalf of the Korean Shock Society
In Press, Received October 15, 2025  Accepted December 29, 2025  Available online January 14, 2026  
DOI: https://doi.org/10.15441/ceem.25.247    [Accepted]

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Machine Learning-Based Clusters of Vital Signs and Lactate Levels Predict Vasopressor Use in Sepsis
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Machine Learning-Based Clusters of Vital Signs and Lactate Levels Predict Vasopressor Use in Sepsis
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Objective
Sepsis remains a major clinical challenge because of its complex, heterogeneous, and multidimensional clustering patterns. This study aimed to investigate the association between vasopressor administration and machine learning–derived clusters based on initial vital signs and lactate measurements obtained in emergency department (ED) and intensive care unit (ICU) settings.
Methods
A retrospective cohort analysis was performed using data from the Korean Shock Society Septic Shock (KOSS) Registry (septic shock in the ED) and the Marketplace for Medical Information in Intensive Care (MIMIC)-IV database (ICU patients with suspected infection). To derive clusters, k-means clustering was applied to six initial vital signs and serum lactate measurements. The primary outcome was vasopressor administration. Secondary outcomes included second vasopressor administration and 28-day mortality.
Results
A total of 17,500 patients were included in the analysis (KOSS cohort, n=7,130; MIMIC-IV cohort, n=10,370). K-means clustering identified three distinct clusters in each cohort. In the KOSS cohort, Cluster 3 was characterized by the lowest mean arterial pressure (MAP) (62 mmHg [IQR, 53–71]) and the highest diastolic shock index (DSI) (2.6 [2.3–3.0]). This cluster was associated with the highest rates of vasopressor administration (93.9%), second vasopressor administration (33.5%), and 28-day mortality (25.3%) (all p<0.001). Comparable physiological and clinical patterns were observed in the MIMIC-IV cohort, in which Cluster 3 likewise demonstrated the lowest MAP (68 mmHg [60–76]) and highest DSI (2.0 [1.8–2.3]). This group similarly exhibited the poorest outcomes, including vasopressor administration (41.0%), second vasopressor administration (16.7%), and 28-day mortality (29.0%).
Conclusion
Machine learning–derived clusters based on initial vital signs and serum lactate levels demonstrated different patterns of vasopressor use and mortality. The clinical utility of this approach for guiding timely or targeted vasopressor therapy requires prospective validation.
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Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study
Matteo Guarino, Giacomo Maroncelli, Benedetta Perna, Paolo Baldin, Caterina Ghirardi, Alex Zanotto, Silvia Eichner, Matteo Bolognesi, Chiara Pesci, Martina Maritati, Carlo Contini, Roberto De Giorgio, Michele Domenico Spampinato
Clin Exp Emerg Med 2026;13(1):44-52.   Published online December 2, 2025
DOI: https://doi.org/10.15441/ceem.25.075

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Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study
Clin Exp Emerg Med. 2026;13(1):44-52.   Published online December 2, 2025
DOI: https://doi.org/10.15441/ceem.25.075
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Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study
Clin Exp Emerg Med. 2026;13(1):44-52.   Published online December 2, 2025
DOI: https://doi.org/10.15441/ceem.25.075
Close
Objective
Sepsis, a life-threatening organ dysfunction, is a major global health concern. Early detection remains challenging due to nonspecific symptoms. Noninvasive tools such as the shock index, diastolic shock index, capillary refill time (CRT), and mottling score (MS) could help clinicians assess hemodynamic status and predict mortality, but a comprehensive comparison of their prognostic value is lacking. This study compares the performance of those four tools in predicting mortality in septic patients at 24 hours, 7 days, and 28 days. Methods A single-center, prospective observational study was conducted from January to September 2024. Adult patients (≥18 years) with suspected infection and a National Early Warning Score-2 of ≥5 were enrolled. Demographic data, vital signs, and CRT and MS results were collected at presentation, and mortality outcomes were recorded at 24 hours, 7 days, and 28 days. Results In total, 135 patients were included (median age, 85 years [interquartile range, 79–90 years]; 44.4% female). The mortality rates were 15.6% at 24 hours, 25.2% at 7 days, and 35.6% at 28 days. CRT showed the highest predictive value for 24-hour mortality (area under the curve [AUC], 0.829; 95% confidence interval [CI], 0.755–0.889), and MS had the best performance at 7 days (AUC, 0.732; 95% CI, 0.646–0.806) and at 28 days (AUC, 0.749; 95% CI, 0.662–0.823). No significant differences emerged in pairwise comparisons. Conclusion Although no one tool significantly outperformed the others, all four tools may provide useful, noninvasive mortality prediction in sepsis. CRT may be most effective for early risk stratification and MS correlates with mid-term outcomes, supporting their integration into clinical assessments.
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Review Articles

Advances in metabolomics in critically ill patients with sepsis and septic shock
Swarnima Pandey
Clin Exp Emerg Med 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211

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Advances in metabolomics in critically ill patients with sepsis and septic shock
Clin Exp Emerg Med. 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211
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Advances in metabolomics in critically ill patients with sepsis and septic shock
Clin Exp Emerg Med. 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211
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Sepsis is associated with high morbidity and mortality rates in hospitalized patients. This condition has a complex pathophysiology and can swiftly progress to the severe form of septic shock, which can lead to organ dysfunction, organ failure, and death. Metabolomics has transformed the clinical and research topography of sepsis, with application to prognosis, diagnosis, and risk assessment. Metabolomics involves detecting and analyzing levels of metabolites in blood (plasma, serum, and/or erythrocytes) and urine; when applied in sepsis, this technology can improve our understanding of the pathogenesis of the disease and aid in better disease management by identifying early biomarkers. For this review article, “metabolomics,” “sepsis,” and “septic shock” were keywords used to search records in various databases including PubMed and Scopus from their inception until December 2023. This review article summarizes information regarding metabolic profiling performed in sepsis and septic shock and illustrates how metabolomics is advancing the diagnosis and prognosis of patients with sepsis.

Citations

Citations to this article as recorded by  Crossref logo
  • Effect of norepinephrine initiation timing on mortality in septic shock: a multicenter cohort study
    Jung Won Choi, Tae Gun Shin, Seung Jin Maeng, Sung Yeon Hwang, Sang-Min Kim, Won Young Kim, Kyuseok Kim, Sung-Joon Park, Sung-Hyuk Choi, Sejoong Ahn, Woon Yong Kwon, Taeyoung Kong, Sung Phil Chung, Byuk Sung Ko, Tae Ho Lim
    BMC Anesthesiology.2026;[Epub]     CrossRef
  • Identification of Volatile Organic Compounds (Distinct Biomarkers) Emitted by Cancer Cells Using Gas Chromatography-mass Spectrometry – A Review
    Surendar Balu, Ashok K. Sundramoorthy
    Current Analytical Chemistry.2026; 22(1): 35.     CrossRef
  • Integrative multi-omics and machine learning identify mitochondrial biomarkers for pathogen-specific sepsis stratification and translational prioritization
    Chaoyuan Jin, Ruijinlin Hao, Bate Gonggaoang, Qingxia Dai, Xingxing Ren, Jie Shen
    European Journal of Medical Research.2026;[Epub]     CrossRef
  • Age–Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study
    Seung Jin Maeng, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Minha Kim, Sejin Heo, Tae Ho Lim, Sung Phil Chung, Sung-Hyuk Choi, Tae Gun Shin
    Healthcare.2026; 14(6): 722.     CrossRef
  • Artificial intelligence-driven cluster analysis for identifying clinical phenotypes in suspected sepsis patients in the emergency department
    Daun Jeong, Jong Rul Park, Seung Jin Maeng, Jung Won Choi, Gun Tak Lee, Sung Yeon Hwang, Chulhong Kim, Jong Eun Park, Tae Gun Shin
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Early prediction of renal replacement therapy within 24 hours after septic shock recognition in the emergency department using machine learning: a retrospective analysis of a prospectively collected multicenter registry
    Sangun Nah, Tae Ho Lim, Sung Phil Chung, Gil Joon Suh, Sung-Hyuk Choi, Woon Yong Kwon, Won Young Kim, Kyuseok Kim, Sangchun Choi, Je Sung You, Han Sung Choi, Tae Gun Shin, Sangsoo Han
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Metabolic reprogramming in sepsis-associated acute kidney injury: insights from lipopolysaccharide-induced oxidative stress and amino acid dysregulation
    Hakan Turk, Ebru Temiz, Ismail Koyuncu
    Molecular Biology Reports.2025;[Epub]     CrossRef
  • Leveraging diverse cell-death patterns in diagnosis of sepsis by integrating bioinformatics and machine learning
    Mi Liu, Xingxing Gao, Hongfa Wang, Yiping Zhang, Xiaojun Li, Renlai Zhu, Yunru Sheng
    PeerJ.2025; 13: e19077.     CrossRef
  • Characterization of metabolism associated with outcomes in severe acute pancreatitis: Insights from serum metabolomic analysis
    Mohd Adnan Siddiqui, Anamika Singh, Swarnima Pandey, Mohammed Haris Siddiqui, Afzal Azim, Neeraj Sinha
    Biophysical Chemistry.2025; 322: 107436.     CrossRef
  • Untargeted lipidomics profiling provides novel insights into pediatric patients with sepsis: an exploratory study
    Reyihangu Awuti, Jiayi Bai, Ye Cheng, Weili Yang, Zimei Cheng, Hetian Zhou, Guoyun Su, Kexin Wang, Yaodong Wang, Tingyan Liu, Ying Liu, Weiming Chen, Hehe Chen, Guoping Lu, Caiyan Zhang
    Metabolomics.2025;[Epub]     CrossRef
  • Multi‐Omics and ‐Organ Insights into Energy Metabolic Adaptations in Early Sepsis Onset
    Lin‐Lin Xu, Zhengyuan Zhou, Sascha Schäuble, Wolfgang Vivas, Karen Dlubatz, Michael Bauer, Sebastian Weis, Mervyn Singer, Roman Lukaszewski, Gianni Panagiotou
    Advanced Science.2025;[Epub]     CrossRef
  • Metabolomics for the Identification of Biomarkers in Rheumatoid Arthritis
    Swarnima Pandey
    Phenomics.2025; 5(3): 343.     CrossRef
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    Amrita Sahu, Upasna Gupta, Bikash Baishya, Dharmendra Singh Bhadauria, Neeraj Sinha
    Molecular Omics.2025; 21(5): 464.     CrossRef
  • Functional metabolomics: unlocking the role of small molecular metabolites
    Hetao Chen, Jiao Kong, Peipei Du, Qian Wang, Tao Jiang, Xixi Hou, Tingting Feng, Jiajia Duan, Chuanxin Liu
    Frontiers in Molecular Biosciences.2025;[Epub]     CrossRef
  • Impact of Metabolically Healthy and Unhealthy Obesity on Outcomes of Sepsis Complicated by Septic Shock in Elderly Patients
    Giorgi Chilingarashvili, Diksha Sanjana Pasnoor, Shreya Bajjuri, Ritika Parekh, Nirmala Manjappachar, Jyotsna Gummadi, Athmananda Nanjundappa, Rupak Desai
    Journal of Intensive Care Medicine.2025;[Epub]     CrossRef
  • Recent advances in biomarkers for detection and diagnosis of sepsis and organ dysfunction: a comprehensive review
    Leiyang Chen, Xiuxiu Zhang, Peizhi Shi
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • Metabolomics for the identification of biomarkers in endometriosis
    Swarnima Pandey
    Archives of Gynecology and Obstetrics.2024; 310(6): 2823.     CrossRef
  • 8,444 View
  • 180 Download
  • 16 Web of Science
  • 17 Crossref
Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines
Gil Joon Suh, Tae Gun Shin, Woon Yong Kwon, Kyuseok Kim, You Hwan Jo, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, for the Korean Shock Society investigators
Clin Exp Emerg Med 2023;10(3):255-264.   Published online July 13, 2023
DOI: https://doi.org/10.15441/ceem.23.065

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Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines
Clin Exp Emerg Med. 2023;10(3):255-264.   Published online July 13, 2023
DOI: https://doi.org/10.15441/ceem.23.065
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Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines
Clin Exp Emerg Med. 2023;10(3):255-264.   Published online July 13, 2023
DOI: https://doi.org/10.15441/ceem.23.065
Close
Although the Surviving Sepsis Campaign guidelines provide standardized and generalized guidance, they are less individualized. This review focuses on recent updates in the hemodynamic management of septic shock. Monitoring and intervention for septic shock should be personalized according to the phase of shock. In the salvage phase, fluid resuscitation and vasopressors should be given to provide life-saving tissue perfusion. During the optimization phase, tissue perfusion should be optimized. In the stabilization and de-escalation phases, minimal fluid infusion and safe fluid removal should be performed, respectively, while preserving organ perfusion. There is controversy surrounding the use of restrictive versus liberal fluid strategies after initial resuscitation. Fluid administration after initial resuscitation should depend upon the patient’s fluid responsiveness and requires individualized management. A number of dynamic tests have been proposed to monitor fluid responsiveness, which can help clinicians decide whether to give fluid or not. The optimal timing for the initiation of vasopressor agents is unknown. Recent data suggest that early vasopressor initiation should be considered. Inotropes can be considered in patients with decreased cardiac contractility associated with impaired tissue perfusion despite adequate volume status and arterial blood pressure. Venoarterial extracorporeal membrane oxygenation should be considered for refractory septic shock with severe cardiac systolic dysfunction.

Citations

Citations to this article as recorded by  Crossref logo
  • Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study
    Kyung Hun Yoo, Gil Joon Suh, Woon Yong Kwon, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Kyuseok Kim, Yoo Seok Park, Tae Gun Shin, Byuk Sung Ko, Tae Ho Lim, Yongil Cho
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • The impact of ketamine on ICU mortality in patients with sepsis: A retrospective cohort study
    Yifei Liu, Jie Yue, Guangdong Wang, Yuxia Jiang, Aihua Shu
    Journal of Critical Care.2026; 92: 155422.     CrossRef
  • Comparison of prognosis in emergency department elderly septic shock patients with initial hypotension versus delayed hypotension
    Chaeeun Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangun Nah, Sangsoo Han
    European Journal of Emergency Medicine.2026;[Epub]     CrossRef
  • Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department
    Sumin Baek, Inwon Park, Seonghye Kim, Young Woo Um, Hee Eun Kim, Kyunghoon Lee, Jae Hyuk Lee, You Hwan Jo
    Heliyon.2025; 11(1): e41252.     CrossRef
  • Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest
    Sejoong Ahn, Bo-Yeong Jin, Sukyo Lee, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sang Kuk Han, Phil Cho Choi, Young Hwan Lee, Sang O. Park, Jong Seok Lee, Ki Young Jeong, Sung Hyuk Choi, Young Hoon Yoon, Su Jin Kim, Kap Su Han, Min Seob Sim, Gun Tak Lee, Yo
    Scientific Reports.2025;[Epub]     CrossRef
  • Using machine learning techniques for early prediction of tracheal intubation in patients with septic shock: a multi-center study in South Korea
    Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han
    Acute and Critical Care.2025; 40(2): 221.     CrossRef
  • Sepsis Heterogeneity and Precision Medicine: Typing Challenges from Clinical Syndromes to Molecular Mechanisms
    硕 盛
    Journal of Clinical Personalized Medicine.2025; 04(03): 259.     CrossRef
  • The evolving landscape of emergency care
    Lewis J. Kaplan
    Current Opinion in Critical Care.2025; 31(3): 235.     CrossRef
  • Prognostic Value of the AST/ALT Ratio in Patients with Septic Shock: A Prospective, Multicenter, Registry-Based Observational Study
    Sungwoo Choi, Sangun Nah, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangsoo Han
    Diagnostics.2025; 15(14): 1773.     CrossRef
  • From Fluid Responsiveness to Prognosis: The Emerging Role of Point-of-Care Echocardiography in Sepsis
    Andrea Piccioni, Gloria Rozzi, Giacomo Spaziani, Michela Novelli, Mariella Fuorlo, Marcello Candelli, Giulia Pignataro, Luca Santarelli, Marcello Covino, Antonio Gasbarrini, Francesco Franceschi
    Diagnostics.2025; 15(20): 2612.     CrossRef
  • Impact of diastolic blood pressure time under range on mortality and acute kidney injury in septic patients: a retrospective cohort study
    Jian Zhao, Si Tong Lin, Ai Hua Qin, Cheng Rui Zhou, Xiang Dong Huang, Hua Guo Chen, Shu Qin Zhou, Hu Peng, Yuan Zhuo Chen
    BMC Anesthesiology.2025;[Epub]     CrossRef
  • Comparison of non-invasive strategies to drive fluid resuscitation in sepsis or septic shock: a meta-analysis of RCTs
    Mara Graziani, Laura Gasperini, Claudia Gasperini, Giorgio Maraziti, Gennaro De Pascale, Cecilia Becattini
    Internal and Emergency Medicine.2025;[Epub]     CrossRef
  • Effect of Intravenous Push and Piggyback Administration of Ceftriaxone on Mortality in Sepsis
    Sun Young Lim, Sumin Baek, You Hwan Jo, Jae Hyuk Lee, Young Woo Um, Hee Eun Kim, Dongkwan Han
    The Journal of Emergency Medicine.2024; 66(5): e632.     CrossRef
  • Temperature trajectories and mortality in hypothermic sepsis patients
    Dongkwan Han, Seung Hyun Kang, Young Woo Um, Hee Eun Kim, Ji Eun Hwang, Jae Hyuk Lee, You Hwan Jo, Yoon Sun Jung, Hui Jai Lee
    The American Journal of Emergency Medicine.2024; 84: 18.     CrossRef
  • Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock
    Chiwon Ahn, Gina Yu, Tae Gun Shin, Youngsuk Cho, Sunghoon Park, Gee Young Suh
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  • Removal of circulating mitochondrial N-formyl peptides via immobilized antibody therapy restores sepsis-induced neutrophil dysfunction
    Woon Yong Kwon, Yoon Sun Jung, Gil Joon Suh, Sung Hee Kim, Areum Lee, Jeong Yeon Kim, Hayoung Kim, Heesu Park, Jieun Shin, Taegyun Kim, Kyung Su Kim, Kiyoshi Itagaki, Carl J Hauser
    Journal of Leukocyte Biology.2024; 116(5): 1169.     CrossRef
  • Diagnostic Accuracy of Plasma Renin Concentration and Renin Activity in Predicting Mortality and Kidney Outcomes in Patients With Septic Shock and Hypoperfusion or Hypotension: A Multicenter, Prospective, Observational Study
    Gun Tak Lee, Byuk Sung Ko, Da Seul Kim, Minha Kim, Jong Eun Park, Sung Yeon Hwang, Daun Jeong, Chi Ryang Chung, Hyunggoo Kang, Jaehoon Oh, Tae Ho Lim, Bora Chae, Won Young Kim, Tae Gun Shin
    Annals of Laboratory Medicine.2024; 44(6): 497.     CrossRef
  • The mortality of patients with sepsis increases in the first month of a new academic year
    Sukyo Lee, Sungjin Kim, Sejoong Ahn, Hanjin Cho, Sungwoo Moon, Young Duck Cho, Jong-Hak Park
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  • Early Mortality Stratification with Serum Albumin and the Sequential Organ Failure Assessment Score at Emergency Department Admission in Septic Shock Patients
    Sang-Min Kim, Seung-Mok Ryoo, Tae-Gun Shin, You-Hwan Jo, Kyuseok Kim, Tae-Ho Lim, Sung-Phil Chung, Sung-Hyuk Choi, Gil-Joon Suh, Won-Young Kim
    Life.2024; 14(10): 1257.     CrossRef
  • External validation of a modified cardiovascular sequential organ failure assessment score in patients with suspected infection using the MIMIC-IV database
    Sung Yeon Hwang, Inkyu Kim, Byuk Sung Ko, Seung Mok Ryoo, Eunah Han, Hui Jai Lee, Daun Jeong, Tae Gun Shin, Kyuseok Kim, Vipa Thanachartwet
    PLOS ONE.2024; 19(11): e0312185.     CrossRef
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    Medicina.2024; 60(11): 1884.     CrossRef
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    Tae Gun Shin
    Clinical and Experimental Emergency Medicine.2024; 11(4): 327.     CrossRef
  • Hemşirelerin Sepsis Farkındalığı ve Sepsis Tanılı Hastalarda Hemşirelik Yönetimi
    Pınar Erman, Güler Balcı Alparslan
    Yoğun Bakım Hemşireliği Dergisi.2024; 28(3): 213.     CrossRef
  • 37,908 View
  • 7,241 Download
  • 20 Web of Science
  • 23 Crossref

Systematic Review

Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
Clin Exp Emerg Med 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005

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Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005
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Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005
Close
Objective
To evaluate mortality from sepsis and septic shock in Korea during the past 10 years, we conducted a systematic review and meta-analysis.
Methods
We searched six databases for studies on mortality from sepsis and septic shock in adult patients. Primary outcomes were 28- or 30-day mortality and in-hospital mortality from sepsis and septic shock. To assess the risk of bias, we used the Newcastle-Ottawa Scale and Risk of Bias 2 tools. The protocol is registered in PROSPERO (No. CRD42022365739).
Results
A total of 61 studies were included. The mortality rates from sepsis and septic shock at 28 or 30 days were 22.7% (95% confidence interval [CI], 20.0%–25.6%; I2=89%) and 27.6% (95% CI, 22.3%–33.5%; I2=98%), respectively, according to the Sepsis-3 criteria. Furthermore, in accordance with the Sepsis-3 criteria, the in-hospital mortality rates were 28.1% (95% CI, 25.2%–31.1%; I2=87%) and 34.3% (95% CI, 27.2%–42.2%; I2=97%), respectively.
Conclusion
The mortality rates from sepsis and septic shock in Korea are high. In the case of septic shock, the in-hospital mortality rate is approximately 30%.

Citations

Citations to this article as recorded by  Crossref logo
  • Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study
    Kyung Hun Yoo, Gil Joon Suh, Woon Yong Kwon, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Kyuseok Kim, Yoo Seok Park, Tae Gun Shin, Byuk Sung Ko, Tae Ho Lim, Yongil Cho
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • Free Thyroxine as a Predictor of Mortality in Critically Ill Septic Patients—A Retrospective Study
    Matei Florin Negruț, Vlad Pastor, Robert Bolcaș, Oana Antal, Robert Szabo, Cristina Petrișor
    Diagnostics.2026; 16(5): 680.     CrossRef
  • Comparison of prognosis in emergency department elderly septic shock patients with initial hypotension versus delayed hypotension
    Chaeeun Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangun Nah, Sangsoo Han
    European Journal of Emergency Medicine.2026;[Epub]     CrossRef
  • Clinical Profiles, Interventions, and Outcomes of Sepsis and Septic Shock in a Saudi Arabian Tertiary ICU: A Five-Year Retrospective Analysis
    Amer Asiri, Khaled Abdulwahab Amer, Mushary Alqahtani, Lena A. Almathami, Osama Ayed Asiri, Sultan Saad Alnasser, Ahmed Ali Khuzayyim, Bander Abdullah Alqahtani, Fatimah Mohammed Asiri, Hatem Mostafa Asiri
    Healthcare.2026; 14(5): 680.     CrossRef
  • Papaverine Mitigates Acute Kidney Injury in Feces-Induced Polymicrobial Sepsis Through Regulation of the HMGB1–RAGE Axis
    Mehmet Fatih Dasiran, Ahmet Akbaş, Bakiye Akbaş, Ejder Saylav Bora, Hatice Aygun, Oytun Erbas
    Medicina.2026; 62(4): 621.     CrossRef
  • Outcomes and risk factors in HIV-positive patients with sepsis: a retrospective study
    Qiang Gao, Tingting Wang, Shun Tan, Yu Tian, An Zhang
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • Prognostic Value of the AST/ALT Ratio in Patients with Septic Shock: A Prospective, Multicenter, Registry-Based Observational Study
    Sungwoo Choi, Sangun Nah, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangsoo Han
    Diagnostics.2025; 15(14): 1773.     CrossRef
  • Epidemiology and outcomes of septic shock in Japan: a nationwide retrospective cohort study from a medical claims database by the Japan Sepsis Alliance (JaSA) study group
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Original Articles
A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection
Seung Ryu, Se Kwang Oh, Bong Kyu Lee, So Young Jeon
Clin Exp Emerg Med 2023;10(1):60-67.   Published online January 3, 2023
DOI: https://doi.org/10.15441/ceem.22.339

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A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection
Clin Exp Emerg Med. 2023;10(1):60-67.   Published online January 3, 2023
DOI: https://doi.org/10.15441/ceem.22.339
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A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection
Clin Exp Emerg Med. 2023;10(1):60-67.   Published online January 3, 2023
DOI: https://doi.org/10.15441/ceem.22.339
Close
Objective
We evaluated the utility of the Korean Modified Early Warning Score (KMEWS), which combines the Modified Early Warning Score (MEWS) and the Korean Triage and Acuity Scale (KTAS), as a triage tool to screen for infection in patients who visit the emergency department.
Methods
We retrospectively reviewed data extracted from electronic medical records. Patients aged ≥18 years with an infection who were admitted to the hospital via the emergency department between January 2018 and December 2019 were eligible for inclusion. The KMEWS score was calculated as the sum of the KTAS level and the MEWS score. We generated receiver operating characteristic curves and determined the area under the receiver operating characteristic curve (AUC) for the KMEWS, KTAS, MEWS, and Mortality in Emergency Department Sepsis (MEDS) scales. The primary outcome was septic shock, and secondary outcomes were intensive care unit admission and in-hospital mortality.
Results
The AUC values (95% confidence interval) for predicting septic shock were as follows: KMEWS, 0.910 (0.902–0.918); MEWS, 0.896 (0.887–0.904); KTAS score, 0.809 (0.798–0.819); and MEDS, 0.927 (0.919–0.934). The AUC values (95% confidence interval) for predicting in-hospital mortality were as follows: KMEWS, 0.752 (0.740–0.764); MEWS, 0.717 (0.704–0.729); KTAS score, 0.764 (0.752–0.776); and MEDS, 0.844 (0.834–0.854). The AUC values (95% confidence interval) for predicting intensive care unit admission were as follows: KMEWS, 0.826 (0.816–0.837); MEWS, 0.782 (0.770–0.793); KTAS score, 0.821 (0.810–0.831); and MEDS, 0.839 (0.829–0.849).
Conclusion
The KMEWS, which is a combination of the MEWS and the KTAS scores, might be a useful triage tool in emergency department patients who present with infection, particularly for predicting septic shock.

Citations

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  • Evaluating the National Early Warning Score (NEWS) in triage: A machine learning perspective
    Arian Zaboli, Francesco Brigo, Serena Sibilio, Magdalena Massar, Gabriele Magnarelli, Gloria Brigiari, Gianni Turcato
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    The American Journal of Emergency Medicine.2025; 97: 84.     CrossRef
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    Jin Hee Lee, Jin Hee Jung, Hyun Noh, Mi Jin Kim
    Scientific Reports.2024;[Epub]     CrossRef
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  • 6 Web of Science
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Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate
Da Seul Kim, Jong Eun Park, Sung Yeon Hwang, Daun Jeong, Gun Tak Lee, Taerim Kim, Se Uk Lee, Hee Yoon, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Tae Gun Shin
Clin Exp Emerg Med 2022;9(3):176-186.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.324

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Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate
Clin Exp Emerg Med. 2022;9(3):176-186.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.324
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Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate
Clin Exp Emerg Med. 2022;9(3):176-186.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.324
Close
Objective
We evaluated the performance of diastolic shock index (DSI) and lactate in predicting vasopressor requirement among hypotensive patients with suspected infection in an emergency department.
Methods
This was a single-center, retrospective observational study for adult patients with suspected infection and hypotension in the emergency department from 2018 to 2019. The study population was split into derivation and validation cohorts (70/30). We derived a simple risk score to predict vasopressor requirement using DSI and lactate cutoff values determined by Youden index. We tested the score by the area under the receiver operating characteristic curve (AUC). We performed a multivariable regression analysis to evaluate the association between the timing of vasopressor treatment and 28-day mortality.
Results
A total of 1,917 patients were included. We developed a score, assigning 1 point each for the high DSI (≥2.0) and high lactate (≥2.5 mmol/L) criteria. The AUCs of the score were 0.741 (95% confidence interval [CI], 0.715–0.768) at hypotension and 0.736 (95% CI, 0.708–0.763) after initial fluid challenge in the derivation cohort and 0.676 (95% CI, 0.631–0.719) at hypotension and 0.688 (95% CI, 0.642–0.733) after initial fluid challenge in the validation cohort, respectively. In patients with scores of 2 points, early vasopressor therapy initiation was significantly associated with decreased 28-day mortality (adjusted odds ratio, 0.37; 95% CI, 0.14–0.94).
Conclusion
A prediction model with DSI and lactate levels might be useful to identify patients who are more likely to need vasopressor administration among hypotensive patients with suspected infection.

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Korean Shock Society septic shock registry: a preliminary report
Tae Gun Shin, Sung Yeon Hwang, Gu Hyun Kang, Won Young Kim, Seung Mok Ryoo, Kyuseok Kim, You Hwan Jo, Sung Phil Chung, Young Seon Joo, Jin Ho Beom, Sung-Hyuk Choi, Young Hoon Yoon, Woon Yong Kwon, Tae Ho Lim, Kap Su Han, Han Sung Choi, Gil Joon Suh
Clin Exp Emerg Med 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204

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Korean Shock Society septic shock registry: a preliminary report
Clin Exp Emerg Med. 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204
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Korean Shock Society septic shock registry: a preliminary report
Clin Exp Emerg Med. 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204
Close
Objective
To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). Methods This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. Results A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. Conclusion This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.

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The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study
Sarah A. Sterling, Michael A. Puskarich, Alan E. Jones
Clin Exp Emerg Med 2015;2(4):197-202.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.025

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The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study
Clin Exp Emerg Med. 2015;2(4):197-202.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.025
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The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study
Clin Exp Emerg Med. 2015;2(4):197-202.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.025
Close
Objective
To describe the effect of liver disease (LD) on lactate clearance during early sepsis resuscitation.
Methods
This is a multicenter randomized clinical trial. An initial lactate >2 mmol/L and subsequent serum lactate measurement within 6 hours were required for inclusion. LD was categorized by two methods: 1) past medical history (PMH) categorized as no LD, mild LD (no Child’s score criteria, but PMH of hepatitis B/C), cirrhosis; and 2) measurable liver dysfunction determined by the liver component of the sequential organ failure assessment (L-SOFA) score as no dysfunction (L-SOFA score 0), mild dysfunction (score 1), moderate-severe dysfunction (score 2 to 4). Primary outcome was the rate of lactate normalization.
Results
One hundred eighty-seven patients were included. When categorized by PMH, 169 patients had no LD, 6 mild LD, and 12 cirrhosis. 63/169 (37%) of patients with no LD achieved lactate normalization, compared to 4/6 (67%) with mild LD, and 1/12 (8%) with cirrhosis (P<0.03). Categorized by L-SOFA score, 59/124 (47%) patients with L-SOFA 0 achieved lactate normalization, compared to 6/31 (19%) with L-SOFA 1, and 3/32 (9%) with L-SOFA 2–4 (P<0.01). Relative lactate clearance [(initial lactate–subsequent lactate)/initial lactate] was lower in patients with more advanced LD by PMH (37.7 vs. 40.4 vs. 21.8, P=0.07), and lower with increasing L-SOFA score (42.0 vs. 30.1 vs. 23.4, P=0.01).
Conclusion
Liver dysfunction was significantly associated with impaired lactate clearance and normalization during the early resuscitation of sepsis.

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Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke
Minji Park, Kyuseok Kim, Jae Hyuk Lee, Changwoo Kang, You Hwan Jo, Dong Hoon Kim, Kyeong Won Kang, Soo Hoon Lee, Chanjong Park, Joonghee Kim, Heajin Chung, Hyunmi Park, Sujin Jang
Clin Exp Emerg Med 2014;1(1):41-48.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.014

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Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke
Clin Exp Emerg Med. 2014;1(1):41-48.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.014
Download Citation

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Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke
Clin Exp Emerg Med. 2014;1(1):41-48.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.014
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Objective

Patients with severe sepsis or septic shock require timely, aggressive management to improve their outcomes, and early presentation of patients to the hospital may also be important. Thus, public awareness about sepsis may be important for improved outcomes. However, there are no studies regarding the public awareness of sepsis in the general Korean population. Therefore, the objective of this survey was to gain insight into the public awareness of sepsis.

 Methods

Prospective paper-based and web-based surveys were issued between May and June 2013 to adults aged ≥18 years.

 Results

A total of 1,081 participants responded to the survey (394 paper-based and 687 web-based). Mean age was 38.7±11.4 years, and 541 participants (50%) were men. Of the 1,081 participants, 831 (76.9%) had heard of the term “sepsis.” Of these participants, only 295 (35%) responded correctly regarding the definition of sepsis. However, 1,019 participants (94.3%) had heard of acute myocardial infarction, and 817 of these (80%) correctly defined acute myocardial infarction. Regarding stroke, 1,047 (96.9%) had heard of stroke, and 975 of these responded (93.1%) correctly to the definition of stroke.

 Conclusion

There is poor public awareness about sepsis compared with that of acute myocardial infarction and stroke. This may limit the timely management of severe sepsis and septic shock.

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CEEM : Clinical and Experimental Emergency Medicine