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Research Snapshot Theater: GI - Nutrition, Adult II

Targeting Treatable Traits in Cirrhotic Critical Illness to Abate Therapeutic Inertia

Sunday, March 22, 2026
11:00 AM - 12:00 PM Central Time
Location: Connections Central - RST 04

  • Patricia Riano Rivero, MD (she/her/hers)

    Florida

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • LF

    Lauren Forchette, DO (she/her/hers)

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • CW

    Caroline N. Wojtas, DO (she/her/hers)

    Florida

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • GR

    Gustavo Ramos Ortiz, MD

    Chief Resident, Internal Medicine Residency Program
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • DJ

    David Jerez Diaz, MD

    Hospice Care Palliative Medicine Fellow PGY-4
    Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • LP

    Luis Palma, MD

    Dr.
    Florida State University at Sarasota Memorial Hospital

    Disclosure information not submitted.

  • AA

    Ahmed Aboutaleb, DO

    Internal Medicine Resident PGY-1
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • KP

    Kajol Patel, MD

    Internal Medicine Resident PGY-1
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • OH

    Omar Hozayen, MD

    Internal Medicine Resident PGY-1
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • RK

    Rheiner Kammer, MD

    Internal Medicine Resident PGY-1
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • RM

    Rumit Mistry, DO

    Internal Medicine Resident PGY-2
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • NL

    Natalia Lattanzio, MD

    Assistant Professor
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • CA

    Cristine Acosta Diaz, MD

    Assisstant Professor
    Florida State University, Internal Medicine Residency Program at Sarasota Memorial Hospital, United States

    Disclosure information not submitted.

  • KM

    Karen M. Hamad, MD

    Dr.
    Florida State University at Sarasota Memorial Hospital

    Disclosure information not submitted.

  • WW

    Wilhelmine Wiese-Rometsch, MD

    Dr.
    Florida State University at Sarasota Memorial Hospital

    Disclosure information not submitted.

  • RA

    Robert A. Smith, PhD, FCCM

    Dr.
    Florida State University at Sarasota Memorial Hospital

    Disclosure information not submitted.

Introduction: Critically ill cirrhosis patients exhibit heterogeneity, often leading to therapeutic inertia. We hypothesized that integrating baseline comorbidity endotypes with dynamic biomarker trajectories would identify clinical phenotypes with actionable "treatable traits," providing a framework for timely intervention.


Methods: We characterized under IRB exemption 1,053 cirrhosis patients stratified by severity (Mild, n=701; Moderate-Severe, n=352). Clustering of Elixhauser Comorbidity Index (v2025.1, n=39) domains defined comorbidity endotypes. Biomarker trajectory (eg, Systemic Immune-Inflammation Index [SII], estimated Plasma Volume Status / Albumin ratio) over first two ICU days (D) captured dynamic host response. These data streams were integrated using sequential machine learning approaches to define clinical phenotypes and treatable traits.


Results: Similar intergroup demographics included age 60 years among females (36%), males (64%), Whites (86%), Blacks (5%) and other races (9%). Mild cohort expressed distinct "Neuro-Psychiatric," "Hemorrhagic-Anemic," and "Cardio-Metabolic" endotypes. Though Moderate-Severe cohort was dominated by "Systemic Decompensation & Multi-Organ Crosstalk" endotype, where liver failure unified disparate organ dysfunction. Biomarker analysis revealed paradoxical trajectories: sicker Moderate-Severe group exhibited blunted inflammatory response (lower D1 CRP and SII; 8.2 mg/dL and 1720) coupled with worsening core organ function (INR increased +0.56), indicative of "immuno-nutritional paralysis." Mild group expressed a robust but resolving inflammatory response (higher D1 CRP and SII; 11.5 mg/dL and 2844) and improving organ function (INR decreased -0.24). Integrating comorbidities with dynamic biomarker data, three clinical phenotypes emerged linked to an actionable treatable trait: "Hyperinflammatory Responder" (resolving inflammation), "Immuno-Nutritional Collapse" (immune paralysis), and "Progressive Endotheliopathy" (capillary leak).


Conclusions: Integrated analysis revealed distinct clinical phenotypes with actionable treatable traits. Translating these phenotypes into clinical practice offers a strategy to overcome therapeutic inertia by providing objective, real-time triggers for titrating care, initiating targeted therapies, or avoiding harmful interventions.