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Star Research Presentations: Sepsis and Septic Shock

Critical Care Immune Dysregulation Framework Differentiates Septic and Cardiogenic Shock

Sunday, March 22, 2026
10:45 AM - 11:35 AM Central Time
Location: Connections Central Theater 1

  • Kevin Ghaffari, MD, MS

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

  • AM

    Andrew R. Moore, MD

    Instructor, Medicine - Pulmonary, Allergy & Critical Care Medicine
    Stanford University

    Disclosure information not submitted.

  • PS

    Pablo Sanchez, MD

    Assistant Professor - Divisions of Cardiology and Critical Care Medicine
    University of California San Francisco

    Disclosure information not submitted.

  • AR

    Angela Rogers, MD

    Associate Professor of Medicine (Pulmonary and Critical Care)
    Stanford University

    Disclosure information not submitted.

  • PK

    Purvesh Khatri, PhD

    Professor of Medicine (Institute for Immunity, Transplantation and Infection)
    Stanford University

    Disclosure information not submitted.

Introduction: A significant barrier to biologically redefining syndromic critical illnesses is a lack of understanding of the overlap in immune dysregulation across critical illness syndromes. We have proposed Hi-DEF (Human immune Dysregulation Evaluation Framework) to quantify cell-specific immune dysregulation across critical illness, which has previously been shown to have diagnostic, prognostic, and therapeutic significance (Moore et al.). Myeloid and lymphoid immune dysregulation has been shown to be associated with the severity of illness, mortality, and differential response to immune-modulating therapies. We investigated whether quantifying myeloid and lymphoid immune dysregulation through Hi-DEF can differentiate septic shock from cardiogenic shock at baseline.


Methods: We retrospectively analyzed publicly available whole blood gene expression data from the ShockOmic study, a two-center study in Europe that sampled septic shock and cardiogenic shock patients at day 0, 2, and 7 of their ICU stay (GSE131411). We normalized RNA sequencing counts using variance stabilizing transformation and calculated Hi-DEF immune dysregulation scores using the existing framework. We then evaluated differences across septic and cardiogenic shock at baseline and over one week using Wilcoxon rank sum test. Finally, we evaluated the AUROC of Hi-DEF to differentiate septic shock from cardiogenic shock at baseline.


Results: Of thirty-one (31) patients included in our analysis, 10 patients had cardiogenic shock and 21 had septic shock. Myeloid and lymphoid dysregulation scores were significantly higher in patients with septic shock than those with cardiogenic shock (p < 0.001 across both comparisons). This difference decreased over time of illness, with myeloid scores increasing over the first week in patients with cardiogenic shock, suggesting possible varying temporal patterns across the two shock states. Hi-DEF was able to differentiate septic from cardiogenic shock at baseline with an AUROC of 0.91 (95% CI 0.81-1).


Conclusions: Our results strongly suggest that the Hi-DEF framework provides important insights into the immune system in cardiogenic and septic shock and may be able to differentiate shock states.