Dynamic changes in plasma sphingosine-1-phosphate concentrations and mortality in sepsis: a prospective cohort study in the emergency department

Declining plasma sphingosine-1-phosphate trajectories in 156 emergency-department adults with sepsis are linked to higher 60-day mortality, with an adjusted hazard ratio of 3.43.

• Why it matters: Sepsis evolves over time, but whether changes in sphingosine-1-phosphate beyond baseline levels relate to death is unclear.
• What they did: Plasma S1P was measured by ELISA on days 1, 3, and before discharge or death, and trajectories were modeled with linear mixed-effects models; Cox models tested baseline, trajectory group, and time-varying S1P against 60-day mortality.
• The result: The descending trajectory group had higher 60-day mortality risk than the ascending group (aHR 3.43; 95% CI 1.11–10.58; p = 0.032), while baseline S1P was not associated (aHR 1.004 per 10 ng/mL decrease; p = 0.803). Each 10 ng/mL decrease in time-varying S1P predicted higher mortality hazard (aHR 1.035; 95% CI 1.002–1.076; p = 0.041).

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