Association between Hemoglobin Turnover Rate and Mortality in Septic Shock Patients

Background Septic shock is associated with high incidence and mortality in intensive care units (ICUs). This study aims to investigate whether Hemoglobin Turnover Rate (HTR) can serve as an early predictor of mortality in patients with septic shock. Methods Patients diagnosed with septic shock within 48 hours of ICU admission were enrolled, and sequential biochemical data from the first 7 days were collected. Restricted cubic splines (RCS) were applied to explore the association between single time-point measurements and outcomes. Group-based trajectory modeling (GBTM) was used to identify latent subgroups of patients with similar progression patterns. The primary outcome was all-cause mortality. Results This study integrated cross-sectional and longitudinal analyses to assess the prognostic significance of HTR in septic shock. Cross-sectionally, elevated HTR-both at admission and within 7 days thereafter-was consistently associated with higher 7-day mortality, with the most pronounced predictive effect observed for measurements taken within the 7 days preceding death (Q4 vs Q1 OR reaching 3.52). Longitudinal trajectory modeling further identified two distinct temporal patterns of HTR, among which a steadily rising trajectory was strongly predictive of fatal outcome. The robustness of these associations was confirmed through sensitivity analyses that excluded patients with severe liver disease, as well as via propensity score–based sensitivity analyses. Conclusion: HTR reflects integrated red blood cell metabolism and bilirubin clearance, capturing aspects of both oxygen transport and metabolic balance. It shows promise as an early prognostic marker in septic shock, though further validation is required before clinical adoption.