Three metabolic clusters exist in patients with septic shock with most metabolites differing between clusters and lipid species being most influential.

Cluster proportions evolved over time with a high metabolite group becoming more prevalent and being associated with survival later in the ICU stay.

These findings support the use of such subgroups to monitor patients longitudinally for risk of poor outcome and may identify groups that could benefit from metabolically active therapies such as lipid modulating drugs.

The main determinants of cluster membership were lipid species, especially lysophospholipids.

Low lysophospholipid sub-phenotypes were associated with higher circulating cytokine levels. Persistence of low lysophospholipid sub-phenotypes was associated with higher mortality compared to the high lysophospholipid sub-phenotype.

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