Fig. 4

Outcome of patients who improve or worsen over time. Patient 4 is a 59-year-old male patient admitted for a severe peritonitis requiring noradrenaline at a rate of 0.05 μg/kg/min, a lactate level of 5.6 mmol/L, and a C-reactive protein level of 256 mg/L. At day 3, the noradrenaline can be stopped, his lactate levels are 0.5 mmol/L, and his C-reactive protein levels decrease to 170 mg/L (indicated by “improvement”), and at day 7, C-reactive protein levels dropped to 50 mg/L. However, if the same patient would develop refractory shock and atrial fibrillation at day 3, his outcome is as shown by “worsening”; at day 7, he develops an ICU-acquired pneumonia but noradrenalin is stopped, showing the net positive effect of worsening (pneumonia) and improvement (stopping of noradrenalin)