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原文摘要

Sepsis is a heterogeneous syndrome. Identifying clinically distinct phenotypes may enable more precise treatment strategies. In recent years, many researchers have applied clustering algorithms to sepsis patients. However, many existing approaches require aggregating or imputing temporal Electronic Health Records (EHRs), which can limit the model's ability to capture disease progression. Furthermore, existing clustering processes seldom incorporate domain-driven constraints, often resulting in phenotypes that lack clear clinical distinction. We propose a novel clustering network, NPCNet, that comprises a text embedding generator, a clustering operator, and a target navigator. We first transformed EHRs into pseudo texts by discretizing continuous clinical measurements and integrated them with static variables to construct the embeddings. The target navigator then infused clinical knowledge into the embeddings through auxiliary tasks, constraining clustering results to better align sepsis phenotypes with clinical significance. Finally, the clustering operator employed an iterative refinement mechanism to jointly optimize phenotype centroids and patient representations under domain-driven constraints. Extensive experiments on public datasets demonstrated that NPCNet achieved superior performance on both internal clustering and clinical metrics. We identify four distinct sepsis phenotypes with divergent SOFA trajectories. Notably, although α and δ exhibit similarly severe conditions initially, NPCNet distinguishes patients likely to improve (α) from those at risk of deterioration (δ). Furthermore, treatment effect analysis suggests that early vasopressor administration may be associated with improved outcomes in the α, \{beta}, and δ phenotypes. These findings highlight NPCNet's potential for phenotype-specific treatment strategies.