Preceding organ trajectories guide dynamic reassessment after apparent stabilisation in sepsis

Apparent organ recovery can conceal residual vulnerability in sepsis. Across 19,690 adults in four intensive care databases, we evaluated six-hour deterioration in low-severity organs after transition to single-organ dysfunction. At 2,492 eICU reassessment alerts, adding preceding organ trajectories increased capture from 219 to 282 episodes (28.8%; difference 63, 95% CI 38.0 to 93.5). Reassessment depended on the availability and updating of that history. Withholding half of record batches lost 108.3 captures; adaptation recovered approximately one third, and targeted retrieval increased timely correct nominations from 151 to 163. New measurements modified the value of earlier history, while local calibration and alert scheduling improved external reassessment. Among 813 norepinephrine-treated patients, history improved hypotension-or-death discrimination (AUROC 0.5925 to 0.6929) and, in the fixed-model comparison, concentrated larger estimated recorded exposure reductions across treatment priorities (AUTOC difference 25.68 micrograms/kg, 95% CI 5.23 to 46.16). These findings support retaining organ trajectories for dynamic reassessment and treatment prioritisation.