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Abstract Background Patient heterogeneity poses significant challenges for managing individuals and designing clinical trials, especially in complex diseases. Existing classifications rely on outcome-predicting scores, potentially overlooking crucial elements contributing to heterogeneity without necessarily impacting prognosis. Methods To address patient heterogeneity, we developed ClustALL, a computational pipeline that simultaneously faces diverse clinical data challenges like mixed types, missing values, and collinearity. ClustALL enables the unsupervised identification of patient stratifications while filtering for stratifications that are robust against minor variations in the population (population-based) and against limited adjustments in the algorithm’s parameters (parameter-based). Results Applied to a European cohort of patients with acutely decompensated cirrhosis (n = 766), ClustALL identified five robust stratifications, using only data at hospital admission. All stratifications included markers of impaired liver function and number of organ dysfunction or failure, and most included precipitating events. When focusing on one of these stratifications, patients were categorized into three clusters characterized by typical clinical features; notably, the 3-cluster stratification showed a prognostic value. Re-assessment of patient stratification during follow-up delineated patients’ outcomes, with further improvement of the prognostic value of the stratification. We validated these findings in an independent prospective multicentre cohort of patients from Latin America (n = 580). Conclusions By applying ClustALL to patients with acutely decompensated cirrhosis, we identified three patient clusters. Following these clusters over time offers insights that could guide future clinical trial design. ClustALL is a novel and robust stratification method capable of addressing the multiple challenges of patient stratification in most complex diseases.

Complexes displaying multiple bonds between different metal atoms have considerable synthetic potential because of the combination of the high electronic and coordinative unsaturation associated to multiple bonds with the intrinsic polarity of heterometallic bonds but their number is scarce and its chemistry has been relatively little explored. In a preliminary study, our attempted synthesis of the unsaturated hydrides [MoMCp(μ-H)(μ-PR2)(CO)5] from anions [MoMCp(μ-PR2)(CO)5]− and (NH4)PF6 yielded instead the ammonia complexes [MoMCp(μ-H)(μ-PR2)(CO)5(NH3)] (M = Mn, R = Ph; M = Re, R = Cy). We have now examined the structure and behaviour of the MoMn complex (Mo⁻Mn = 3.087(3) Å) and found that it easily dissociates NH3 (this requiring some 40 kJ/mol, according to DFT calculations), to yield the undetectable unsaturated hydride [MoMnCp(μ-H)(μ-PPh2)(CO)5] (computed Mo⁻Mn = 2.796 Å), the latter readily adding simple donors L such as CNR (R = Xyl, p-C6H4OMe) and P(OMe)3, to give the corresponding electron-precise derivatives [MoMnCp(μ-H)(μ-PPh2)(CO)5(L)]. Thus the ammonia complex eventually behaves as a synthetic equivalent of the unsaturated hydride [MoMnCp(μ-H)(μ-PPh2)(CO)5]. The isocyanide derivatives retained the stereochemistry of the parent complex (Mo⁻Mn = 3.0770(4) Å when R = Xyl) but a carbonyl rearrangement takes place in the reaction with phosphite to leave the entering ligand trans to the PPh2 group, a position more favoured on steric grounds.