Bibliographic record
Abstract
Introduction: The VASST clinical trial compared use of vasopressin versus norepinephrine infusion in patients with septic shock. From this study, cytokine blood levels were measured in a total of 362 patients at both baseline and 24 hours in addition to approximately 300 clinical features (such as age, sex, blood pressure, temperature, dose of norepinephrine to treat). Hypothesis: Inflammatory effects are believed to underlie aspects of sepsis, so we hypothesized that cluster analysis of cytokines would independently identify subgroups of patients at risk of death or other clinical outcome such renal failure.` Methods: Cytokines were measured using a Luminex cytokine array. Hierarchical clustering was performed on cytokine values to identify patients groups. Enrichment analysis identified clinical features occurring more often than expected in each patient group. Independently, classification and regression tree analysis was performed to assess the importance of clinical features and cytokines on predicting patient outcome. Significance was assessed using over-representation analysis and survival curves. Results: Cytokine levels at baseline and 24 hours produced four similar clusters of patients with differing risks of adverse outcome or previous clinical features. With p-value < 0.05 and enrichment >50%, one cluster of 47 patients showed enrichment for severe septic shock, coagulopathy, renal failure, and risk of death at 28 days. A separate cluster of 95 patients was enriched for chronic obstructive pulmonary disease and recent surgical history but not increased risk of death. Independent of cluster analysis, tree analysis of survival indicated that IL8 levels at 24 hours had greatest predictive content for survival. Combined with IL8, patient age and dose of norepinephrine needed to treat gave the greatest predictive performance for survival rate. We noted that IL8 at was weakly but significantly correlated (spearman correlation of 0.52) with dose of norepinephrine. Conclusions: Cytokine levels in sepsis patients significantly predict risk of death and other clinical outcomes. Further analysis of cytokines may lead to enhanced understanding of the disease process in sepsis though clinical interventions may confound interpretation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.331 | 0.140 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".