Adrenomedullin: A Double-edged Sword in Septic Shock and Heart Failure Therapeutics?
Bibliographic record
Abstract
We agree that fluid administered during initial sepsis resuscitation, before ICU admission, is a crucial consideration for randomized trials of fluid management in critical illness.A strength of the current analysis is that, for patients presenting to the emergency department or operating room, choice of crystalloid was controlled from initial presentation through ICU discharge-a key difference from other randomized trials studying crystalloid composition in critically ill patients (5).Further research is needed to specifically evaluate the relative effects of crystalloid composition during initial resuscitation in the emergency department compared with fluid administration after ICU admission.We also thank Dr. Hammond and colleagues for their metaanalysis combining the results of our SMART sepsis subgroup analysis with results from prior studies comparing balanced crystalloids to saline among patients with sepsis.In their metaanalysis, the point estimate favored balanced crystalloids over saline for all outcomes, and 95% confidence intervals demonstrated a statistically significant difference (major adverse kidney events and acute kidney injury) or approached a statistically significant difference (receipt of renal replacement therapy and death).We agree that, while awaiting additional data, using of balanced crystalloids rather than saline for adults with sepsis is reasonable.
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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 | 0.012 | 0.058 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.004 | 0.009 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.032 | 0.048 |
| Insufficient payload (model declined to judge) | 0.005 | 0.004 |
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".