Abstract 14409: Elucidating Clinical Phenotypes of Patients With Mixed Shock Admitted to Cardiac Intensive Care Units: Insights From the Critical Care Cardiology Trials Network
Bibliographic record
Abstract
Background: Emerging data suggests that patient with mixed cardiogenic and vasodilatory shock have high morbidity and mortality; however, this population is still poorly understood and is not well-characterized. Methods: The Critical Care Cardiology Trials Network is a multicenter network of advanced cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Each CICU contributed an annual 2-month period of all consecutive medical CICU admissions from 2017-2020 (n=13,300). Mixed shock (MS) subjects were stratified into those with acute MI (AMI-MS) and those without (non-AMI-MS). Results: Among 3884 CICU admissions with shock, 840 (22%) presented with MS; 169 AMI-MS and 671 non-AMI-MS. Mean age was 66y, 37.1% were female, and 69.5% were white. Median Sequential Organ Failure Assessment was 10.0 (25 th -75 th %ile, 7.0-12.5). On presentation, AMI-MS had more end-organ injury: lactate (3.5 vs. 2.7, p < 0.01) & AST (126 vs. 54, p < 0.01). AMI-MS had fewer CV & non-CV comorbidities ( p < 0.01 for all). Sepsis was less common in AMI-MS (47.8% vs. 67.6%, p < 0.0001). Use of advanced ICU therapies was high, as 25.4% overall cohort required renal replacement therapy (RRT). AMI-MS required more mechanical ventilation (81.1% vs. 67.5%, p < 0.001), invasive cardiac procedures (76.3% vs. 16.2%, p < 0.0001), and temporary mechanical support (tMCS) (56.8% vs. 16.7%, p < 0.0001). Both AMI-MS and non-AMI-MS patients had high in-hospital mortality (50.3% [95% CI 42.5% - 58.1%] & 43.5% [95% CI 39.7% - 47.4%], respectively). AMI-MS patients with a worst pH < 7.25, ≥ 3 pressors, and RRT use have a 4.9-fold, 3.9-fold, and 2.9-fold risk of in-hospital mortality, respectively (Figure). Conclusion: In a contemporary multicenter analysis of advanced CICUs, patients with mixed shock have high in-hospital mortality and frequent need for advanced ICU therapies. Patients with AMI-MS present with particularly high shock severity and subsequent resource utilization.
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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 | 0.010 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
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".