Significance of lactate clearance in septic shock patients with high bilirubin levels.
Bibliographic record
Abstract
Abstract Background Although lactate clearance is affected by hepatic function, it is unclear whether the hepatic dysfunction is associated with lactate clearance as a prognostic marker of clinical outcomes in septic shock. We aimed to evaluate association between the lactate clearance and mortality divided by hepatic dysfunction based on total bilirubin level using two cohort of septic shock patients. Methods Lactate clearance, delta base excess and delta anion gap in 24 hours from septic shock onset were analyzed using two cohorts of septic shock patients (derivation cohort, n = 230; validation cohort, n = 396) categorized into two groups by total bilirubin levels (TBIL) < 2 mg/dL and ≥ 2 mg/dL on day 1. The primary analysis was association between lactate clearance and 28-day mortality by total bilirubin category. Results In derivation cohort, lactate clearance was lower in non-survivors compared to survivors in the patients with TBIL ≥ 2 mg/dL (P = 0.0035), while there was a no significant difference in those with TBIL < 2 mg/dL. There were no significant differences in delta base excess and delta anion gap between non-survivors and survivors both in the patients with TBIL ≥ 2 mg/dL and < 2 mg/dL. In the multivariate logistic regression analysis, increased lactate clearance was significantly associated with decreased 28-day mortality in TBIL ≥ 2 mg/d group (10% lactate clearance, adjusted odds ratio 0.88, 95%CI; 0.80–0.97, P = 0.0075), whereas there was no significant association in TBIL < 2 mg/d group. We next tested for lactate clearance in TBIL ≥ 2 mg/dL using the validation cohort; lactate clearance was lower in non-survivors compared to survivors in the TBIL ≥ 2 mg/dL group (P = 0.0006), while no significant difference was observed in TBIL < 2 mg/dL. Increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted odds ratio 0.89, 95%CI; 0.83–0.96, P = 0.0038); while no significant difference was observed in TBIL < 2 mg/dL in the validation cohort. Conclusions Patients with increased lactate clearance had decreased 28-day mortality when patients had hepatic dysfunction (TBIL ≥ 2 mg/dL) in septic shock.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".