The immunomodulatory effect of continuous ultrafiltration during pediatric cardiac surgery
Bibliographic record
Abstract
Background Cardiopulmonary bypass is associated with systemic inflammation during pediatric cardiac surgery and features elevated systemic concentrations of complement, cytokines and chemokines. The objective of this study is to quantify the immunologic efficacy of ultrafiltration (UF) used continuously throughout CPB. Methods Pediatric patients were enrolled in a single-arm prospective clinical study (NCT05154864) and received standard cardiac operations, CPB and subzero-balance ultrafiltration (SBUF) with an effluent extraction rate of 30 mL/kg/hr and conventional ultrafiltration (CUF). Paired arterial and UF effluent samples were taken at regular intervals during CPB and the concentration of 33 inflammatory mediators were measured. An exploratory counterfactual analysis assessed whether UF removed a significant amount of mediator mass using area under the curve (AUC), generalized linear mixed-effects models (GLMEM), and median fold change [95% CI] comparisons between observed data (UF) and reconstructed counterfactual data (no UF). Results Forty consecutive eligible consenting patients participated; the majority were male (58%), age of 7.3 (1.7 – 39.0) months and weight of 6.7 (4.6 – 14.9) kg. All patients received UF therapy with effluent extraction of 155 (100 – 185) ml/kg during CPB. C3a, C5a, TNF, IL-1α, IL-1β, IL-1Ra, IL-2, IL-6, IL-10, CCL2, CCL3, CCL4, CXCL1, CXCL2, CXCL8, ET1, GM-CSF and TRAIL were detected in the UF effluent. In the counterfactual analysis, only C3a was significantly extracted by UF using AUC ( p = 3.5 × 10 −12 ), GLMEM ( p = 2.3 × 10 −87 ), and median fold change [95% CI] as C3a showed a decrease of −0.2 [−0.3 to 0] relative to CPB initiation, in the observed data, compared to the counterfactual with a median fold increase of 4.3 [3.1 – 5.3]. Conclusions Ultrafiltration during pediatric CPB extracts cytokines and chemokines continuously throughout CPB with relatively low effectiveness. In an exploratory counterfactual analysis, C3a was the only inflammatory mediator meaningfully removed from the circulation by UF.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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".