Inadequate Oxygen Delivery During Cardiopulmonary Bypass Drives Inflammatory Reaction after Cardiac Surgery
Bibliographic record
Abstract
OBJECTIVES: Systemic inflammatory response syndrome (SIRS) is a common complication following cardiopulmonary bypass (CPB), associated with increased mortality. We assessed the relationship between indexed oxygen delivery (DO2i) during CPB and SIRS. METHODS: We conducted a prospective observational study at 2 institutions. The primary end-point was clinically-defined SIRS 12 hours after surgery. The secondary end-point was a composite outcome comprising death, TIA/stroke, renal replacement therapy, bleeding, mechanical circulatory support, or intensive care unit (ICU) stay >96 hours. The primary analysis modelled DO2i in multivariable logistic regression. Linearity was assessed with restricted cubic splines, knot-sensitivity, quintiles, and piecewise fits. The optimal ROC-derived threshold was explored. Patients above and below the threshold were matched 1:1 by propensity score. Structural equation modelling (SEM) assessed mediation between DO2i, SIRS, and outcomes. RESULTS: Of 1154 patients screened, 908 were analysed; 221 (24.3%) developed SIRS. Median DO2i was lower in the SIRS group (274 vs 302 mL/min/m2, P < .001). DO2i was inversely associated with SIRS (aOR 0.798; 95% CI 0.750-0.850, P < .001, per +10 mL/min/m2). In the secondary analysis, DO2i ≤293 mL/min/m2 was identified as threshold (sensitivity 62%, specificity 74%). Propensity score matched 390 patient pairs, with higher SIRS incidence in the low-DO2i group (33.3% vs 14.4%; P < .001). The composite outcome occurred more frequently in the low-DO2i cohort (17.7% vs 8.2%; P < .001). SEM showed mediation by SIRS, accounting for 46.2% of the DO2i effect on outcomes (OR 1.052; 95% CI 1.036-1.067; P < .001). CONCLUSIONS: Low DO2i during CPB predicts SIRS and adverse outcomes. Goal-directed perfusion to reduce inflammation warrants evaluation in randomized trials.
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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 | 0.007 |
| 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 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".