Associations Between Mean Arterial Pressure Thresholds and Clinical Outcomes in Decompensated Cirrhosis With Septic Shock
Bibliographic record
Abstract
INTRODUCTION: Short-term mortality remains high in decompensated cirrhosis patients with septic shock. While a mean arterial pressure (MAP) >65 mm Hg is recommended for the management of septic shock in the general population, the optimal MAP for decompensated cirrhosis is not well defined. We evaluated the association between various MAP thresholds, 28-day mortality, and acute kidney injury (AKI) nonrecovery. METHODS: We conducted a multicenter retrospective analysis of decompensated cirrhosis patients with septic shock admitted to intensive care units across 20 Texas hospitals (January 1, 2014-December 31, 2022). Time weighted average MAP (TWA-MAP) during the initial 72 hours of admission was calculated to quantify hypotension exposure. Multivariable logistic regression models assessed the impact of various TWA-MAP thresholds (60-90 mm Hg) on 28-day mortality and AKI nonrecovery, adjusting for relevant confounders. RESULTS: Among 1,145 patients (mean age 64, Model for End-Stage Liver Disease 26, 43% female, 19% non-White, 22% Hispanic, 38% alcohol-associated cirrhosis), 66% had AKI, with 37% nonrecovery; 28-day mortality was 56%. Increasing TWA-MAP from <60 mm Hg to 75 mm Hg was associated with a stepwise reduction in the odds of 28-day mortality (<60 odds ratio [OR] 2.775; <65 OR 1.607; <70 OR 1.305; <75 OR 1.180). However, the survival benefit plateaued >75 mm Hg. Similar associations were found for AKI nonrecovery (<60 1.151; <65 OR 1.153; <70 OR 1.110; <75 OR 1.079) and reductions attenuated >75 mm Hg. DISCUSSION: Maintaining MAP between 70 and 75 mm Hg may optimize survival and kidney recovery in patients with decompensated cirrhosis and septic shock. Randomized trials are needed to compare traditional MAP targets (60-65 mm Hg) with intermediate targets (70-75 mm Hg) to improve outcomes in this high-risk population.
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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 | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".