The Impact of Hydroxocobalamin on Vasodilatory Shock: A Systematic Review and Meta-analysis Study
Bibliographic record
Abstract
Background: Vasodilatory shock, defined as systemic vasodilation and impaired tissue perfusion, is a critical condition associated with high morbidity and mortality in critically ill patients. Current treatments often include norepinephrine as the first-line vasopressor, but there is limited guidance on secondary agents for refractory vasodilatory shock. Hydroxocobalamin (HCB), a Vitamin B12 derivative, has emerged as a potential therapy due to its nitric oxide binding and antioxidant properties. This systematic review and meta-analysis evaluated the impact of HCB on vasodilatory shock in critically ill patients. Methods: A systematic search was conducted across a comprehensive literature search through PubMed, Web of Science, Scopus, and Cochrane. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing HCB pre–postadministration, placebo, and methylene blue. The primary outcomes were vasopressor requirements and mean arterial pressure (MAP), while the secondary outcomes included systemic vascular resistance (SVR), intensive care unit (ICU), hospital length of stay (LOS), mortality, and renal replacement therapy (RRT). The meta-analysis assessed the quality using the Newcastle-Ottawa scale and the ROB2 tool. Results: Of 1793 studies screened, eight studies (one RCT and seven observational) with 467 patients were included. HCB significantly reduced vasopressor requirements within 30–60 min of postadministration (mean difference [MD]: −0.07 mcg/kg/min, 95% confidence interval [CI]: −0.11 to − 0.03) and increased MAP (MD: 7.91 mmHg, 95% CI: 5.36 to 10.47) compared to preadministration. However, no significant differences were observed in hospital or ICU LOS, mortality, MAP after 24 h, SVR, or the need for RRT. Conclusion: HCB demonstrates a reduction in vasopressor requirements and a transient increase in MAP in vasodilatory shock. However, it does not have a statistically significant impact on longer-term outcomes such as ICU LOS or mortality. Further high-quality studies and RCTs are needed to confirm the HCB impact on vasodilatory 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 | 0.012 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.042 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| 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".