{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:34:06Z","timestamp":1789580046106,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Study Objectives<\/jats:title><jats:p>The objective of this study was to develop and externally validate a model to predict adjunctive vasopressin response in patients with septic shock being treated with norepinephrine for bedside use in the intensive care unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This was a retrospective analysis of two adult tertiary intensive care unit septic shock populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Barnes\u2010Jewish Hospital (BJH) from 2010 to 2017 and Beth Israel Deaconess Medical Center (BIDMC) from 2001 to 2012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Two septic shock populations (548 BJH patients and 464 BIDMC patients) that received vasopressin as second\u2010line vasopressor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Patients who were vasopressin responsive were compared with those who were nonresponsive. Vasopressin response was defined as survival with at least a 20% decrease in maximum daily norepinephrine requirements by one calendar day after vasopressin initiation, without a third\u2010line vasopressor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Two supervised machine learning models (gradient\u2010boosting machine [XGBoost] and elastic net penalized logistic regression [EN]) were trained in 1000 bootstrap replications of the BJH data and externally validated in the BIDMC data to predict vasopressin responsiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>Vasopressin responsiveness was similar among each cohort (BJH 45% and BIDMC 39%). Mortality was lower for vasopressin responders compared with nonresponders in the BJH (51% vs. 73%) and BIDMC (45% vs. 83%) cohorts, respectively. Both models demonstrated modest discrimination in the training (XGBoost area under receiver operator curve [AUROC] 0.61 [95% confidence interval (CI) 0.61\u20130.61], EN 0.59 [95% CI 0.58\u20130.59]) and external validation (XGBoost 0.68 [95% CI 0.63\u20130.73], EN 0.64 [95% CI 0.59\u20130.69]) datasets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Vasopressin nonresponsiveness is common and associated with increased mortality. The models' modest performances highlight the complexity of septic shock and indicate that more research will be required before clinical decision support tools can aid in anticipating patient\u2010specific responsiveness to vasopressin.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2683","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T03:51:56Z","timestamp":1649994716000},"page":"460-471","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Machine learning to predict vasopressin responsiveness in patients with septic shock"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0482-9612","authenticated-orcid":false,"given":"Aileen","family":"Scheibner","sequence":"first","affiliation":[{"name":"Department of Pharmacy Barnes\u2010Jewish Hospital  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6007-359X","authenticated-orcid":false,"given":"Kevin D.","family":"Betthauser","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Barnes\u2010Jewish Hospital  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice F.","family":"Bewley","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Juang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Barnes\u2010Jewish Hospital  St. Louis Missouri USA"},{"name":"Department of Pharmacy Practice University of Health Sciences and Pharmacy  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Lizza","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Barnes\u2010Jewish Hospital  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Micek","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice University of Health Sciences and Pharmacy  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1557-2787","authenticated-orcid":false,"given":"Patrick G.","family":"Lyons","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05872-y"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-03419-y"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003892"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-019-2478-6"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4683-6"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005337"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202102-196OC"},{"issue":"4","key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1097\/CCM.0000000000005305","article-title":"Association between vasopressin rebranding and utilization in patients with septic shock","volume":"50","author":"Sacha GL","year":"2022","journal-title":"Crit Care Med"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-018-0379-5"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028017729480"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067373"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002323"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000059722.94182.79"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2016.35"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.10485"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.05.007"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1159\/000180580"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7992"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004246"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0697"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1145\/2939672.2939785"},{"key":"e_1_2_7_23_1","unstructured":"KuhnM WickhamH.Tidymodels: a collection of packages for modeling and machine learning using tidyverse principles.2020. 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