{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:03:11Z","timestamp":1786446191204,"version":"build-2736575974"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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 &amp;gt;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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2009&amp;lt;\u2009.001). DO2i was inversely associated with SIRS (aOR 0.798; 95% CI 0.750-0.850, P\u2009&amp;lt;\u2009.001, per +10 mL\/min\/m2). In the secondary analysis, DO2i \u2264293 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\u2009&amp;lt;\u2009.001). The composite outcome occurred more frequently in the low-DO2i cohort (17.7% vs 8.2%; P\u2009&amp;lt;\u2009.001). 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\u2009&amp;lt;\u2009.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Low DO2i during CPB predicts SIRS and adverse outcomes. Goal-directed perfusion to reduce inflammation warrants evaluation in randomized trials.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf340","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T11:57:32Z","timestamp":1759406252000},"source":"Crossref","is-referenced-by-count":2,"title":["Inadequate Oxygen Delivery During Cardiopulmonary Bypass Drives Inflammatory Reaction after Cardiac Surgery"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6887-747X","authenticated-orcid":false,"given":"Enrico","family":"Squiccimarro","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia , Foggia, 71122,","place":["Italy"]},{"name":"Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre , Maastricht, 6229 HX,","place":["The 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