{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:27:00Z","timestamp":1787304420114,"version":"build-2736575974"},"reference-count":20,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cardiac surgery with cardiopulmonary bypass (CPB) often induces systemic inflammatory reaction syndrome (SIRS), affecting postoperative outcome. We aimed to explore adaptive\/maladaptive inflammation using unsupervised machine learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a post hoc analysis of 1908 adult patients who underwent elective cardiac surgery with CPB between June 2016 and June 2020 at a single institution. Patients were assessed for SIRS 12\u00a0hours post-surgery and clustered using the partitioning around medoids (PAM) algorithm based on Gower distance. The influence of SIRS on a composite outcome comprising death, stroke\/TIA, renal replacement therapy, reoperation for bleeding, mechanical circulatory support, and ICU stay &gt;96\u00a0hours was analyzed via multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SIRS occurred in 28.7% of patients (median age 69\u00a0years; 68.7% male). Clustering revealed two subgroups: maladaptive SIRS (52.9%) with higher preoperative risk and worse outcomes, and adaptive SIRS (47.1%) with favorable outcomes. Maladaptive SIRS patients had higher 30-day mortality (21.7% vs 1.6%, p &lt; .001). Adaptive SIRS patients had outcomes similar to SIRS-negative controls. In selected clusters, SIRS was independently associated with a lower risk of the composite outcome (OR 0.44; 95% CI 0.26-0.74, p = .002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Unsupervised machine learning effectively identifies adaptive and maladaptive SIRS in cardiac surgery patients, providing a basis for personalized postoperative care. Several clinical and procedural factors associated with maladaptive SIRS may be modifiable, supporting future precision strategies to reduce harmful inflammation after cardiac surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591251372507","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T22:40:54Z","timestamp":1756334454000},"page":"1042-1054","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Unsupervised machine learning to explore inflammation following cardiopulmonary bypass"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6887-747X","authenticated-orcid":false,"given":"Enrico","family":"Squiccimarro","sequence":"first","affiliation":[{"name":"University of Foggia"},{"name":"Maastricht University Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1777-2045","authenticated-orcid":false,"given":"Roberto","family":"Lorusso","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre"},{"name":"Cardiovascular Research Institute Maastricht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Vetuschi","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Rauseo","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Paternoster","sequence":"additional","affiliation":[{"name":"University of Basilicata"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Speziale","sequence":"additional","affiliation":[{"name":"GVM Care & Research"},{"name":"GVM Care & Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P","family":"Whitlock","sequence":"additional","affiliation":[{"name":"McMaster University"},{"name":"Population Health Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Paparella","sequence":"additional","affiliation":[{"name":"University of Foggia"},{"name":"GVM Care & Research"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivac241"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2025.03.011"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.06.052"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivac243"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14171"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2024.12.013"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/ni1274"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2009.03893.x"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2019.01.043"},{"issue":"3","key":"e_1_3_5_11_2","first-page":"ivaf066","article-title":"Sex-related differences in systemic inflammatory response and outcomes after cardiac surgery and cardiopulmonary bypass","volume":"40","author":"Squiccimarro E","year":"2025","unstructured":"Squiccimarro E, Lorusso R, Margari V, et al. 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