{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T18:25:09Z","timestamp":1786904709832,"version":"build-2736575974"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Goal-directed perfusion during cardiopulmonary bypass (CPB) has traditionally focused on indexed oxygen delivery (DO\n                      <jats:sub>2<\/jats:sub>\n                      i), yet metabolic behavior during aortic cross-clamping likely reflects a more complex interaction among oxygen delivery, oxygen extraction (O\n                      <jats:sub>2<\/jats:sub>\n                      ER), and temperature-dependent oxygen demand. We aimed to identify temperature-adjusted perfusion-metabolic phenotypes during cross-clamping and to explore their association with early postoperative outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective single-center study, perfusion data (restricted to the aortic cross-clamp period) were linked with clinical data at the case level. Variables\u2019 trajectories were normalized in time, resampled at 15 equidistant points, and represented using DO\n                      <jats:sub>2<\/jats:sub>\n                      i, O\n                      <jats:sub>2<\/jats:sub>\n                      ER, and temperature-adjusted indexed oxygen consumption and carbon dioxide production corrected to 37\u00b0C with a Q10-based approach (VO\n                      <jats:sub>2<\/jats:sub>\n                      i_37eq and VCO\n                      <jats:sub>2<\/jats:sub>\n                      i_37eq). Principal component analysis and k-means clustering were applied. Logistic regression was used to assess the association between cluster membership and postoperative acute kidney injury (AKI) according to KDIGO criteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy patients were included (mean age 64.3\u00a0years, 35.7% females). A 3-cluster solution identified a low-extraction\/low-metabolic-demand phenotype, a high-delivery\/compensated-metabolic-demand phenotype, and a high-extraction\/high-metabolic-stress phenotype. The latter showed the highest incidence of AKI of any stage (53.1%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.034), the highest incidence of stage 2\u20133 AKI (18.8%), greater postoperative creatinine increase, and longer intensive care unit stay. In multivariable logistic regression, this phenotype remained associated with postoperative AKI after exploratory multivariable adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Temperature-adjusted unsupervised analysis of perfusion trajectories identified three physiologically coherent phenotypes. The high-extraction\/high-metabolic-stress phenotype was associated with the least favorable early postoperative renal profile, supporting a GDP framework beyond DO\n                      <jats:sub>2<\/jats:sub>\n                      i alone.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261477624","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:22:10Z","timestamp":1786706530000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Temperature-adjusted perfusion-metabolic phenotyping during cardiopulmonary bypass: An exploratory study"],"prefix":"10.1177","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"}]},{"given":"Sara","family":"Catalano","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Colombaro","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Doronzo","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Martulli","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruggiero","family":"Rociola","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Vetuschi","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Di Mauro","sequence":"additional","affiliation":[{"name":"University of Foggia"},{"name":"Maastricht University Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Paparella","sequence":"additional","affiliation":[{"name":"University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.05.069"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf362"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf340"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.04.045"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2026.02.018"},{"key":"e_1_3_7_7_2","doi-asserted-by":"crossref","unstructured":"Sharabiani MTA Mahani AS Issitt RW et al. Towards goal-directed perfusion - part II: temperature dependence of Q10 oxygen-demand dependence on age and weight further clinical insights. Perfusion 2025; 2676591251385838. https:\/\/doi.org\/10.1177\/02676591251385838 Epub ahead of print 14.","DOI":"10.1177\/02676591251385838"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2024.12.013"},{"key":"e_1_3_7_9_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. Sex-related differences in systemic inflammatory response and outcomes after cardiac surgery and cardiopulmonary bypass. Interdiscip Cardiovasc Thorac Surg 2025; 40: ivaf066. https:\/\/doi.org\/10.1093\/icvts\/ivaf066","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"e_1_3_7_10_2","first-page":"1","article-title":"KDIGO clinical practice guideline for acute kidney injury","volume":"2","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group","year":"2012","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 1\u2013138.","journal-title":"Kidney Int Suppl"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/02676591231211503"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261477624","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591261477624","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261477624","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T17:49:37Z","timestamp":1786902577000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591261477624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":10,"alternative-id":["10.1177\/02676591261477624"],"URL":"https:\/\/doi.org\/10.1177\/02676591261477624","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"article-number":"02676591261477624"}}