{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:04:00Z","timestamp":1784311440891,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chung-Ang University Research Grants in 2024","award":["20240087"],"award-info":[{"award-number":["20240087"]}]},{"name":"Samsung Medical Center Research Fund","award":["SMO 1220811"],"award-info":[{"award-number":["SMO 1220811"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute respiratory failure (ARF) is a leading cause of intensive care unit (ICU) admission and is frequently complicated by shock. However, the prognostic significance of shock at ICU admission across the heterogeneous ARF population remains incompletely defined. We aimed to evaluate the association between shock at ICU admission and mortality in patients with ARF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 3,497 adult patients with ARF admitted to a tertiary medical center ICU in South Korea between January 2019 and December 2023. Shock was defined as the need for vasopressor or inotropic support at ICU admission. The primary outcome was hospital mortality, and the secondary outcome was ICU mortality. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3,497 patients, 652 (18.6%) had shock at ICU admission. Patients with shock had significantly higher ICU mortality (46.4% vs. 17.1%) and hospital mortality (56.4% vs. 26.2%) compared with those without shock. After adjustment for potential confounders, shock remained independently associated with increased ICU mortality (aHR 1.84; 95% CI 1.56\u20132.17) and hospital mortality (aHR 1.58; 95% CI 1.37\u20131.82). This association was consistent across subgroups stratified by illness severity, respiratory support modality, and neutropenia status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Shock at ICU admission was independently associated with increased mortality in patients with ARF, with consistent findings across clinically relevant subgroups. The presence of shock at ICU admission may serve as a readily identifiable marker for risk stratification in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353556","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:29:22Z","timestamp":1784309362000},"page":"e0353556","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of shock at ICU admission in acute respiratory failure"],"prefix":"10.1371","volume":"21","author":[{"given":"Tae Wan","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3794-1889","authenticated-orcid":true,"given":"Jae Young","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6637-1352","authenticated-orcid":true,"given":"Joonho","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Song","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Ryang","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8138-1367","authenticated-orcid":true,"given":"Jeong Hoon","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gee Young","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4945-5623","authenticated-orcid":true,"given":"Ryoung-Eun","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"pone.0353556.ref001","doi-asserted-by":"crossref","DOI":"10.1097\/01.CCM.0000057906.89552.8F","article-title":"Epidemiology and outcome of acute respiratory failure in intensive care unit patients","volume":"31","author":"JL Vincent","year":"2003","journal-title":"Crit Care Med"},{"issue":"6","key":"pone.0353556.ref002","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1378\/chest.11-1197","article-title":"Epidemiology of critical care syndromes, organ failures, and life-support interventions in a suburban US community","volume":"140","author":"R Cartin-Ceba","year":"2011","journal-title":"Chest"},{"issue":"3","key":"pone.0353556.ref003","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1177\/0885066605282784","article-title":"The changing epidemiology of mechanical ventilation: a population-based study","volume":"21","author":"SS Carson","year":"2006","journal-title":"J Intensive Care Med"},{"issue":"6","key":"pone.0353556.ref004","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1164\/ajrccm.159.6.9808136","article-title":"Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. 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