{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T06:14:11Z","timestamp":1778739251217,"version":"3.51.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiogenic shock (CS) carries high short-term mortality. In this study, we test whether coexisting hypoalbuminemia and hyperchloremia (dual-index phenotype, DIP) and early intensive care unit (ICU) reassessment are associated with 28-day in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center prospective observational cohort study (January 2021\u2013December 2025), DIP was defined as albumin &amp;lt;35\u2005g\/L and chloride &amp;gt;110\u2005mmol\/L on paired laboratories within 0\u20136\u2005h of ICU admission. We used a prespecified 30\u2005h landmark: patients alive and still in the ICU at 30\u2005h formed the analytic cohort, and outcome follow-up began at the landmark. A subset with a second paired assessment at 18\u201330\u2005h was categorized as non-DIP\u2009\u2192\u2009non-DIP, non-DIP\u2009\u2192\u2009DIP, DIP\u2009\u2192\u2009non-DIP, and DIP\u2009\u2192\u2009DIP. Sensitivity analyses included baseline-only adjustment, propensity-score overlap weighting, Fine\u2013Gray competing-risk modeling, and exploratory incremental prognostic performance assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 982 screened admissions, 444 patients alive and still in the ICU at 30\u2005h comprised the analytic cohort; 74\/444 (16.7%) had baseline DIP. The 28-day in-hospital mortality rate was 18.2% (81\/444) and was higher in DIP than in non-DIP (37.8% vs. 14.3%). In the 30-h conditional model, baseline DIP remained associated with mortality [adjusted odds ratio (aOR) 2.46, 95% confidence interval (CI) 1.30\u20134.64;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005]. The results were directionally consistent in a baseline-only model (aOR 2.71, 95% CI 1.45\u20135.06), a propensity-score overlap-weighted model (OR 2.39, 95% CI 1.27\u20134.50), and a Fine\u2013Gray competing-risk model [subdistribution hazard ratio (sHR) 2.31, 95% CI 1.35\u20133.95]. Adding DIP to the clinical landmark model modestly improved discrimination (C-statistic 0.782\u20130.801). In the reassessment subset (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200996), the mortality rate was 8.3% in non-DIP\u2009\u2192\u2009non-DIP and 60.0% in DIP\u2009\u2192\u2009DIP, with wide uncertainty due to small subgroup sizes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among CS patients alive and still in the ICU at 30\u2005h, baseline DIP and persistence of DIP by approximately 24\u2005h identified a subgroup at higher risk of 28-day in-hospital death. The association was robust in baseline-only, propensity-weighted, and competing-risk sensitivity analyses, but trajectory findings remained exploratory because of small subgroup sizes. These findings apply to the selected 30\u2005h survivor cohort and should not be used as an ICU-admission prognostic model or extrapolated to early deaths, early ICU transfers, or patients without paired early laboratories without external validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1825969","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:45:52Z","timestamp":1778737552000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of a dual-index phenotype and early ICU reassessment with 28-day in-hospital mortality in cardiogenic shock: a single-center observational cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Rongtai","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Cardiac Intensive Care Unit, Meizhou People\u2019s Hospital","place":["Meizhou, Guangdong, 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China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinping","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Intensive Care Unit, Meizhou People\u2019s Hospital","place":["Meizhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e232","DOI":"10.1161\/CIR.0000000000000525","article-title":"Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association","volume":"136","author":"van Diepen","year":"2017","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1002\/ejhf.1922","article-title":"Epidemiology, pathophysiology and contemporary management of cardiogenic shock: a position statement from the Heart Failure Association of the European Society of 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