{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:10:58Z","timestamp":1788952258334,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"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>Lactate in cardiogenic shock is commonly summarized by a single measurement or a two-point estimate of clearance, although its first-day pattern may offer a more interpretable account of early clinical evolution. We examined whether first-day lactate trajectories identify reproducible patterns associated with subsequent mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicohort study used MIMIC-IV for trajectory discovery and internal prediction modeling and eICU-CRD to evaluate transportability. Adults with a first ICU admission for cardiogenic shock and at least two lactate measurements within 24\u2005h were eligible for trajectory construction. Primary analyses were restricted to patients alive and still hospitalized at a 24-hour landmark.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four patterns were identified among 2,181 eligible MIMIC-IV patients: low-stable, moderate-decreasing, high-decreasing, and persistent-high. The 24-hour landmark risk set included 2,015 patients, with subsequent mortality ranging from 24.34% to 72.88%. Compared with low-stable, adjusted odds ratios were 2.08 [95% confidence interval (CI) 1.56\u20132.77] for high-decreasing and 5.81 (95% CI 3.57\u20139.46) for persistent-high. After centering each trajectory at its initial window, the increasing pattern remained associated with mortality after adjustment for initial lactate and clinical covariates (odds ratio 2.91, 95% CI 1.75\u20134.85, vs. the largest-decrease pattern). In foldwise cross-validation, the trajectory model had an area under the receiver operating characteristic curve (AUROC) of 0.724 and an area under the precision-recall curve (AUPRC) of 0.572. Last lactate and initial plus last lactate performed better (AUROC 0.734 and 0.736; AUPRC 0.592 and 0.594). Among 429 landmark-eligible eICU-CRD patients assigned to fixed MIMIC-IV centroids, mortality ranged from 25.49% to 78.12%; in 366 complete cases, the adjusted risk ratio for group 4 was 2.30 (95% CI 1.47\u20133.62).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>First-day lactate trajectories provided a clinically interpretable framework for characterizing lactate burden and evolution after repeated testing. The low-stable and persistent-high extremes showed the most consistent cross-database separation, whereas the four-group partition should be interpreted as a descriptive continuum rather than four validated clinical risk classes. Simpler last-lactate summaries provided better discrimination when prediction alone was the objective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1948425","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:18:15Z","timestamp":1788949095000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["First-day lactate trajectories and subsequent in-hospital mortality in cardiogenic shock: a landmark multicohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaoye","family":"Xu","sequence":"first","affiliation":[{"name":"Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tielong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hangzhou TCM Hospital Affiliated with Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Ying","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hangzhou TCM Hospital Affiliated with Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huili","family":"Zhou","sequence":"additional","affiliation":[{"name":"Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hangzhou TCM Hospital Affiliated with Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Wang","sequence":"additional","affiliation":[{"name":"Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengqin","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hangzhou TCM Hospital Affiliated with Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jacc.2022.04.049","article-title":"Criteria for defining stages of cardiogenic shock severity","volume":"80","author":"Kapur","year":"2022","journal-title":"J Am Coll 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