{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:59:00Z","timestamp":1780894740041,"version":"3.54.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypoxic hepatitis (HH) after on-pump coronary artery bypass grafting (CABG) is associated with poor outcomes, but dedicated prediction tools are lacking. We developed and internally validated a parsimonious model for severe postoperative aminotransferase elevation compatible with HH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center study included 626 consecutive adults who underwent CABG with cardiopulmonary bypass at Beijing Anzhen Hospital between June 2020 and June 2023. The outcome was peak postoperative alanine aminotransferase or aspartate aminotransferase \u2265800 U\/L after exclusion of alternative causes of acute liver injury during data extraction. Missing predictor data were addressed with random-forest multiple imputation (20 datasets). Prespecified predictors were screened with LASSO penalized logistic regression in each imputed dataset using 10-fold cross-validation; stably selected variables entered the final logistic model. Internal validation used bootstrap optimism correction, with temporal split and complete-case analyses as secondary analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The outcome occurred in 57\/626 patients (9.1%) and was associated with higher in-hospital mortality (49.1% vs. 4.6%;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Final predictors were total sternotomy count (OR 3.533, 95% CI 1.724\u20137.241), cardiopulmonary bypass duration (OR 1.047 per minute, 95% CI 1.035\u20131.059), and peak intraoperative lactate (OR 1.403 per mmol\/L, 95% CI 1.251\u20131.574). Apparent and optimism-corrected AUCs were 0.907 and 0.903; temporal validation AUC was 0.955.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A three-predictor model estimated the risk of severe postoperative aminotransferase elevation compatible with HH after on-pump CABG and may support intraoperative or early postoperative risk awareness. External validation is required before routine use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1785046","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:23:38Z","timestamp":1780892618000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of a prediction model for hypoxic hepatitis after coronary artery bypass grafting with cardiopulmonary bypass"],"prefix":"10.3389","volume":"13","author":[{"given":"Yan","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya Mei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1111\/j.1478-3231.2011.02655.x","article-title":"Hypoxic hepatitis.","volume":"32","author":"Henrion","year":"2011","journal-title":"Liver Internat."},{"key":"B2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.26574\/maedica.2018.13.1.5","article-title":"Ischemic hepatitis - intercorrelated pathology.","volume":"13","author":"Ciobanu","year":"2018","journal-title":"Maedica."},{"key":"B3","doi-asserted-by":"publisher","first-page":"239","DOI":"10.14218\/JCTH.2020.00126","article-title":"Progress in the clinical features and pathogenesis of abnormal liver enzymes in coronavirus disease 2019.","volume":"9","author":"Wu","year":"2021","journal-title":"J Clin Transl Hepatol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"100834","DOI":"10.1016\/j.resplu.2024.100834","article-title":"Hypoxic hepatitis in survivors of cardiac arrest: a systematic review and meta-analysis.","volume":"20","author":"Gao","year":"2024","journal-title":"Resusc Plus."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1007\/s00134-009-1508-2","article-title":"Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients.","volume":"35","author":"Fuhrmann","year":"2009","journal-title":"Intensive Care Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s13613-018-0356-z","article-title":"Epidemiology, causes, evolution and outcome in a single-center cohort of 1116 critically ill patients with hypoxic hepatitis.","volume":"8","author":"Van den Broecke","year":"2018","journal-title":"Ann Intensive Care."},{"key":"B7","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1016\/j.jfma.2019.08.028","article-title":"Impact of MELD score and cardiopulmonary bypass duration on post-operative hypoxic hepatitis in patients with liver cirrhosis undergoing open heart surgery.","volume":"119","author":"Chou","year":"2020","journal-title":"J Formos Med Assoc."},{"key":"B8","doi-asserted-by":"publisher","first-page":"101665","DOI":"10.1016\/j.clinre.2021.101665","article-title":"Clinical characteristics and outcomes of COVID-19 patients with hypoxic hepatitis.","volume":"45","author":"Wu","year":"2021","journal-title":"Clin Res Hepatol Gastroenterol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"701537","DOI":"10.3389\/fcvm.2021.701537","article-title":"Development and validation of a diagnostic model to predict the risk of ischemic liver injury after stanford A aortic dissection surgery.","volume":"8","author":"Liu","year":"2021","journal-title":"Front Cardiovasc Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/BF01324740","article-title":"Ischemic hepatitis.","volume":"24","author":"Bynum","year":"1979","journal-title":"Digest Dis Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1097\/00004836-199612000-00016","article-title":"Ischemic hepatitis: the need for precise criteria.","volume":"23","author":"Henrion","year":"1996","journal-title":"J Clin Gastroenterol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/s0002-9343(00)00461-7","article-title":"Ischemic hepatitis: clinical presentation and pathogenesis.","volume":"109","author":"Seeto","year":"2000","journal-title":"Am J Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1016\/j.amjmed.2015.07.033","article-title":"The incidence and outcomes of ischemic hepatitis: a systematic review with meta-analysis.","volume":"128","author":"Tapper","year":"2015","journal-title":"Am J Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"263","DOI":"10.14218\/JCTH.2016.00022","article-title":"Hypoxic hepatitis: a review and clinical update.","volume":"4","author":"Waseem","year":"2016","journal-title":"J Clin Transl Hepatol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1002\/hep.30824","article-title":"Liver injury and failure in critical illness.","volume":"70","author":"Horvatits","year":"2019","journal-title":"Hepatology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.4254\/wjh.v13.i11.1688","article-title":"Abnormal liver enzymes: a review for clinicians.","volume":"13","author":"Kalas","year":"2021","journal-title":"World J Hepatol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"607206","DOI":"10.3389\/fmed.2020.607206","article-title":"Prevalence and characteristics of hypoxic hepatitis in COVID-19 patients in the intensive care unit: a first retrospective study.","volume":"7","author":"Huang","year":"2020","journal-title":"Front Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1016\/j.jtcvs.2021.01.028","article-title":"Modern practice and outcomes of reoperative cardiac surgery.","volume":"164","author":"Kindzelski","year":"2022","journal-title":"J Thoracic Cardiovasc Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1186\/s12872-023-03664-3","article-title":"Association between cardiopulmonary bypass time and mortality among patients with acute respiratory distress syndrome after cardiac surgery.","volume":"23","author":"Hu","year":"2023","journal-title":"BMC Cardiovasc Disord."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1165912","DOI":"10.3389\/fmed.2023.1165912","article-title":"Prediction of lactate concentrations after cardiac surgery using machine learning and deep learning approaches.","volume":"10","author":"Kobayashi","year":"2023","journal-title":"Front Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1186\/s12893-025-03082-6","article-title":"Association between intraoperative lactate levels and acute kidney injury after on-pump cardiac surgery: a retrospective cohort study across two centers.","volume":"25","author":"Chen","year":"2025","journal-title":"BMC Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"513","DOI":"10.15562\/bmj.v14i2.5607","article-title":"The correlation between cardiopulmonary bypass time and lactate levels and the length of stay in intensive care unit in post-operative patients of coronary artery bypass grafting surgery.","volume":"14","author":"Utami","year":"2025","journal-title":"Bali Med J."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v045.i03","article-title":"Mice: multivariate imputation by chained equations inR.","volume":"45","author":"Buuren","year":"2011","journal-title":"J Stat Softw."},{"key":"B24","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1093\/aje\/kwt312","article-title":"Comparison of random forest and parametric imputation models for imputing missing data using MICE: a CALIBER study.","volume":"179","author":"Shah","year":"2014","journal-title":"Am J Epidemiol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression Shrinkage and Selection Via the Lasso.","volume":"58","author":"Tibshirani","year":"1996","journal-title":"J R Stat Soc B."},{"key":"B26","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression Modeling Strategies : With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis.","author":"Harrell","year":"2015"},{"key":"B27","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1023\/A:1010933404324","article-title":"Random forests.","volume":"45","author":"Breiman","year":"2001","journal-title":"Mach Learn."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e078378","DOI":"10.1136\/bmj-2023-078378","article-title":"TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods.","volume":"385","author":"Collins","year":"2024","journal-title":"Bmj."},{"key":"B29","doi-asserted-by":"publisher","first-page":"W1","DOI":"10.7326\/M18-1377","article-title":"PROBAST: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration.","volume":"170","author":"Moons","year":"2019","journal-title":"Ann Internal Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.resuscitation.2016.03.021","article-title":"Hypoxic hepatitis after out-of-hospital cardiac arrest: incidence, determinants and prognosis.","volume":"103","author":"Champigneulle","year":"2016","journal-title":"Resuscitation."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2994","DOI":"10.3390\/jcm9092994","article-title":"The impact of hypoxic hepatitis on clinical outcomes after extracorporeal cardiopulmonary resuscitation.","volume":"9","author":"Lee","year":"2020","journal-title":"J Clin Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1035675","DOI":"10.3389\/fcvm.2022.1035675","article-title":"Prediction of 30-day mortality in heart failure patients with hypoxic hepatitis: development and external validation of an interpretable machine learning model.","volume":"9","author":"Sun","year":"2022","journal-title":"Front Cardiovasc Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/BF01536147","article-title":"Plugged liver biopsy in patients with impaired coagulation.","volume":"34","author":"Tobin","year":"1989","journal-title":"Digest Dis Sci."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1136\/gutjnl-2020-321299","article-title":"Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology.","volume":"69","author":"Neuberger","year":"2020","journal-title":"Gut."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1785046\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:23:39Z","timestamp":1780892619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1785046\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":34,"alternative-id":["10.3389\/fmed.2026.1785046"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1785046","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"article-number":"1785046"}}