{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:11:38Z","timestamp":1784135498068,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"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>Objective<\/jats:title>\n                    <jats:p>To investigate the time-dependent interplay between early metabolic failure and delayed systemic inflammatory response in 24-h conditional survivors of post-cardiac arrest syndrome (PCAS). We aimed to develop a non-linear risk stratification tool using Classification and Regression Tree (CART) analysis based on serial lactate and procalcitonin (PCT) kinetics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 158 24-h conditional survivors of PCAS. Arterial lactate levels were monitored at admission (T0), 6\u202fh, 12\u202fh, 24\u202fh, and 48\u202fh, while PCT levels were recorded at T0 and T24. Missing data were handled using multiple imputation by chained equations (MICE). The primary endpoint was in-hospital mortality. A landmark analysis was performed at 24\u202fh to address immortal time bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The in-hospital mortality rate was 70.9%. Non-survivors exhibited significantly higher rates of non-shockable rhythms, longer CPR durations, and higher APACHE II scores. In the multivariable logistic regression model adjusted for Targeted Temperature Management (TTM), persistent hyperlactatemia at 48\u202fh (T48) remained a significant independent predictor of mortality (OR: 1.92; 95% CI: 1.22\u20133.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003). Lactate burden (AUC) demonstrated superior prognostic performance compared to baseline T0 measurements (Bootstrap-validated DeLong test,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.019). CART analysis identified a high-risk phenotype (T0 lactate &amp;gt;5\u202fmmol\/L AND T24 PCT\u202f&amp;gt;\u202f5.5\u202fng\/mL) associated with a 92% mortality risk (PPV: 91.8%). The CART model showed excellent calibration (Brier score: 0.14) and comparable discrimination to logistic regression (Logistic Regression Brier score: 0.12 vs. CART Brier score: 0.14; AUC: 0.830 vs. 0.842,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.412).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In 24-h conditional survivors of PCAS, persistent metabolic debt at 48\u202fh is a potent independent biochemical indicator of poor outcome. Integrating serial lactate and PCT kinetics through non-linear CART analysis identifies a high-risk \u201cmetabolic-inflammatory failure\u201d phenotype. This model may facilitate early clinical decision-making and guide the escalation to advanced circulatory or extracorporeal support strategies in high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1859459","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:36:01Z","timestamp":1782916561000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Serial lactate\u2013procalcitonin interaction identifies a high-risk phenotype in 24-h conditional survivors of post-cardiac arrest syndrome: a CART-based analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ali Muhittin","family":"Tasdogan","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Gaziantep University Faculty of Medicine","place":["Gaziantep, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130stemi Taha","family":"Polat","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ministry of Health Of State Hospital","place":["Trabzon, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emin Erdem","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ministry of Health Gaziantep City Hospital","place":["Gaziantep, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ufuk Ozgur","family":"Balica","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Ministry of Health \u015eanl\u0131urfa Bal\u0131kl\u0131g\u00f6l State Hospital","place":["Sanliurfa, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yavuz","family":"Saygili","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Gaziantep University Faculty of Medicine","place":["Gaziantep, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1097\/pcc.0000000000001273","article-title":"Epidemiology and outcomes of cardiac arrest in pediatric cardiac ICUs*","volume":"18","author":"Alten","year":"2017","journal-title":"Pediatr Crit Care Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"109946","DOI":"10.1016\/j.resuscitation.2023.109946","article-title":"Mortality and healthcare resource utilisation after cardiac arrest in the United States - a 10-year nationwide analysis prior to the COVID-19 pandemic","volume":"193","author":"Thevathasan","year":"2023","journal-title":"Resuscitation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4817","DOI":"10.1093\/eurheartj\/ehac414","article-title":"Trends in survival after cardiac arrest: a Swedish nationwide study over 30 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