[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-442819-105":59,"doc-detail-442819-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","clarifying-prognostic-and-translational-aspects-of-lactate-and-map-thresholds-in-cirrhosis-correspondence","Clarifying prognostic and translational aspects of lactate and MAP thresholds in cirrhosis - Correspondence","","Letter discussing methodological points to improve interpretation of a study on serum lactate and mean arterial pressure (MAP) thresholds in cirrhosis with septic shock. It questions whether sepsis definitions may be confounded by chronic hepatic dysfunction, highlights the need for clarification on diagnostic adjudication (Sepsis-3) and on whether dynamic lactate/MAP trends were analyzed. It also argues for modeling thresholds continuously with ROC/Youden-derived cutoffs, and for considering cirrhosis-specific circulatory physiology and subgroup contexts to enhance reproducibility and bedside applicability.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/clarifying-prognostic-and-translational-aspects-of-lactate-and-map-thresholds-in-cirrhosis-correspondence/442819/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/clarifying-prognostic-and-translational-aspects-of-lactate-and-map-thresholds-in-cirrhosis-correspondence/442819.png","ImageObject",300,407,{"name":92,"@type":93},"OmBimo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why might baseline hepatic dysfunction confound sepsis definitions in cirrhosis?","Question",{"text":113,"@type":114},"The letter notes that Sepsis definitions using SOFA ≥ 2 with positive cultures or radiographic pneumonia may conflate chronic hepatic dysfunction with infection-related organ failure, since elevated SOFA in advanced cirrhosis can reflect factors like hyperbilirubinemia or coagulopathy rather than acute sepsis.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What clarification is requested regarding lactate and MAP measurements?",{"text":118,"@type":114},"The authors ask whether only baseline lactate and MAP were analyzed or whether serial and/or time-weighted measures over 24–48 hours after resuscitation were evaluated, since dynamic trends could introduce time-varying confounders.",{"name":120,"@type":111,"acceptedAnswer":121},"How should thresholds be handled to better represent risk?",{"text":122,"@type":114},"The letter argues against purely dichotomous cutoffs (e.g., lactate ≥ 4 mmol/L, MAP ≤ 60 mm Hg) because risk may follow a continuous, nonlinear trajectory; it recommends continuous modeling (e.g., restricted cubic splines) and ROC analysis with Youden-derived optimal cutoffs with reported CIs and AUCs.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},442819,1790820776,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":24,"preview_page_count":4},962090893581,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","DOI: 10.1097/HC9.0000000000000886  \nCORRESPONDENCE  \nClarifying prognostic and translational aspects of lactate and MAP thresholds in cirrhosis  \nWe read with great interest the article by Smith et al. [1] entitled “Serum lactate and mean arterial pressure thresholds in patients with cirrhosis and septic shock.”The authors demonstrated that a lactate concentration ≥ 4 mmol/L and a mean arterial pressure (MAP)≤ 60 mm Hg were independently associated with mortality, underscoring their prognostic value in patients with cirrhosis and septic shock. These findings advance critical-care hepatology, and we wish to offer several methodological clarifications that may refine their clinical interpretation.  \nFirst, the definition of sepsis adopted (SOFA score ≥ 2 with positive cultures or radiographic pneumonia) may conflate baseline hepatic dysfunction with infection-related organ failure. In advanced cirrhosis, elevated SOFA scores may reflect chronic hyperbilirubinemia or coagulopathy rather than acute sepsis. Clarifying whether diagnostic adjudication followed Sepsis-3—“suspected infection + organ dysfunction”confirmed by clinical context—would improve comparability. [2] Moreover, only baseline lactate and MAP were analyzed; dynamic trends within 24–48 hours after resuscitation could introduce timevarying confounders. Could the authors clarify whether serial or time-weighted measures were evaluated, or whether single baseline values were modeled as fixed predictors?  \nSecond, thresholds were handled dichotomously (lactate ≥ 4 mmol/L, MAP ≤ 60 mm Hg), although physiologic risk likely follows a continuous, nonlinear trajectory. Recent studies in Hepatology Communications indicate that hemodynamic risk is better represented with restricted cubic splines. [3] In addition, ROC analysis with the Youden index can empirically verify optimal discriminative cutoffs and avoid arbitrary dichotomization. [4] If ROC-derived thresholds (with CIs) were estimated, reporting their Youden-optimal cutoffs and AUCs would confirm discriminative validity and generalizability.  \nThird, clinical translation should consider the unique circulatory physiology of cirrhosis. Patients with portal hypertension often exhibit low systemic vascular resistance and high-output states, which may render a conventional MAP ≥ 65 mm Hg insufficient for organ perfusion. [5] Analyses stratified by vasopressor dose, hyperdynamic status, or renal perfusion markers could contextualize optimal resuscitation thresholds. Such subgroup insights may help define individualized therapeutic targets aligned with AASLD critical-care guidance.  \nIn summary, clarifying diagnostic adjudication, ROCbased threshold derivation, and physiologic context would enhance the reproducibility and bedside applicability of this important study. These refinements may provide statistical robustness and actionable hemodynamic guidance for patients with advanced liver disease.  \nAUTHOR CONTRIBUTIONS  \nQing-Bao Jiang and Guo-Ming Zhang conceived and drafted the correspondence, verified all the data interpretations, and approved the final version.  \nFUNDING INFORMATION  \nThis correspondence received no specific grant from any funding agency, commercial, or not-for-profit sector. The author declares no funding.  \nCONFLICTS OF INTEREST  \nThe authors have no conflicts to report.  \nQing-Bao Jiang 1  Guo-Ming Zhang2   \n1Department of Laboratory Medicine, Daqing Hospital of Traditional Chinese Medicine, Daqing, Heilongjiang, People ’s Republic of China  \nAbbreviation: MAP, mean arterial pressure.  \n-- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- -  \nThis is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially wit","cbCaioebuwZR5fRl","https://ap.wps.com/l/cbCaioebuwZR5fRl","pdf",160110,"English","# Correspondence\n## Prognostic and translational clarification points\n## Sepsis definition and diagnostic adjudication\n## Dynamic vs baseline measurements\n## Dichotomous vs continuous risk modeling\n## ROC/Youden-based threshold derivation\n## Cirrhosis-specific circulatory physiology and subgroup analyses\n## Summary and implications","[{\"question\":\"Why might baseline hepatic dysfunction confound sepsis definitions in cirrhosis?\",\"answer\":\"The letter notes that Sepsis definitions using SOFA ≥ 2 with positive cultures or radiographic pneumonia may conflate chronic hepatic dysfunction with infection-related organ failure, since elevated SOFA in advanced cirrhosis can reflect factors like hyperbilirubinemia or coagulopathy rather than acute sepsis.\"},{\"question\":\"What clarification is requested regarding lactate and MAP measurements?\",\"answer\":\"The authors ask whether only baseline lactate and MAP were analyzed or whether serial and/or time-weighted measures over 24–48 hours after resuscitation were evaluated, since dynamic trends could introduce time-varying confounders.\"},{\"question\":\"How should thresholds be handled to better represent risk?\",\"answer\":\"The letter argues against purely dichotomous cutoffs (e.g., lactate ≥ 4 mmol/L, MAP ≤ 60 mm Hg) because risk may follow a continuous, nonlinear trajectory; it recommends continuous modeling (e.g., restricted cubic splines) and ROC analysis with Youden-derived optimal cutoffs with reported CIs and AUCs.\"}]","Clarifying prognostic and translational aspects of lactate and MAP thresholds in cirrhosis - Correspondence | PDF",1790701796]