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Critical Care Medicine www. ccmjournal. org 1671 subgroup analysis in patients without SHP at admission (defined as level of< 11.2 µmol/dL, n= 383) and separated them into those with a genetic predisposition to developing SHP (GRS≥ 2, n= 165), and those without (GRS< 2, n= 218). First, they found that a higher proportion of patients with a GRS≥ 2 develop SHP during their CICU admission compared with those with a GRS< 2 (31.5% vs 16.1%; p= 0.001). The second novel finding of this study is that, after adjusting for confounders, a GRS≥ 2 was associated with a higher hazard of mortality (hazard ratio, 1.74; 95% CI, 1.18–2.56; p= 0.005) using multivariable cox-proportional hazard modeling. From this, the authors conclude that the development of SHP, due to a patient’s genetic predisposition, resulted in cardiotoxicity leading to an increased risk of mortality. There is no clearly described causal pathway …