Search Results (814)

Background: Oral nutritional supplementation (ONS) is commonly prescribed in malnourished older adults after hip fracture, but formulations are heterogeneous, and their comparative association with mortality remains unclear. We aimed to evaluate whether HMB-containing ONS was associated with lower mortality than non-HMB ONS and to explore whether supplement formulation combined with treatment persistence was associated with differential mortality patterns. Methods: This was a formulation-specific subanalysis of a previously described prospective cohort of older adults with hip fracture and malnutrition or significant nutritional risk. Only patients with known ONS formulation were included (n = 107): 59 received HMB-containing ONS, and 48 received non-HMB ONS, including standard, diabetes-specific, and renal-oriented formulations. Mortality at 3, 6, and 12 months was analyzed using crude comparisons and multivariable logistic regression adjusted for sex, age, and Charlson comorbidity index. A 6-month adjusted Cox model was used as the main time-to-event analysis. Exploratory analyses assessed mortality according to supplement formulation and treatment persistence. Results: Overall mortality was 14.0% at 3 months, 23.4% at 6 months, and 29.9% at 12 months. At 6 months, mortality was lower among patients receiving HMB-containing ONS than among those receiving non-HMB ONS (13.6% vs. 35.4%; p = 0.011), and the association remained significant after adjustment (OR 0.267; 95% CI 0.091–0.784; p = 0.016). Associations at 3 and 12 months were directionally consistent but not statistically significant. In the adjusted Cox model, prescription of HMB-containing ONS was associated with a lower hazard of death within 6 months (HR 0.358; 95% CI 0.145–0.885; p = 0.026). Exploratory analyses showed a 6-month mortality gradient according to formulation and persistence, ranging from 0.0% in patients receiving HMB-ONS for ≥3 months to 41.2% in those receiving non-HMB ONS for <3 months. Conclusions: In this formulation-specific subanalysis of malnourished older adults with hip fracture, an association between HMB-containing ONS and lower 6-month mortality was observed compared with non-HMB ONS. Exploratory findings suggested a clinically relevant mortality gradient according to both supplement formulation and treatment persistence, although these results should be interpreted cautiously. Larger prospective studies are warranted to confirm these findings. Full article

Background and Objectives: Nutritional impairment and systemic inflammation contribute to disease progression and poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). The geriatric-nutritional-risk-index (GNRI) and prognostic-nutritional-index (PNI) are practical markers reflecting both nutritional and immune status. In elderly COPD patients, malnutrition-related exacerbations often worsen quality of life and increase hospitalization. Identifying reliable predictors of exacerbation risk is therefore important for improving disease management. This study evaluated the association between GNRI, PNI and exacerbation frequency across different age groups in COPD. Materials and Methods: This multicenter retrospective study included 302 patients with COPD from 10 medical centers. All patients were classified as GOLD Group-E according to exacerbation history. Demographic characteristics, pulmonary function tests, Charlson-Comorbidity-Index (CCI), pharmacological treatments, dyspnea scores, and annual exacerbation frequency were obtained from hospital databases. Laboratory parameters including complete blood count, C-reactive protein, albumin, and total protein were recorded. GNRI, PNI, and neutrophil-to-lymphocyte ratio (NLR) were calculated to evaluate nutritional and inflammatory status. Results: The mean age of participants was 67.9 ± 9.6 years and 26.5% were female. Elderly patients had significantly higher CCI scores, longer disease duration, greater cumulative smoking exposure, and more frequent exacerbations than younger patients (p < 0.001). Pulmonary function parameters were significantly lower in the elderly group, while long-term oxygen therapy and nebulizer use were more common (p < 0.001). Baseline and exacerbation NLR levels were higher in elderly patients, whereas GNRI and PNI values were lower during both stable disease and exacerbation periods. Patients with more than four exacerbations per year had significantly higher NLR and lower GNRI values. Conclusions: Elderly COPD patients in GOLD Group-E demonstrate marked inflammatory and nutritional burden. Lower PNI values were independently associated with increased annual exacerbation frequency, while lower GNRI values were observed in patients with greater inflammatory and nutritional burden. Routine immune-nutritional assessment may improve risk stratification and help identify patients who could benefit from early multidisciplinary management. Full article

Background/Objective: Long-term tenofovir disoproxil fumarate (TDF) therapy is associated with progressive bone mineral density loss in patients with chronic hepatitis B (CHB), yet existing fracture risk algorithms, such as FRAX, were not designed for this population. We aimed to develop and internally validate a clinical nomogram for identifying TDF-associated osteoporosis using penalized regression on demographic, virological, and biochemical predictors. Methods: In this single-center retrospective cohort study, 237 adult CHB patients receiving TDF for at least 12 months underwent dual-energy X-ray absorptiometry (DXA). Osteoporosis was defined as a T-score of −2.5 or lower at the lumbar spine or femoral neck. Thirteen candidate predictors were evaluated using LASSO regression with 10-fold cross-validation; selected variables were entered into an unpenalized multivariable logistic regression model; internal validation employed bootstrap resampling with 200 replications to derive optimism-corrected estimates of discrimination and calibration. The clinical utility was assessed using decision curve analysis (DCA). Results: Osteoporosis prevalence was 15.2% (n = 36). LASSO selected three predictors: prior fragility fracture (OR 11.45, 95% CI 4.82–27.15), the Charlson Comorbidity Index (OR 1.45 per unit, 95% CI 1.15–1.85), and alkaline phosphatase. The model demonstrated strong discrimination (apparent C-index 0.860; optimism-corrected 0.845) with excellent calibration (slope 0.94, intercept 0.02; Brier score 0.095). At a 0.15 probability threshold, sensitivity was 86.0%, specificity 78.0%, and negative predictive value 97.0%. DCA confirmed superior net clinical benefit over default strategies across the 0.10–0.30 threshold range; a pre-specified sensitivity analysis excluding fracture history retained meaningful discrimination (corrected C-index 0.791). Conclusions: This nomogram offers a clinically actionable, disease-specific tool for stratifying osteoporosis risk in TDF-treated CHB patients, particularly well suited for safely deferring DXA imaging in low-risk individuals. External validation in multicenter and ethnically diverse cohorts is required before widespread implementation. Full article

Background: Population-level predictors of intraocular pressure (IOP)-lowering surgery for neovascular glaucoma (NVG) are understudied. This study examines factors associated with IOP-lowering surgery in California (CA) Medicare beneficiaries with NVG. Methods: The study population included all 2019 CA Medicare beneficiaries with NVG. Covariates included age, sex, race/ethnicity, history of treatments for retinal ischemia, dual Medicare/Medicaid eligibility, Social Vulnerability Index score, and Charlson Comorbidity Index (CCI) score. Outcomes included incidence of trabeculectomy, tube shunt, minimally invasive glaucoma surgery, cyclophotocoagulation (CPC), or any IOP-lowering surgery. Results: Of 1843 beneficiaries, 264 (14.3%) had IOP-lowering surgeries. In multivariable logistic regression including all covariates, CCI ≥ 5 versus 0 was associated with lower odds of any IOP-lowering surgery and of each type of surgery except CPC (adjusted odds ratio [aOR] = 0.47, 95% confidence interval [CI] = 0.29, 0.75 for any versus no surgery; aOR = 1.35, CI = 0.51, 3.60 for CPC). Compared to Non-Hispanic White, racial and ethnic minorities had increased odds of trabeculectomy (aOR = 3.77, CI = 1.05, 13.57 for Black; aOR = 2.69, CI = 1.04, 6.92 for Hispanic) and tube shunt (aOR = 2.62, CI = 1.27, 5.41 for Other/Unknown). Beneficiaries 75–79 versus 65–69 years old had decreased odds of trabeculectomy (aOR = 0.21, CI = 0.05, 0.98). Conclusions: Among CA Medicare beneficiaries, higher systemic disease burden was associated with a decreased likelihood of surgery for NVG, while racial and ethnic minorities were more likely to undergo certain procedures. These findings suggest surgical risk stratification and treatment pattern disparities for individuals with NVG. Full article

Background: The factors contributing to physical inactivity in patients with asthma remain unclear. We aimed to explore the pulmonary and extra-pulmonary factors associated with physical activity (PA) in these patients, with stratification by activity intensity. Methods: Patient demographics, Charlson Comorbidity Index, lung function, bronchial and alveolar nitric oxide (NO) levels, six-minute walk test (6 MWT), and PA were cross-sectionally evaluated in healthy participants (n = 14) and patients with asthma (n = 29). The desaturation–distance ratio (DDR) was measured as an index derived from travel distance and desaturation levels during the 6 MWT. Results: Patients with asthma had significantly lower PA than healthy participants, regardless of activity intensity (≥2 metabolic equivalents [METs]: 198 min vs. 240 min, p < 0.05; ≥3 METs: 54 min vs. 86 min, p < 0.05; ≥4 METs: 10 min vs. 26 min, p < 0.01). Extra-pulmonary factors (age, comorbidities, and 6 MW distance) showed higher correlation coefficients with PA as activity intensity increased. Contrastingly, pulmonary factors (asthma severity, airflow limitation, and alveolar exhaled NO) showed lower correlation coefficients with PA as activity intensity increased. The DDR was negatively associated with active time across all activity intensities. Conclusions: Our findings suggest that aging and comorbidities are potential limiting factors for moderate-to-vigorous physical activity, whereas asthma severity and airway dysfunction restrict daily life in patients with asthma. Moreover, the DDR could facilitate detection of real-life physical inactivity in patients with asthma. Full article

Background: Short-term mortality stratification in sepsis remains clinically challenging, particularly because outcome is influenced by acute inflammation, coagulation abnormalities, organ dysfunction, and baseline comorbidity burden. This study evaluated the clinical performance of the BIO-S and BIO-SC composite bioscores for 28-day mortality stratification in adults with sepsis and septic shock. Methods: We conducted a prospective observational monocentric cohort study including 572 adult patients admitted between January 2022 and December 2024. BIO-S integrated procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), International Normalized Ratio (INR), and Sequential Organ Failure Assessment (SOFA) score, while BIO-SC extended this model by adding the Charlson Comorbidity Index (CCI). Prognostic performance was assessed using receiver operating characteristic (ROC) curve analysis, DeLong comparisons, bootstrap validation, calibration analysis, Kaplan–Meier survival curves, and Cox proportional hazards models. Results: The cohort included 418 patients with sepsis and 154 patients with septic shock. Overall 28-day mortality was 31.5% and was significantly higher in septic shock than in sepsis, 77.9% versus 14.4%, p < 0.001. BIO-S and BIO-SC showed strong discriminatory ability for 28-day mortality, with areas under the curve (AUCs) of 0.889 and 0.897, respectively. BIO-SC had the highest AUC, although the difference between BIO-SC and BIO-S was not statistically significant by the DeLong test, p = 0.328. At the optimal thresholds, BIO-S showed 97.8% sensitivity and 69.4% specificity, while BIO-SC showed 89.4% sensitivity and 77.8% specificity. Both bioscores stratified observed mortality across predefined risk categories and remained significantly associated with 28-day mortality in adjusted Cox models. Conclusions: BIO-S and BIO-SC showed clinically relevant performance for 28-day mortality stratification in adults with sepsis and septic shock. BIO-SC provided a numerically higher AUC and slightly better calibration, suggesting that comorbidity burden may improve prognostic characterization, although further independent multicenter validation is needed before broader clinical implementation. Full article

Background: The American Society of Anesthesiologists Physical Status (ASA-PS) classification is widely used for perioperative risk stratification but is subject to inter-rater variability. The 2024 South Korean medical crisis abruptly shifted preoperative ASA-PS assessment from resident-led to specialist-centered care, providing a natural opportunity to examine how this transition affected ASA-PS distribution and prognostic performance. Methods: In this single-center retrospective cohort study, surgical patients during the pre-crisis (January 2022–December 2023) and crisis (March 2024–August 2025) periods were matched 1:2 by propensity score on age, sex, Charlson Comorbidity Index, surgical specialty, emergency status, and anesthesia type. The primary outcome was 30-day mortality; secondary outcomes were postoperative intensive care unit (ICU) admission and length of stay. ASA-PS discrimination was compared between periods using DeLong’s test, and ASA × crisis interaction terms were assessed by the likelihood ratio test. Results: A total of 53,895 cases (35,930 pre-crisis; 17,965 crisis) were matched, with all post-matching standardized mean differences below 0.1. ASA-PS demonstrated higher discrimination for 30-day mortality during the crisis than the pre-crisis period (area under the curve [AUC], 0.891 [0.863–0.919] vs. 0.827 [0.803–0.851]; ΔAUC = 0.064, p < 0.001). The ASA-PS × crisis interaction remained significant after adjustment (p = 0.014). Discrimination for ICU admission was similar between periods. Conclusions: ASA-PS classifications assigned during the crisis period were associated with higher discrimination for 30-day mortality than those from the pre-crisis period, suggesting that the operational performance of perioperative risk-assessment tools may vary with evaluator context and broader healthcare system conditions. Full article

Background/Objectives: To evaluate the prognostic significance of automated, volumetric body composition analysis (BCA) derived from pretreatment thoracic computed tomography (CT) scans in patients with head and neck cancer (HNC). Methods: We retrospectively assessed 160 patients (median age: 63 years; 26.9% women) undergoing primary treatment. BCA quantified various tissue volumes, including bone (B), skeletal muscle (SM), and subcutaneous adipose tissue (SAT). Optimal sex-specific cutoffs for BCA metrics were established via maximally selected log-rank tests. Internal validation of BCA cutoffs was conducted via bootstrap resampling. Kaplan–Meier survival analysis and Cox proportional hazards modeling were used to investigate progression-free survival (PFS). Results: The median PFS for all patients was 51.7 months (95% confidence interval (CI): 31.4–68.8). Among the continuous BCA parameters, only SM/B was significant across the total cohort (hazard ratio (HR): 0.23; 95%CI: 0.12–0.46; p < 0.0001, males (p = 0.0009), females (p = 0.004)). Internal validation of gender-specific cutoffs demonstrated strong-to-intermediate stability for SM/B across both sexes and for SAT/B in males. In contrast, SAT/B exhibited only weak stability among female participants. In univariate PFS analysis, dichotomized SM/B, SAT/B, Union for International Cancer Control (UICC) stage, Eastern Cooperative Oncology Group (ECOG) status, higher body mass index (BMI), normal albumin, and Charlson Comorbidity Index were identified as significant predictors of PFS. Multivariable analysis identified high SM/B (HR: 0.53; 95% CI: 0.3–0.93; p = 0.026) and high SAT/B (HR: 0.58; 95% CI: 0.35–0.95; p = 0.029) as independent prognostic factors, alongside lower UICC stage (p = 0.045) and lower Charlson Comorbidity Index (p = 0.038). Patients with high SM/B and SAT/B ratios had the longest median PFS (65.9 months, 95%CI: 51.7–.), compared to 36.4 months (95%CI: 19.4–.) for high SM/B or SAT/B and 12.6 months (95%CI: 4.2–25.1) for low SM/B and SAT/B (p < 0.0001). Conclusions: Although the BCA parameters SM/B and, to a lesser extent, SAT/B appear to be promising biomarkers, external validation and investigation within well-defined patient subgroups are warranted to establish their generalizability in clinical practice. Full article

Background: Malnutrition is a major global geriatric health problem, reported in approximately one-fifth of older adults worldwide and occurring even more frequently in acute care and hospital settings. Among older adults presenting to the emergency department (ED), nutritional vulnerability is often underrecognized because early ED decision-making is primarily dominated by acute physiological instability and the need for rapid disposition. Clarifying whether commonly used malnutrition screening tools provide clinically useful information beyond frailty, comorbidity burden and acute illness severity may help determine their role in early geriatric ED risk stratification, in-hospital care planning, and resource utilization. Objectives: To evaluate the prevalence, agreement, and clinical utility of three validated malnutrition screening tools the Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS-2002), and the clinician-administered Subjective Global Assessment (SGA) in older ED patients, and to examine their associations with hospital admission and length of stay (LOS). Methods: This prospective single-center study included 325 patients aged ≥65 years presenting to the ED. Nutritional status was assessed using the MUST, the NRS-2002, and the SGA. Agreement between tools was evaluated using Cohen’s kappa, positive percent agreement, and negative percent agreement. Associations with hospital admission were analyzed using multivariable logistic regression adjusted for age, sex, Clinical Frailty Scale, National Early Warning Score 2, and Charlson Comorbidity Index. Multivariable linear regression was used to identify predictors of LOS. Results: Overall, 32.6% of patients required hospital admission. Among admitted patients, the median hospital length of stay was 5 days (IQR 2–9). The prevalence of high nutritional risk varied substantially across tools, from 16.6% with the MUST to 41.5% with the NRS-2002 and 23.4% with the SGA. Agreement between tools was moderate overall (κ = 0.41–0.60), with moderate concordance in identifying low-risk and high-risk patients. After adjustment for clinically relevant covariates, none of the screening tools was independently associated with hospital admission. However, high-risk classification by the NRS-2002 was independently associated with prolonged LOS (β = 0.47, 95% CI 0.10–0.85; p = 0.01), whereas the MUST and the SGA were not. Conclusions: In older ED patients, malnutrition screening tools did not add independent value for predicting immediate hospital admission beyond frailty, comorbidity burden, and acute illness severity. However, the NRS-2002 was associated with longer hospital stay, suggesting potential value for early identification of patients who may require more complex in-hospital care and resource planning. Full article

Background/Objectives: Frailty is highly prevalent among individuals with chronic obstructive pulmonary disease (COPD) and further elevates the risk of disability, hospitalization, and mortality. However, longitudinal evidence examining the combined impact of COPD and frailty on adverse events remains limited. This study aims to examine the longitudinal association of COPD and frailty with adverse events. Methods: This longitudinal study analyzed data from the Toledo Study for Healthy Aging, including 1576 Spanish community-dwelling older adults (mean age 75 ± 6 years; 44% women). COPD was diagnosed according to GOLD criteria. Frailty was assessed using the Frailty Trait Scale-5 (FTS5), analyzed from both continuous and dichotomous perspectives. Multivariate proportional hazard regression models were used to assess mortality and hospitalization, and logistic regression was used for assessing worsening disability, adjusting for age, sex, and Charlson comorbidity index. Results: COPD was associated with an increased risk of hospitalization (HR: 1.43; 95%CI: 1.02–2.01; p = 0.04), but not mortality or disability. Frailty was independently associated with increased risk of mortality, hospitalization, and worsening disability (OR/HR ranging from 1.07 to 3.09; p < 0.001). Among individuals with COPD, frailty significantly increased the risk of mortality (HR: 5.51; 95%CI: 1.32–22.92; p = 0.019) and hospitalization (HR: 3.56; 95%CI: 1.42–8.92; p = 0.007). Compared with individuals without either frailty or COPD, the coexistence of COPD and frailty was associated with significantly higher risks of mortality and hospitalization, but not with worsening disability (p 0.069), whereas COPD alone (in non-frail individuals) was not associated with any adverse event. Conclusions: Frailty significantly increases the association of adverse outcomes, highlighting the importance of routinely assessing frailty in COPD population. Full article

Background: Lichen planus (LP) is a chronic inflammatory dermatosis with multiple clinical variants involving the skin, mucous membranes, nails, and hair follicles. Methods: We conducted a retrospective, descriptive study of patients diagnosed with LP at a tertiary referral center from January 2011 to December 2024. Inclusion required concordance between clinical presentation and histopathologic findings. Demographic characteristics, LP subtypes, anatomical involvement, comorbidities, therapeutic approaches, and treatment outcomes were extracted from electronic health records. In addition, an exploratory sensitivity analysis restricted to patients with a single LP subtype was performed to allow for independent subgroup comparisons, and a modified Charlson Comorbidity Index (CCI) based on available comorbidity domains was calculated. Pairwise multivariable logistic regression models adjusted for age, sex, and outcome-specific modified CCI were performed for selected comorbidities. Results: A total of 754 patients were included (mean age 53.1 years), with cutaneous LP (cLP), oral LP (oLP), genital LP (gLP), and lichen planopilaris (LPP) being the most frequent subtypes; a total of 620 had a single major LP subtype and were included in the mutually exclusive analysis. In these groups, modified CCI, age-adjusted modified CCI, and overall comorbidity count differed significantly across subtypes (Kruskal–Wallis p < 0.001). After adjustment in pairwise models, cLP-only showed higher odds of malignancy compared with oLP-only, gLP-only, and LPP-only and higher odds of diabetes mellitus compared with all other pure subtypes. Most other comorbidity comparisons were non-significant or imprecise because of low event numbers. Topical glucocorticoids were the most frequently used treatment, and treatment responses varied by subtype, being more effective in cLP and gLP compared to LPP. Topical calcineurin inhibitors demonstrated the highest response rates in gLP. Acitretin was most effective in cLP, whereas isotretinoin showed favorable responses in oLP. Conclusions: This large, histopathologically confirmed cohort highlights distinct differences in comorbidity patterns, anatomical involvement, and therapeutic response across LP subtypes. Treatment outcomes vary substantially by subtype, underscoring the need for individualized management strategies. Prospective studies are warranted to further elucidate subtype-specific disease associations and optimize treatment approaches. Full article

Background: Debridement, antibiotics, and implant retention (DAIR) is an established treatment for early periprosthetic joint infection (PJI) following hip arthroplasty; however, reported success rates remain highly variable, particularly in patients with significant comorbidities, fracture-related arthroplasty, or resistant microorganisms. Augmentation of standard DAIR with structured local antimicrobial strategies may improve infection control but remains insufficiently standardized and evaluated. Methods: This retrospective single-center case series evaluated outcomes of a standardized multimodal DAIR-based strategy, the Mursa protocol, in 16 consecutive patients treated for early hip PJI between 2022 and 2025. PJI was diagnosed according to European Bone and Joint Infection Society criteria. The treatment included radical surgical debridement and exchange of mobile components with sequential intraoperative antiseptic microdebridement using povidone–iodine and hypochlorous/hypochlorite solution, followed by postoperative drain-based local antimicrobial irrigation and systemic antibiotic therapy. Treatment success was defined as sustained infection eradication with implant retention, absence of clinical and radiological signs of infection, no requirement for long-term suppressive antibiotics, and no infection-related mortality at a minimum one-year follow-up. Results: The cohort was clinically complex, with a predominance of arthroplasty procedures performed for fracture-related indications (11/16), a high comorbidity burden (median Charlson Comorbidity Index 5), revision arthroplasty in four patients, and a high rate of resistant or polymicrobial infections. At final follow-up, 15 of 16 patients (93.8%) achieved treatment success. One patient required implant removal due to persistent polymicrobial infection. No irrigation-related complications, wound-healing problems, or clinically relevant systemic toxicity were observed. Conclusions: In this high-risk cohort, a structured multimodal DAIR protocol incorporating sequential antiseptic microdebridement and postoperative local antimicrobial irrigation was feasible, safe, and associated with encouraging infection control. However, these findings should be interpreted as hypothesis-generating, and further prospective comparative studies are required to validate the protocol. Full article

Objective: The primary objective was to evaluate whether admission serum albumin predicts six-month all-cause mortality in older adult patients admitted to the intensive care unit (ICU) after simple fracture surgery, and to compare its predictive performance with the modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the Nutrition Risk Screening 2002 (NRS-2002). The secondary objectives were to identify baseline predictors of six-month mortality and high-risk mNUTRIC classification. Methods: This retrospective cohort study included patients aged ≥65 years admitted to the ICU of a tertiary care hospital after surgery for a simple fracture between July and December 2024. Demographic data, comorbidities, admission laboratory values (including albumin, prealbumin, and 25-hydroxy vitamin D, the latter included as an adjunctive nutritional biomarker), APACHE II, SOFA, mNUTRIC, and NRS-2002 scores were recorded. Postoperative complications and admission durations were evaluated. Binomial logistic regression models were constructed for six-month all-cause mortality and nutritional risk group classification. Receiver operating characteristic (ROC) analysis with the Youden Index was performed to determine cutoff values. Results: A total of 172 patients (mean age 80.84 ± 7.72 years; 67.4% female) were analyzed. Six-month all-cause mortality was 22.7%. Serum albumin (OR 0.823, 95% CI 0.729–0.928, p = 0.002) and ICU admission duration (OR 1.413, 95% CI 1.101–1.812, p = 0.007) were independent predictors of six-month all-cause mortality, whereas mNUTRIC, NRS-2002, and vitamin D were not. Neither mNUTRIC nor NRS-2002 scores differed significantly between survivors and non-survivors. In nutritional risk group analysis, age (OR 1.117, p = 0.001) and APACHE II (OR 1.694, p = 0.001) were independent predictors of high mNUTRIC risk. Head-to-head ROC analysis for the primary outcome of six-month all-cause mortality showed that admission serum albumin (AUC 0.698, 95% CI 0.604–0.793) provided significantly better discrimination than mNUTRIC (AUC 0.570, DeLong p = 0.046) and NRS-2002 (AUC 0.550, DeLong p = 0.039). In a sensitivity model restricted to admission-time variables (albumin, age, APACHE II, vitamin D, Charlson Comorbidity Index), admission albumin remained an independent predictor (OR 0.830, 95% CI 0.747–0.923, p < 0.001) and age emerged as a further independent predictor (OR 1.062, p = 0.034). Conclusions: Serum albumin outperformed mNUTRIC and NRS-2002 in predicting six-month all-cause mortality among older adult post-fracture ICU patients. Because neither mNUTRIC nor NRS-2002 discriminated between survivors and non-survivors, these scores alone cannot be recommended as mortality-prediction tools in this orthogeriatric ICU population. Whether admission albumin adds incremental value to existing nutritional scoring in this setting requires prospective, adequately powered validation. Full article

Background and Objectives: We aimed to determine whether gynecologic cancer–related factors are associated with postoperative clinically significant cognitive decline (CCD) after accounting for age and comorbidity using competing-risk models. Materials and Methods: We performed a retrospective cohort study of adult women undergoing index surgery for gynecologic cancer at a tertiary university hospital. CCD was defined as new clinician-documented cognitive impairment, neurology/psychiatry consultation, or initiation of cognition-targeted pharmacotherapy ≥30 days postoperatively. Competing events were all-cause death and major neurologic events/hospice. We fit Fine–Gray subdistribution hazard models adjusted for age, Charlson Comorbidity Index (CCI), cancer stage, and treatment intensity, and evaluated a prespecified age × stage interaction. Results: Among 1023 eligible patients (mean age 62.4 ± 11.8 years; 41.3% International Federation of Gynecology and Obstetrics [FIGO] stage III–IV; median CCI 3 [IQR 2–5]), CCD occurred in 98 (9.6%). The 12-month cumulative incidence of CCD was 11.2% accounting for competing risks. Advanced stage was independently associated with higher CCD risk (sHR 1.85, 95% CI 1.27–2.69; p = 0.001). A significant age × stage interaction was observed (p < 0.001), with the strongest association in patients ≥70 years (sHR 2.48, 95% CI 1.61–3.81). Perioperative factors associated with CCD included open surgery (sHR 1.54) and postoperative delirium (sHR 2.76); these findings should be interpreted as associative signals rather than validated causal treatment targets. A stratified blinded chart review of 160 patients (80 flagged-positive and 80 unflagged controls) supported the CCD definition (PPV 88.8%; sensitivity 72.1%; specificity 94.3%; NPV 91.5%). Visit-frequency adjustment confirmed robustness (advanced stage sHR 1.78; p = 0.003). Conclusions: Gynecologic cancer–related factors, particularly advanced stage, are independently associated with CCD after accounting for competing risks, and high-risk phenotypes (age ≥70, FIGO III–IV) may benefit from perioperative pathways integrating cognitive screening, delirium prevention, and neurocognitive follow-up. Full article

Background: Aspirin, initially recognized for its anti-inflammatory, antipyretic and analgesic properties, holds a prominent role in the treatment of cardiovascular disease. The utility of aspirin in cancer therapeutics has been explored and stratified into COX-dependent and -independent mechanisms. COX2 gene expression has been demonstrated to be significantly upregulated in colorectal cancer and various other gastrointestinal malignancies including pancreatic, esophageal, and gastric cancer. This study investigates the relationship of aspirin use and outcomes in patients with colorectal cancer. Methods: The Nationwide Inpatient Sample (NIS) database from 2017 to 2022 was analyzed for patients age > 18 who were hospitalized for colorectal cancer and its decompensations using ICD-10 diagnostic codes. These patients were further stratified based on the long-term use of aspirin. The principal outcome of this investigation are the odds of in-hospital mortality, with secondary outcomes including odds of pulmonary embolism, portal vein thrombosis, acute kidney injury, septic shock, requiring an ICU level of care and odds of hepatic, pulmonary, gastrointestinal and peritoneal or retroperitoneal metastatic disease. Multivariate logistic regression accounting for hospital and patient characteristics was implemented for analysis, with the Charlson Comorbidity Index used to adjust for coexisting comorbidity burden; a p-value (p) of <0.05 was considered statistically significant. Results: In our analysis of the NIS, 596,160 patients were identified with colorectal cancer and 11.7% (69,750) of this population were identified with long-term use of aspirin. Aspirin use was identified to have a significantly reduced odds of in-patient mortality (adjusted odds ratio) [aOR] 0.530, p value < 0.001 95% CI (confidence interval): 0.460–0.617. Patients with aspirin use also demonstrated significantly reduced odds of adverse outcomes and gastrointestinal, hepatic, pulmonary and retroperitoneal/peritoneal metastasis; (aOR 0.606, 95% CI: 0.564–0.653, p < 0.001), (aOR 0.628, 95% CI: 0.582–0.678, p < 0.001), (aOR 0.676, 95% CI: 0.605–0.755, p < 0.001) and (aOR 0.751, 95% CI: 0.685–0.825, p < 0.001) respectively. Conclusions: In recent years, there has been an alarming increase in incidence of colorectal cancer, particularly amongst younger individuals with increased associated mortality. This mortality increase, albeit alarming, is a driving force for treatment innovation with continual examination of our repertoire of medications for possible repurposed applications. COX2-mediated signaling serves as a key promotor of tumorigenic molecular signaling that directly contributes to tumor cell proliferation, angiogenesis and metastasis in colorectal cancer. Aspirin use and its inhibitory action on COX2 demonstrated a significantly reduced odds of in-hospital mortality. Aspirin use is also associated with significantly reduced odds of developing metastatic disease to the liver, gastrointestinal system, lungs and peritoneum in patients with colorectal cancer. These findings convey that aspirin use reduces the likelihood of in-hospital mortality, major comorbid conditions and of developing metastatic disease as compared to those who do not use aspirin. Full article