Search Results (337)

Introduction: Infective endocarditis (IE) remains a serious life-threatening condition associated with substantial morbidity and mortality. Within the Republic of Ireland, there is limited national data regarding the clinical and economic impact of IE. This study aimed to describe IE in Ireland. Methods: We conducted a retrospective cohort study using national Hospital Inpatient Enquiry (HIPE) data accessed through the National Quality Assurance and Improvement System (NQAIS). All admissions with a principal diagnosis of acute or subacute infective endocarditis (ICD10: I33.0, I33.8) from 1 January 2018–30 July 2025 were included. Duplicate episodes, incomplete records, nonemergency admissions, and cases without documented transoesophageal echocardiography (TOE) were excluded. Demographic, clinical, procedural, and outcome variables were explored. Costs were assigned using Healthcare Pricing Office guidance for length of stay (LOS). Results: A total of 441 patients met inclusion criteria. The mean age was 64.1 years (SD 17.0), and 75.5% were male. Surgical intervention occurred in 18.4% of cases. Surgically managed patients were younger than medically managed patients (mean age 58.8 years vs. 65.7 years, p < 0.001) and experienced a longer LOS (mean of 51 days vs. 36 days, p < 0.001). The overall in-hospital mortality rate was 9.5% (n = 42). On multivariable analysis, higher comorbidity burden (measured by Charlson comorbidity index (CCI)) was independently associated with in-hospital mortality (OR 1.09, 95% CI 1.06–1.13, p < 0.001). The total expenditure was €20.6 million. Discussion: IE in Ireland affects predominantly older, comorbid patients and is associated with significant healthcare resource utilization. In-hospital mortality rates appear favourable compared with published international series. Full article

Background: The Falls Efficacy Scale-International (FES-I) is an assessment tool designed to measure the level of fear of falling in older adults. This scale was developed to evaluate how much an individual fears falling during various daily activities. The aim of the study was to assess the discriminatory power of FES-I to predict falls within 2 years. The secondary objective was to evaluate the relationship between FES-I and vascular status. Material and Methods: In this prospective study, 130 patients (mean age, 64.7 ± 14.6 years) with chronic kidney disease (CKD) were analyzed. Of these, 90 patients had nondialysis CKD: 15 had stage G3 (G3a, n = 5; G3b, n = 10), 38 had stage G4, and 37 had stage G5. The remaining 40 patients (30.7%) were prevalent patients receiving maintenance hemodialysis. The most frequent cause of CKD was hypertension and diabetes in 57 (43.8%) of patients. The Falls Efficacy Scale-International (FES-I) was used to assess fear of falling. The Charlson Comorbidity Index (CCI) was used to measure comorbidity, and the 10-year cardiovascular risk was assessed using a web-based calculator QRESEARCH Cardiovascular Risk Algorithm, version 3 (QRISK^®3), and hemodynamic parameters were measured using a Mobil-O-Graph monitor. Participants were followed for 2 years to assess the occurrence of falls. Results: During the two-year follow-up, 49 of 130 participants (37.7%) experienced at least one fall. FES-I demonstrated good discrimination for falls (AUC 0.836; bootstrap 95% CI, 0.760–0.903). In multivariable logistic regression adjusted for age, sex, dialysis status, comorbidity, and functional status, FES-I remained independently associated with falls (adjusted OR per 1-point increase, 1.145; 95% CI, 1.060–1.237; p < 0.001). Addition of FES-I to the basic clinical model increased the AUC from 0.826 to 0.874, although the difference was of borderline statistical significance in paired receiver operating characteristics (ROC) comparison (p = 0.053). The data-derived Youden-optimal threshold was 25 points; however, bootstrap analysis indicated threshold variability, and this cut-off should be considered exploratory. Conclusions: Higher FES-I scores were independently associated with falls during two-year follow-up and may provide additional prognostic information beyond selected clinical risk factors. FES-I may represent a candidate screening instrument for fall-risk assessment in CKD; however, the proposed cut-off (25 points) requires prospective external validation. Full article

Background: Body mass index (BMI) is an important consideration in perioperative evaluation. High BMI is correlated with more comorbidities and poorer operative outcomes; however, there is limited literature on the impact of BMI on patient-reported outcome measures (PROMs) after multilevel cervical disc replacement (CDR) surgery. Objective: The objective was to evaluate the relationship between BMI and PROMs in two-level CDR. Methods: A single-surgeon database was retrospectively reviewed for patients who underwent two-level CDR between August 2017 and October 2024. Patients were stratified as non-obese (BMI < 30 kg/m²; n = 44) or obese (BMI ≥ 30 kg/m²; n = 34). The final analytic cohort included 78 patients. Mean follow-up was 7.65 ± 5.53 months. Multivariable linear and logistic regression models adjusted for age, hypertension, diabetes, and Charlson Comorbidity Index. Patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) were also analyzed. Statistical analysis was conducted using Stata 18.0 (StataCorp LP, College Station, TX, USA). Results: Obese patients had a higher CCI than non-obese patients (0.90 ± 1.06, 1.87 ± 1.31, p = 0.001). Patient-reported outcomes were collected and analyzed after controlling for hypertension, diabetes, CCI scores, and age. At the final postoperative follow-up, only VR12-MCS differed, with the obese cohort having worse scores (60.7 ± 5.0 versus 53.9 ± 10.2, p = 0.040). MCID achievement rates did not differ between groups across PROMs (p > 0.183 for all). Conclusion: Patients with and without obesity demonstrated comparable early-to-midterm PROM trajectories and MCID achievement following two-level CDR. These findings suggest that obesity was not associated with substantially different patient-reported recovery during the observed follow-up period. Full article

Background: The ASA Physical Status (ASA-PS) classification and the Charlson Comorbidity Index (CCI) are common pre-operative scoring tools. Language models could automate structured pre-operative scoring, but direct comparisons require paired inference because all models are evaluated on the same patients. Methods: In this retrospective single-center concordance analysis, 101 consecutive adult orthopedic patients were independently rated by two clinicians; the rounded mean for ASA-PS and arithmetic mean for CCI formed a clinician-derived composite reference. The cohort contained no ASA-PS IV-V patients. Six model configurations received identical prompts. Agreement was assessed using quadratic weighted kappa, ICC(2,1), exact and adjacent agreement, MAD, RMSE, and Bland–Altman limits. Post hoc between-model comparisons used 10,000 patient-level paired bootstrap replicates with Benjamini–Hochberg correction. Results: Inter-clinician weighted kappa was 0.713 for ASA-PS and 0.914 for CCI. GPT-5.2 reached kappa 0.884 for ASA-PS and 0.970 for CCI. In paired analyses, GPT-5.2 had significantly higher quadratic weighted kappa than every other tested model for both outcomes and significantly higher ICC for CCI after multiplicity correction. Phi4 and deepseek-r1-70B were not significantly different from inter-clinician agreement for CCI kappa or ICC; equivalence was not tested. Conclusions: Among the six evaluated model configurations, GPT-5.2 achieved significantly higher agreement with the clinician-derived composite reference than the other tested models for both ASA-PS and CCI in post hoc paired analyses with multiplicity correction. Locally deployable phi4 and deepseek-r1-70B showed CCI agreement estimates that were not statistically distinguishable from inter-clinician agreement, although equivalence was not tested. These findings are limited to the evaluated models and study cohort. Full article

Background/Objectives: Temporomandibular joint (TMJ) abnormalities are a common finding in the general adult population, but they have been rarely investigated in people receiving chronic dialysis. The TMJ is a unique synovial joint that can be altered by either inflammatory or degenerative processes, both of which are amenable to ultrasound (US) assessment. The aim of this study was to describe the pattern of TMJ involvement in a cohort of hemodialysis patients using TMJ ultrasound (TMJ US). Methods: This cross-sectional, single-center study evaluated the clinical utility of TMJ US to detect inflammatory and degenerative changes in patients undergoing chronic hemodialysis and was carried out between June and December 2025. Demographic data, dialysis vintage, the Controlling Nutritional Status (CONUT) score and the Charlson Comorbidity Index (CCI) were collected and related to TMJ US findings and to bone-metabolism biomarkers (calcium, phosphate, parathyroid hormone). Results: 100 hemodialysis patients were included (65 male, 65%; mean age 71.6 ± 13.1 years). Comorbidity and undernutrition were frequent findings (CCI ≥ 4 in 63%; CONUT ≥ 3 in 68%). TMJ US revealed that degenerative indicators were more common than inflammatory ones: calcifications (36%), condylar irregularities (33%) and enthesophytes (25%) were the most prevalent degenerative findings, whereas joint effusion (16%), synovial hypertrophy (15%) and cartilage changes (15%) were the leading inflammatory findings; a positive power Doppler signal was rare (1%). Cortical/condylar irregularity was significantly more prevalent in patients with a dialysis vintage of less than 30 months (43.8% vs. 23.1%, p = 0.034), who also had lower serum calcium levels. No other TMJ US finding showed a significant association with age, sex, comorbidity burden, nutritional status, or bone-metabolism parameters on univariate. Conclusions: TMJ US demonstrated a substantial burden of subclinical degenerative and, to a lesser extent, inflammatory TMJ findings in this cohort of hemodialysis patients; none of these abnormalities were spontaneously reported as symptomatic, and their prevalence was independent of age, dialysis vintage, comorbidity, nutritional status and classical bone-metabolism parameters. These findings cannot be directly attributed to the dialysis/uremic environment rather than to age-related degeneration; they support the concept that the TMJ warrants further investigation as a potentially under-recognized target within the broader systemic metabolic derangement of end-stage kidney disease, and suggest that TMJ US is a feasible, accessible technique for detecting subclinical TMJ involvement in this population, pending confirmation of clinical utility in controlled studies. Full article

Background and Objectives: Critically ill surgical patients frequently fail to achieve prescribed enteral nutrition targets because of feeding interruptions and variability in conventional physician-directed feeding practices. Although volume-based feeding (VBF) has been proposed to improve nutritional delivery, concerns remain regarding refeeding syndrome and gastrointestinal intolerance. The aim of this study was to evaluate whether a Volume-Based Plus (VBF+) protocol integrating volume-targeted feeding with mandatory refeeding risk stratification and a standardized semi-elemental enteral formula improves nutritional delivery without increasing gastrointestinal or metabolic complications. Materials and Methods: We conducted an ambispective before-and-after implementation study (retrospective control phase, prospective intervention phase) in the surgical intensive care unit of a tertiary care center between January 2023 and March 2026. Ninety-six patients requiring enteral nutrition for ≥3 days were enrolled (48 control and 48 intervention). Both groups underwent the same refeeding risk stratification to guide feeding strategy, while the intervention group additionally received the standardized VBF+ protocol with risk-stratified caloric advancement and volume-based compensation for feeding interruptions, and a standardized semi-elemental enteral formula. The primary outcomes were median daily caloric delivery (% of target) and mean daily protein delivery (g/kg/day). Multivariable regression analyses adjusted for Nutritional Assessment Form (NAF), APACHE II score, and Charlson Comorbidity Index (CCI) were performed. Results: The VBF+ protocol was independently associated with higher caloric delivery (β = 31.2 percentage points, 95% CI 17.6 to 44.8; p < 0.001) and higher protein delivery (β = 0.168 g/kg/day, 95% CI 0.040–0.297; p = 0.011). Longitudinal analysis showed a significantly faster increase in protein delivery in the intervention group (p < 0.001), while the group-by-time interaction for caloric delivery did not reach statistical significance (p = 0.073). Rates of gastrointestinal intolerance and metabolic complications were comparable between groups; as VBF+ bundled the compensatory algorithm with a semi-elemental formula, this gastrointestinal benefit is hypothesis-generating. Conclusions: In this before-and-after study, the VBF+ bundle protocol was associated with improved caloric and protein delivery and reduced gastrointestinal intolerance; because the algorithm and formula were not evaluated independently, the gastrointestinal benefit remains hypothesis-generating and requires confirmation in randomized trials. Full article

Objective. Heart-team decisions in transcatheter aortic valve implantation (TAVI) lean on EuroSCORE II, yet the comorbidity burden that often drives the final choice is rarely scored. We tested a specific two-part hypothesis: whether formally quantifying comorbidity burden (via the Charlson Comorbidity Index [CCI] and a modified CCI [mCCI]) recovers prognostic value beyond EuroSCORE II for Valve Academic Research Consortium-3 (VARC-3) outcomes, and whether aggregating comorbidities preserves or dilutes the prognostic signal of individually informative predictors. Methods. In 234 consecutive patients (mean age 76.6 ± 6.1 years) undergoing TAVI for severe aortic stenosis, EuroSCORE II, CCI, and mCCI were computed before the procedure. The primary endpoint was the 30-day VARC-3 composite; secondary endpoints were individual VARC-3 outcomes and one-year mortality. We compared discrimination (AUC, DeLong test) and incremental value with bootstrapping, and analyzed survival by Kaplan–Meier/Cox regression. Results. All three scores discriminated the 30-day composite (63 patients, 26.9%) poorly (AUCs 0.50–0.54), collapsing to chance after correction; neither comorbidity index improved on EuroSCORE II (all p > 0.40). EuroSCORE II’s only meaningful signal was stage 3 acute kidney injury (AKI; AUC 0.676), where it significantly exceeded mCCI (p = 0.048). Serum albumin and chronic kidney disease (HR 2.97 for one-year mortality) were informative individually but not within an aggregate score. Conclusions. In elderly TAVI, the actionable prognostic information resided in individual markers of organ reserve—serum albumin and chronic kidney disease—that count-based comorbidity aggregation dissipated rather than concentrated. EuroSCORE II retained a focused, mechanistically coherent association with stage 3 AKI, reflecting its renal components. These findings support a shift from disease-counting toward direct measurement of organ reserve and frailty in TAVI risk assessment, and the development of TAVI-specific tools that preserve dominant individual predictors rather than averaging them into a single score. Full article

Background: Active surveillance (AS) represents a cornerstone of personalized medicine in uro-oncology, offering an individualized management strategy for low- and selected favourable intermediate-risk prostate cancer that aligns treatment intensity with patient-specific risk profiles; however, real-world adherence data from southern European academic centres remain scarce. This study aimed to evaluate AS discontinuation rates, reasons for transition to active treatment, and quality of life (QoL) in a single-centre Greek university hospital cohort. Methods: This is an observational retropective cohort study of patients enrolled in an AS protocol at the First Department of Urology, Aristotle University of Thessaloniki, between October 2016 and July 2022. Treatment-free survival (TFS) was estimated using Kaplan–Meier analysis. Associations between AS discontinuation and age at diagnosis, PSA level, and Charlson Comorbidity Index (CCI) were explored using univariable and multivariable Cox proportional hazards regression. QoL, erectile function, and anxiety were assessed cross-sectionally in patients remaining on AS using SF-12, IIEF-6, STAI-6, and MAX-PC. Results: Thirty-six patients were included (32 low-risk; 4 favourable intermediate-risk), with a median age of 69.5 years, median PSA of 6.92 ng/mL, and median CCI of 3. After a median follow-up of 24 months (IQR 21–45), 19 patients (52.8%) transitioned to active treatment; the median time to treatment was 21 months (IQR 17–34). Among the 10 patients with a known reason for discontinuation, 6 (31.6% of all discontinued) showed histopathological or clinical disease progression, 3 (15.8%) had a PSA increase alone, and 1 (5.3%) transitioned due to urinary symptoms; the reason was unknown in 9 cases (47.4%). In exploratory Cox regression, PSA ≥ 7.0 ng/mL was the only factor with complete documented output significantly associated with transition to active treatment (univariable HR 3.70, 95% CI 1.35–10.1, p = 0.011; multivariable HR 3.93, 95% CI 1.42–10.9, p = 0.008). Cross-sectional QoL assessment in 10 patients remaining on AS demonstrated median scores above established population norms for SF-12 and below clinical anxiety thresholds on STAI-6 and MAX-PC. Conclusions: In this single-centre cohort, AS discontinuation occurred early and at a rate higher than that of established international programmes, consistent with the institution’s initial AS experience. Higher PSA at diagnosis was the only factor with complete analytical documentation to be significantly associated with earlier transition. Full article

Background/Objectives: The optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute cholangitis remains controversial. This study evaluated the association between ERCP timing and clinical outcomes in patients with acute cholangitis secondary to choledocholithiasis. Methods: This retrospective cohort study included 271 consecutive patients treated between January 2020 and March 2025. Patients were categorized according to ERCP timing as ≤24 h, 24–72 h, and >72 h. Only patients with successful biliary cannulation and drainage during the index ERCP who did not require repeat ERCP were included. Disease severity was assessed using Tokyo 2018 severity grades, qSOFA scores, and Charlson Comorbidity Index (CCI). Hospital stay, intravenous antibiotic duration, complications, and 30-day mortality were analyzed. Corrected post-ERCP hospitalization duration was additionally calculated by excluding the admission-to-ERCP interval. Results: Age, CCI, and Tokyo severity grades were comparable among groups, whereas qSOFA scores differed significantly (p = 0.015). Admission neutrophil-to-lymphocyte ratio was highest in the ≤24 h group (p = 0.014). Overall complication rates were similar among groups (p = 0.136). Thirty-day mortality differed according to ERCP timing and was highest in patients undergoing ERCP within 24 h (16.7% vs. 5.6% vs. 6.6%, p = 0.020). Corrected post-ERCP hospital stay remained significantly longer in the >72 h group (p = 0.045). Multivariable analysis identified increasing age and CCI > 5 as independent predictors of mortality. After multivariable adjustment, ERCP performed between 24 and 72 h was associated with lower mortality than ERCP performed within 24 h, although residual confounding by indication cannot be excluded. Biliary stent placement was more common among older and more comorbid patients but was not associated with differences in mortality or other clinical outcomes. Conclusions: In patients with acute cholangitis secondary to choledocholithiasis, increasing age, greater comorbidity burden, and ERCP timing were independently associated with mortality. However, the higher mortality observed in patients undergoing ERCP within 24 h most likely reflected greater baseline physiological instability rather than a detrimental effect of early biliary drainage. Although delayed ERCP was associated with prolonged corrected post-procedural hospitalization, complication rates were similar across groups. The higher mortality observed in the ≤24 h group may reflect greater physiological instability at presentation rather than the effect of urgent ERCP itself. Similarly, no significant association was observed between biliary stent placement and clinical outcomes. Full article

Background/Objectives: Glucagon-like Peptide 1 receptor agonists (GLP-1s) have increased in popularity for obesity management and treatment of various metabolic conditions. The medications, however, have significant side effects and carry a risk for adverse events. The objective of this study was to investigate the prevalence of patients taking these medications presenting to the Emergency Department (ED). Methods: We conducted a multi-center retrospective study at two EDs: an urban level 1 trauma center and an academic quaternary medical center (combined annual census approximately 90,000) over a 9-year period (2017–2025). We collected data on all ED encounters involving patients taking GLP-1s, including dual GLP-1/GIP (Glucose-dependent Insulinotropic Polypeptide) agonists, at the time of admission, including demographic information, presenting complaints, comorbidities, and disposition. Descriptive and comparative statistics were used to characterize GLP-1 patient encounters vs. non-GLP-1 patient encounters overall and by diabetes status. The change in encounters over the study period was also assessed. p-values < 0.05 were considered statistically significant. Results: Over the 9-year study period, the proportion of ED encounters involving patients on GLP-1s increased from 0.4% in 2017 to 5.8% in 2025 (p < 0.001). Patients taking GLP-1s were more often female (53.9%), obese (59.4%), and middle-aged, ranging from 35 to 64 years of age (57.3%), and commonly presented with complaints of abdominal or other pain, weakness, or dizziness. Nearly three-quarters of all patients had a Charlson Comorbidity Index (CCI) score of 3 or higher (74.0%). These patients had a higher rate of inpatient admission from the ED (33.5% vs. 23.7%, p < 0.001). Conclusions: The number of patients presenting to the ED who were taking GLP-1s significantly increased over time as these medications became more widely utilized. Patients taking GLP-1s were more often obese with multiple comorbidities and were more likely to be admitted for inpatient care. Further studies are needed to determine whether GLP-1 use independently influences emergency care utilization and the need for hospitalization. Full article

Background/Objectives: Possible sarcopenia has been proposed as an early clinical category for identifying individuals at risk of adverse muscle-related outcomes before full diagnostic evaluation. This study examined whether comorbidity burden is associated with possible sarcopenia more strongly than routinely available clinical and laboratory variables. Methods: We conducted a retrospective propensity score-matched case–control study using the Korean National Health Insurance Service database (2002–2019). Possible sarcopenia was not defined according to guideline-based muscle strength, muscle mass, or physical performance criteria. Instead, we used KCD code M62.5 as a claims-based proxy for clinically suspected muscle wasting or atrophy suggestive of possible sarcopenia. After exclusion of individuals with missing data, 1793 cases were matched 1:1 with 1793 controls according to age, sex, residential area, and insurance type. Anthropometric measures, biochemical parameters, lifestyle factors, and Charlson Comorbidity Index (CCI) scores were compared. Logistic regression and receiver operating characteristic analyses were performed to evaluate associations and discriminatory performance. Results: In the matched population, most anthropometric, biochemical, and lifestyle variables were not significantly different between groups. Fasting blood glucose and gamma-glutamyl transferase were higher in the claims-based possible sarcopenia group, but these associations were not retained in the multivariable model. The CCI score was independently associated with possible sarcopenia (odds ratio: 1.25, 95% confidence interval: 1.20–1.30; p < 0.001). In receiver operating characteristic analysis, the CCI showed the highest discriminatory ability among individual predictors (area under the curve, 0.603). The multivariable model yielded an area under the curve of 0.610. Conclusions: In administrative health data, claims-recorded muscle wasting or atrophy suggestive of possible sarcopenia was more consistently associated with multimorbidity burden than with individual routine clinical or laboratory markers. These findings support cautious, comorbidity-aware interpretation of muscle wasting/atrophy codes, but do not establish diagnostic validity for possible sarcopenia. Full article

Background/Objectives: Multiple age-related systemic conditions, including frailty, cognitive impairment, and comorbid diseases, have been suggested to be associated with glaucoma. However, their relationship with corneal biomechanical properties in patients with glaucoma remains unclear. Methods: This retrospective cross-sectional study included patients with glaucoma who attended the Department of Ophthalmology at Shimane University Hospital between May 2019 and August 2024. Corneal biomechanical parameters, including corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated intraocular pressure (IOPg), were measured using the Ocular Response Analyzer (ORA; Reichert Technologies, Depew, NY, USA). Geriatric assessments, including the Geriatric 8 (G8), Mini-Cog, and Charlson Comorbidity Index (CCI), were also evaluated. Associations between geriatric assessment measures and ocular parameters were examined using multivariable linear mixed-effects models adjusted for age, sex, medication score, and glaucoma subtype. Results: A total of 280 patients (456 eyes) were included. The mean age was 70.2 ± 11.1 years, and 126 patients (45.0%) were women. In multivariable linear mixed-effects models, lower G8 scores were significantly associated with lower CRF (β = 0.18, 95% CI: 0.05 to 0.30), lower IOPcc (β = 0.55, 95% CI: 0.18 to 0.92), and lower IOPg (β = 0.62, 95% CI: 0.25 to 1.00). In contrast, no significant association was observed between G8 scores and CH (β = −0.02, 95% CI: −0.12 to 0.09). Neither Mini-Cog nor CCI was significantly associated with any ocular parameters. Conclusions: In patients with glaucoma, frailty may be associated with corneal biomechanical properties, particularly CRF and intraocular pressure-related parameters. Full article

Background and Objectives: This study aimed to translate and culturally adapt the Pictorial Fit–Frail Scale (PFFS) into Turkish and to evaluate its validity and reliability in older adults. Materials and Methods: The study included 156 community-dwelling older adults aged ≥ 65 years. Frailty status was determined using the Clinical Frailty Scale (CFS), and participants with a CFS ≥ 4 were classified as frail. All participants underwent the PFFS, Katz ADL, Lawton–Brody IADL, Short-Form Geriatric Depression Scale (GDS), Mini Nutritional Assessment—Short Form (MNA-SF), Standardized Mini-Mental State Examination (SMMSE), and Charlson Comorbidity Index (CCI). The reliability of the PFFS was assessed using internal consistency (Cronbach α), inter-rater reliability, and test–retest reliability (ICC); its construct validity was assessed using correlation analysis with the CFS. Furthermore, the diagnostic performance of PFFS in identifying frailty was analyzed using the ROC curve. Results: Of the 156 individuals participating in the study, 63.5% were women, and 89 individuals (57.1%) were frail. The Turkish version of PFFS showed high internal consistency (Cronbach α = 0.838). Inter-rater and test–retest reliability were found to be ICC = 0.995 and 0.996, respectively. A strong and positive correlation was found between PFFS and CFS scores (Spearman r = 0.760, p < 0.001). ROC analysis showed that PFFS had good performance in distinguishing frailty (AUC = 0.851, optimal cut-off ≥ 14; sensitivity = 69.7%, specificity = 83.6%). Frail individuals were older, had higher comorbidities, and showed greater dependence in activities of daily living. Conclusions: The Turkish version of the PFFS appears to be a reliable, valid, rapid, and multidimensional tool for assessing frailty in older adults. The PFFS can contribute to the effective assessment of frailty in clinical practice and research. Full article

Tuberculosis (TB) remains a major infectious disease associated with substantial healthcare burdens. Although previous studies mainly focused on mortality and treatment outcomes, factors associated with TB-related hospitalization have not been sufficiently investigated. The aim of our study was to evaluate clinical factors associated with TB-related hospitalization in patients with TB. Patients diagnosed with TB at Kangwon National University Hospital between January 2024 and December 2025 were included in our study. The primary outcome was TB-related hospitalization during follow-up after TB diagnosis. Hospitalization-free probability was analyzed using Kaplan–Meier analysis, and Cox proportional hazards regression analysis was performed to identify factors associated with hospitalization risk. A total of 81 patients were included; 63 patients were in the outpatient group and 18 patients were in the hospitalization group. The median time to hospitalization was 36 days. The Charlson comorbidity index (CCI) was significantly higher in the hospitalization group (5.78 ± 2.88 vs. 4.16 ± 2.22, p = 0.038). Patients with CCI values ≥ 5 showed significantly lower hospitalization-free probability during the 180-day follow-up period (log-rank p = 0.013). In multivariable Cox hazards regression analysis, both serum creatinine (hazard ratio (HR), 1.599; 95% confidence interval (CI), 1.057–2.419; p = 0.026) and CCI (HR, 1.221; 95% CI, 1.018–1.466; p = 0.032) were significantly associated with TB-related hospitalization. A higher comorbidity burden may help identify patients at risk for TB-related hospitalization. Full article

Objective: This study aimed to evaluate clinical and functional factors associated with one-year mortality after intensive care unit (ICU) discharge among ICU survivors aged 80 years and older, with particular emphasis on comorbidity burden and post-discharge dependency. Methods: This retrospective, single-center observational study included 131 ICU survivors aged ≥ 80 years who were discharged alive from the ICU between January 2023 and April 2025. Patients were categorized according to one-year survival status after ICU discharge as survivors (n = 63) and non-survivors (n = 68). Demographic characteristics, comorbidities, acute illness severity scores, ICU- and hospital-related variables, discharge characteristics, post-discharge care requirements, respiratory support status, and nutritional routes were analyzed. Multivariable logistic regression analysis was performed to identify factors independently associated with one-year mortality. Results: The one-year mortality rate after ICU discharge was 51.9%. Non-survivors were significantly older than survivors (85.41 ± 3.85 vs. 84.30 ± 4.26 years, p = 0.038). The Charlson Comorbidity Index (CCI) was significantly higher in non-survivors (5.69 ± 2.27 vs. 4.08 ± 2.07, p < 0.001) and remained independently associated with one-year mortality (OR = 1.432, 95% CI: 1.107–1.851; p = 0.006). Additionally, post-discharge care requirement was independently associated with increased mortality (OR = 6.35, 95% CI: 2.83–14.21; p < 0.001), while the presence of spontaneous breathing was associated with lower odds of mortality (OR = 0.32, 95% CI: 0.15–0.66; p = 0.002). ICU and hospital lengths of stay were longer in non-survivors, and vasopressor use was more frequent in this group. Survivors were more likely to be discharged home, were less likely to require post-discharge care, and had higher rates of spontaneous breathing. In contrast, non-survivors more frequently required post-discharge care and oxygen concentrator support. Conclusions: Among ICU survivors aged 80 years and older who were discharged alive from the ICU, one-year mortality after discharge was strongly associated with comorbidity burden and post-discharge dependency indicators. These findings highlight the importance of structured post-ICU follow-up, functional assessment, and individualized care planning for very elderly ICU survivors. Full article