Search Results (763)

Background/Objectives: Transaxillary access (TAx) is an established alternative to transfemoral access (TF) for transcatheter aortic valve implantation (TAVI) in patients with unfavorable iliofemoral anatomy. While TAx-TAVI has been increasingly adopted at experienced centers, propensity score-matched comparative data with VARC-3 endpoint definitions are scarce, and most existing series originate from Western European cohorts. We aimed to address this gap by reporting outcomes from a propensity-matched TAx versus TF cohort using VARC-3 endpoints, contributing contemporary data from a high-volume Turkish center with established alternative access expertise. Methods: Among 2389 consecutive TAVI procedures screened between January 2016 and December 2024, 291 patients with complete data were included. After stratification by access route (TAx n = 51; TF n = 240) and exclusion of one TAx patient with missing covariates, 1:2 greedy nearest-neighbor propensity score matching was performed using nine covariates. The final cohort comprised 150 patients (50 TAx, 100 TF). All outcomes were defined per VARC-3 criteria. Results: All nine covariates achieved standardized mean differences <0.1 after matching. Technical success was comparable (TAx 94.0% vs. TF 96.0%; p = 0.686). The VARC-3 early safety event rate did not differ significantly (16.0% vs. 15.0%; p = 1.000); no equivalence can be inferred given the small event counts and wide confidence intervals. Any bleeding (VARC-3) was significantly lower in the TAx group (8.0% vs. 22.0%; OR 0.31, 95% CI 0.10–0.95; p = 0.039), confirmed by conditional logistic regression for the matched structure (OR 0.32 [0.10–0.97]; p = 0.043); this should be considered an exploratory finding. Thirty-day all-cause mortality (encompassing in-hospital deaths) (6.0% vs. 10.0%; p = 0.545), 1-year mortality (12.0% vs. 16.0%; p = 0.628), and Kaplan–Meier 1-year survival (88.0% vs. 84.0%; log-rank p = 0.510) did not differ significantly. ICU stay (median 2 [1–2] vs. 2 [1–3] days; p = 0.020) and hospital stay (median 5 [4–6] vs. 5 [4–6] days; p = 0.005) yielded statistically significant p-values; however, medians were identical in both comparisons, and significance was driven by outlier-prolonged admissions in the TF group rather than a meaningful difference in typical recovery duration. Conclusions: TAx-TAVI demonstrated comparable mortality, safety, and hemodynamic outcomes to TF-TAVI, with a significantly lower rate of bleeding complications. Axillary access represents a safe and effective alternative route in patients unsuitable for transfemoral TAVI. Full article

Background/Objectives: Colistin is a last-resort agent against multidrug-resistant Gram-negative infections and is administered predominantly to complex, comorbid inpatients in whom mortality is high. We aimed to identify independent baseline predictors of in-hospital mortality in colistin-treated patients and to characterize temporal changes in mortality over 15 years. Methods: We conducted a retrospective cohort study of 1225 consecutive patients receiving systemic colistin between November 2009 and November 2024 at Parhon Hospital, a tertiary urology–nephrology center in Iași, Romania; independent predictors of death were identified using multivariable logistic regression restricted to variables fixed at the time of colistin initiation, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Patients were predominantly male (60.2%), with a mean age of 65.1 ± 14.4 years; 85.6% were admitted to urology or nephrology. In-hospital mortality was 27.6%. Mortality was independently associated with acute kidney injury (aOR 3.72, 95% CI 2.76–5.01), sepsis (aOR 2.79, 95% CI 2.11–3.70), emergency admission (aOR 1.91, 95% CI 1.40–2.61), Charlson comorbidity index (aOR 1.13 per point, 95% CI 1.05–1.22), and older age (aOR 1.03 per year, 95% CI 1.02–1.04); sex was not associated. Crude mortality increased across the study period (odds ratio 1.16 per year, 95% CI 1.13–1.20) and remained elevated after adjustment for case-mix (adjusted odds ratio 1.13 per year, 95% CI 1.09–1.17). Conclusions: Acute kidney injury, sepsis, emergency admission, comorbidity burden, and age were independently associated with in-hospital death. Mortality rose progressively over 15 years, only partly explained by an increasingly severe case-mix, supporting early risk stratification of colistin recipients. Full article

Background/Objectives: Postprocedural respiratory complications encompass heterogeneous patterns of invasive respiratory support. We examined whether hospital-course respiratory-support phenotypes were associated with in-hospital mortality among operative pediatric discharges. Methods: We analyzed the 2022 Healthcare Cost and Utilization Project Kids’ Inpatient Database. Discharges with Clinical Classifications Software Refined category RSP017 were restricted to those with a major operating-room procedure. AHRQ Pediatric Quality Indicator 09 timing criteria anchored postoperative mechanical ventilation and intubation. Survey-weighted logistic regression accounted for KID strata, hospital clustering, and discharge weights, and adjusted for age, sex, multisystem complication involvement, AHRQ nonweighted comorbidity burden, and procedure domain. Results: Of 7378 operative RSP017 discharges, 6358 were aged ≤17 years and 6334 entered the final model, with 216 deaths. Survey-weighted mortality was 35.46% with ECMO support, 7.35% with postoperative 24–96 h ventilation/intubation, 4.71% with postoperative ventilation > 96 h, 4.11% with other invasive support, and 0.73% in the reference phenotype. Corresponding adjusted odds ratios were 60.12, 8.76, 5.28, and 4.85. Before hierarchical assignment, 350/6358 discharges (5.50%) met more than one candidate phenotype definition. Alternative hierarchy and operative-anchor analyses yielded similar associations. When the combined phenotype was disaggregated, qualifying postoperative intubation had a stronger association with mortality than 24–96 h ventilation alone. Conclusions: Administrative respiratory-support phenotypes were associated with markedly different in-hospital mortality. Findings were robust to alternative classification and timing rules, but the framework is hypothesis-generating and requires external clinical validation. Full article

Background: The prognostic relevance of left ventricular ejection fraction (LVEF) categories in acute heart failure (AHF) remains debated. We compared the clinical phenotype of patients hospitalized for AHF with preserved (LVEF ≥ 50%) versus reduced (LVEF < 50%) ejection fraction (EF), and compared the prognostic influence of the two phenotypes on in-hospital and post-discharge mortality. Methods: We analyzed 530 consecutive patients enrolled in a prospective single-center AHF registry (February 2023–June 2025), followed through June 2026, grouped as preserved (LVEF ≥ 50%, n = 264) or reduced (LVEF < 50%, n = 266). Baseline characteristics, in-hospital course, and post-discharge events (death, renal replacement therapy [RRT], acute HF rehospitalization, and a triple composite) were compared. Given the distinct prognostic mechanisms operating during hospitalization and after discharge, the two periods were analyzed separately. In-hospital mortality was reported descriptively, whereas predictors of post-discharge mortality were evaluated using multivariable Cox regression with follow-up beginning at discharge. Results: Patients with preserved LVEF were older, predominantly women, and more often frail and in atrial fibrillation, whereas LVEF < 50% was associated with an ischemic etiology, right heart failure, and higher values of natriuretic peptides (all p < 0.05). In-hospital mortality was higher with LVEF < 50% (7.1% vs. 3.0%, p = 0.046) and was almost entirely cardiovascular (6.4% vs. 1.1%, p = 0.002). Among the 503 patients discharged alive, post-discharge mortality did not differ between phenotypes (27.7% vs. 22.7%, p = 0.23), nor did terminal RRT (2.7% vs. 3.2%) or the triple composite (49.6% vs. 42.1%, p = 0.11); emergency-department visits were more frequent with preserved LVEF (69.1% vs. 58.6%, p = 0.048). In the multivariable model of post-discharge mortality (n = 494, 124 deaths), frailty (HR 1.96, 95% CI 1.09–3.51) and log NT-proBNP (HR 1.86, 95% CI 1.45–2.38) were independent predictors, whereas worsening renal function was not. LVEF < 50% was associated with lower post-discharge mortality in the full model (HR 0.58, 95% CI 0.38–0.89), but this association was not robust across specifications, as follows: it disappeared when NT-proBNP was omitted (HR 0.88, 95% CI 0.60–1.27), and no alternative LVEF cut-point was associated with mortality. Conclusions: The two phenotypes are dissimilar in in-hospital mortality and similar in post-discharge mortality, with no consistent independent contribution to prognosis of this specific cut-off of LVEF of 50%. Full article

Background and Objectives: Left-sided intracardiac masses (infected vegetations and non-infected thrombotic/tumor lesions) are traditionally managed with surgery in many cases, but procedural risk can be prohibitive. We systematically reviewed published experience with the AngioVac system for percutaneous debulking of left-sided cardiac masses. Methods: PubMed, Scopus, and Web of Science were searched for reports through November 2025, supplemented by hand-searching of congress abstract supplements; records were screened and assessed independently by two reviewers. Adult patients undergoing AngioVac removal of infected or non-infected left-sided cardiac masses were included. The primary effectiveness endpoint was technical success (≥70% debulking without conversion to open surgery). Safety outcomes included procedure-related complications. Data were synthesized descriptively due to heterogeneous designs and reporting. Patient-level and study-level data were distinguished a priori, pooled means were weighted by the number of patients contributed by each report, and pre-specified sensitivity analyses addressed possible patient overlap between reports from the same institution and exclusion of a non-intracardiac (aortic arch) target. Results: A total of 30 studies were included (predominantly single-patient reports, 90.0%). The pooled cohort comprised 42 patients; 23/42 (54.8%) had infective endocarditis (IE) and 45.2% had non-infected masses. Mean age was 62.9 years (range 30.0–86.0); sex distribution was female 47.6%, male 42.9%, and not reported 9.5%. All 42 patients were deemed to be at a prohibitively high risk of surgery. Access was mainly transseptal (29/42, 69.0%) or transapical (8/42, 19.0%). Mass size was reported in 23/42 (54.8%), with mean 23.3 mm, median 20.0 mm, and range 11.0–57.0 mm. Technical success was achieved in 35/42 (83.3%); residual mass occurred in 6/42 (14.3%) and one patient had cardiac perforation requiring conversion to open heart surgery (1/42, 2.4%). Procedure-related complications included valvular dysfunction (paravalvular leak or progressive mitral regurgitation), cardiac perforation, and cerebral infarctions (4/42, 9.5%). There were two deaths (2/42, 4.8%) after successful debulking, one in-hospital with recurrent embolic events and septic shock, and the other 4 months after the procedure following procedure-related progressive mitral regurgitation. Complications clustered in transapical procedures (3/8, 37.5% vs. 0/29 transseptal; p = 0.007) and in fungal endocarditis (2/2; p = 0.012). New clinically apparent embolic events occurred in 2/42 (4.8%), both in patients without documented cerebral protection, the choice of which to apply in the total population was unrelated to mass size (mean 23.5 vs. 23.2 mm). Estimates were stable in sensitivity analyses (technical success 32/38, 84.2% after maximal-overlap de-duplication; 31/37, 83.8% restricted to strictly intracardiac targets). Length of stay was reported in 8/42 (19.0%) with a median of 3.5 days (range 1.0–30.0). Conclusions: In published, highly selected non-surgical candidates, left-sided AngioVac debulking achieved ≥70% mass reduction in 83% of the 42 patients, with 4.8% mortality and one patient (2.4%) converting to emergency surgery. Because the evidence consists almost entirely of single-patient reports subject to publication bias, and because technical success is operator-reported and did not preclude death, these data do not support substituting debulking for a guideline-indicated operation. The technique is best positioned as a bridge or palliative strategy, with transapical access and fungal aetiology identified as signals warranting particular caution. Full article

Background: Early identification of patients at risk of severe acute pancreatitis (AP) remains a clinical priority. We evaluated whether the admission Systemic Immune-Inflammation Index (SII, ×10⁹/L) adds prognostic value to the BISAP score, alone and in combination. SII integrates neutrophil, lymphocyte, and platelet counts from the routine complete blood count. Methods: In this retrospective single-center cohort, 523 adults with AP (January 2020–December 2025) were classified by the Revised Atlanta Classification. Admission SII and BISAP were related to severe AP, intensive care unit (ICU) admission, and in-hospital mortality using logistic regression, ROC analysis with DeLong comparison, 1000-sample bootstrap validation, and decision curve analysis. Results: Severe AP occurred in 48 patients (9.2%), ICU admission in 61 (11.7%), and death in 26 (5.0%). Admission SII was markedly higher in severe than non-severe disease (4085 vs. 1499; p < 0.001). Both SII and BISAP independently predicted all three outcomes after mutual adjustment (severe AP: SII odds ratio 2.12 and BISAP odds ratio 4.92 per standard deviation). For severe AP, the combined BISAP + SII model outperformed either marker (AUC 0.954 vs. 0.911 and 0.917), as it did for mortality (0.957); for ICU admission SII was the strongest single marker (0.869) and the combined model did not significantly improve discrimination compared with SII alone (DeLong p = 0.287). Internal validation showed adequate calibration with modest optimism and suggested potential net clinical benefit across the evaluated threshold ranges, pending external validation. Conclusions: Combining the admission SII with the BISAP score provides incremental prognostic information beyond BISAP alone for the early risk stratification of severe acute pancreatitis and in-hospital mortality using data already available at presentation. External, prospective validation is warranted before routine adoption. Full article

Background/Objectives: Carotid revascularization reduces stroke risk in patients with carotid stenosis. Postoperative length of stay (LOS) reflects resource utilization and recovery, yet its determinants remain poorly described in Central Asia. This study examined whether baseline patient characteristics predict prolonged postoperative LOS in a Kazakhstani referral cohort. Methods: We analyzed a single-center retrospective cohort (clinical registry) of 320 consecutive patients who underwent carotid revascularization between January 2018 and December 2025. Carotid endarterectomy (CEA) was performed in 88 patients (27.5%) and carotid artery stenting (CAS) in 228 (71.2%). Prolonged postoperative LOS was defined a priori as >8 days (75th percentile). Multivariable logistic regression was performed, with negative binomial regression; a model additionally including procedure type, and a model including in-hospital complications were used as sensitivity analyses. Results: Patients were predominantly male (74.7%) with a mean age of 71.1 ± 7.5 years and a high burden of comorbidities. Median postoperative LOS was 6 days (IQR 4–8), and 72 patients (22.5%) had prolonged LOS. Postoperative LOS was similar after endarterectomy and stenting (median 6 vs 5 days). In-hospital complications occurred in 11 patients (3.4%), with two deaths (0.6%). No baseline characteristic independently predicted prolonged LOS (all p > 0.05; AUC = 0.629; Hosmer–Lemeshow p = 0.45), and procedure type was not associated with prolonged LOS (adjusted OR 1.14, 95% CI 0.61–2.14). In contrast, in-hospital complications were strongly associated with prolonged LOS (adjusted OR 8.50, 95% CI 2.04–35.40; p = 0.003), although this estimate was imprecise owing to the small number of events. Median postoperative LOS increased from 6 days in patients without complications to 12.5 days in those with complications (p < 0.001). Conclusions: In this elderly, comorbidity-heavy cohort, prolonged postoperative LOS was associated with perioperative complications rather than baseline patient characteristics. Because complications lie on the causal pathway between baseline risk and hospital stay, this finding is best interpreted as hypothesis-generating: it suggests that efforts to shorten stay may be better directed toward complication prevention than preoperative risk stratification, a hypothesis that warrants prospective evaluation. Full article

Introduction: delayed abdominal closure following congenital diaphragmatic hernia (CDH) repair is required in patients with large defects in whom primary fascial closure would risk abdominal compartment syndrome. Several strategies have been described, but most require prolonged time to definitive closure. We present a novel technique based on a Gore-Tex^® abdominal patch with dynamic traction under intra-abdominal pressure monitoring. Methods: retrospective observational study of 41 neonates undergoing CDH repair at a tertiary referral center (2015–2023). Patients were divided into primary closure (n = 27) and delayed dynamic abdominal wall closure (DDAC) (n = 14) groups. Baseline characteristics, surgical outcomes, and mortality were compared between groups using Fisher’s exact test and the Wilcoxon rank-sum test. Results: patients requiring DDAC had more severe baseline disease, including lower O/E LHR (26.30 [21.40–31.00] vs. 42.00 [34.00–46.00], p < 0.001), higher rates of liver herniation (13/14 vs. 4/27, p < 0.001), more advanced defect type (p < 0.001) and greater need of ECMO (9/14 vs. 3/27, p < 0.001). Definitive fascial closure was achieved at a median of 6 days. In-hospital mortality after diaphragmatic repair was 19.5% (8/41), with 7 deaths occurring in the DDAC group. Mortality was strongly associated with the gradient of disease severity across prenatal and anatomical markers, although an independent contribution of the abdominal closure strategy cannot be excluded. Conclusions: DDAC achieves early definitive fascial closure and appears technically feasible in CDH patients unsuitable for primary closure. Higher mortality in this group was strongly associated with baseline disease severity, though its independent relationship with the closure technique remains to be established. Full article

Background/Objectives: Endovascular thrombectomy (EVT) has transformed the treatment of acute ischaemic stroke due to large-vessel occlusion, yet peri-procedural haemodynamic instability may compromise penumbral perfusion and neurological recovery. We assessed the frequency, determinants and clinical consequences of post-procedural hypotension after EVT. Methods: We retrospectively reviewed 201 consecutive adults who underwent endovascular thrombectomy for anterior-circulation large-vessel occlusion at a single tertiary centre over a period of eight years, from 1 January 2017 to 31 January 2025. Post-procedural hypotension was defined as hypotension requiring initiation of a continuous noradrenaline infusion within 24 h of the procedure. Comorbidities, anaesthetic modality (general anaesthesia [GA] or conscious sedation [CS]), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores, and in-hospital mortality were recorded. Logistic regression identified independent predictors of hypotension. Results: Fifty-five patients (27.4%) developed post-procedural hypotension. They presented with more severe strokes (NIHSS 16.0 ± 5.0 vs. 13.7 ± 5.0; p = 0.002), had higher NIHSS scores at day 2 (14.0 ± 6.9 vs. 9.4 ± 6.7; p < 0.001) and day 7 (p = 0.003), and displayed markedly higher in-hospital mortality (50.9% vs. 20.5%; p < 0.001). In an ordinal analysis of the day 7 modified Rankin Scale with death coded as 6, hypotension was associated with a shift towards greater disability (common OR 2.57, 95% CI 1.40–4.72; p = 0.002). In an exploratory model, each additional 10 min of door-to-groin time was independently associated with hypotension (adjusted OR 1.10, 95% CI 1.03–1.18; p = 0.003). Independent predictors of hypotension were baseline NIHSS (adjusted OR 1.11 per point, 95% CI 1.04–1.19; p = 0.003) and active malignancy (adjusted OR 2.90, 95% CI 1.04–8.09; p = 0.042). Hypotension occurred with similar frequency under GA and CS (28.6% vs. 24.6%; adjusted OR 1.12, 95% CI 0.54–2.34; p = 0.766). Conclusions: Post-EVT hypotension is common and associated with poorer early neurological recovery and a more than two-fold higher in-hospital mortality rate. Its independent predictors were baseline stroke severity and active malignancy. Patients with severe stroke or active cancer may warrant intensified haemodynamic surveillance after thrombectomy. Procedural delay emerged as the only modifiable predictor identified and warrants prospective evaluation. Full article

Background: Risk stratification after colorectal cancer surgery remains challenging. We evaluated whether a perioperative ratio combining immediate postoperative lactate with preoperative albumin is associated with in-hospital mortality after elective colorectal resection. Methods: In this single-center retrospective cohort, 282 patients underwent open elective colorectal resection. The perioperative lactate-to-albumin ratio (LAR) was calculated as arterial lactate (mmol/L) divided by serum albumin (g/dL), and discrimination was assessed by receiver operating characteristic (ROC) analysis with age-adjusted association by Firth’s penalized logistic regression and fixed-model bootstrap validation. Results: Seventeen patients (6.0%) died in hospital, and mortality rose across LAR tertiles (2.1%, 5.3%, and 10.6%; p = 0.014). LAR showed moderate discrimination (AUC 0.73; 95% CI 0.58–0.87; optimism-corrected AUC 0.78), with no evidence of better discrimination than lactate or albumin alone. At the Youden threshold of 0.555, sensitivity was 76.5% and specificity 61.1%. The age-adjusted Firth odds ratio was 1.19 per 0.1-unit increase (95% CI 1.09–1.29). Conclusions: The perioperative lactate-to-albumin ratio was associated with in-hospital mortality after age adjustment in this single-center cohort. Given the small number of deaths and absence of external validation, LAR should be regarded as a candidate marker requiring prospective multicenter validation before clinical application. Full article

Background/Objectives: Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, and in Mexico’s rapidly growing older-adult population it may place increasing pressure on hospital-based care; however, Mexico-specific evidence to inform adult RSV immunization policy remains limited. This study estimated the long-term clinical and economic burden of medically attended RSV among adults aged 60–99 years in Mexico and evaluated the health impact and cost-effectiveness of a year-round RSVpreF vaccination program. Methods: A population-based Markov cohort model compared the RSVpreF vaccination with no vaccination in a hypothetical Mexican cohort aged 60–99 years over a lifetime horizon. Outcomes included RSV-related hospitalizations, emergency department (ED) and physician office (PO) encounters, in-hospital deaths, life-years (LYs), and quality-adjusted life-years (QALYs). Analyses were conducted from Mexican healthcare system and societal perspectives in 2025 Mexican pesos (MXN$) and US dollars (US$), with costs and outcomes discounted at 5% annually. One-way and probabilistic sensitivity analyses and scenario analyses assessed the robustness of the findings. Results: With 58% uptake, RSVpreF reduced hospitalizations by 187,825, ED encounters by 178,278, PO encounters by 465,976, and RSV-related deaths by 15,384. In the first 5 years, hospitalizations, ED encounters, and deaths declined by 31% each, and PO encounters by 14%. Over the lifetime horizon, vaccination generated an additional 96,227 discounted LYs and 71,526 discounted QALYs, while avoiding MXN$ 19,484 million (US$ 1061 million) in direct medical costs and MXN$ 3324 million (US$ 181 million) in indirect costs. Conclusions: Year-round RSVpreF vaccination in Mexico among adults aged 60–99 years could substantially reduce medically attended RSV cases and RSV-related mortality and is projected to be cost-effective, thereby supporting the adoption of preventive strategies to address the growing clinical and economic burden of RSV in Mexico’s aging population. Full article

Background: Post-cardiac arrest syndrome (PCAS) involves a complex interplay between systemic inflammatory and compensatory anti-inflammatory responses. The hyperacute kinetics of these cytokines and their incremental prognostic value beyond established brain injury biomarkers remain inadequately characterized. We aimed to evaluate whether the 6 h post–return-of-spontaneous-circulation (ROSC) cytokine profile predicts neurological outcome, with the Th1/Th2 ratio largely reflecting the IL-10 signal. Methods: This retrospective analysis of prospectively collected data from a single-center cardiac arrest registry included 56 cardiac arrest survivors (40 out-of-hospital, 16 in-hospital) treated with targeted temperature management (TTM) at 33 °C or 36 °C between January 2024 and December 2025. Serum IL-6, IL-10, IFN-γ (interferon-γ), and TNF-α (tumor necrosis factor-α) were measured at five time points (initial presentation (INIT), and 6, 24, 48, and 72 h post-ROSC). Neurological outcome was assessed using the Cerebral Performance Category (CPC) scale at 6 months after cardiac arrest, with poor outcome defined as CPC 3–5. Results: Eighteen patients (32.1%) had a good outcome (CPC 1–2) and 38 (67.9%) had a poor outcome at 6 months after cardiac arrest. Among the 38 poor-outcome patients, 2 were classified as CPC 3, 8 as CPC 4, and 28 as CPC 5 (death) at 6 months; the 6-month outcome was available for all 56 patients, with no loss to follow-up. Patients with poor outcomes exhibited a synchronized surge of IL-6 and IL-10 peaking at 6 h post-ROSC. IL-10 at 6 h showed the highest discriminative power among cytokines (area under the curve (AUC) 0.844) compared with IL-6 (AUC 0.761). Multivariable analysis using Youden-derived cut-offs revealed that IL-10 ≥ 154.32 pg/mL (adjusted odds ratio (aOR) 15.28, 95% CI 2.02–115.38, p = 0.008) and a Th1/Th2 ratio ≥ 0.0314 (aOR 0.09, 95% CI 0.01–0.61, p = 0.013) were independently associated with neurological outcome after adjustment for age and initial shockable rhythm. Conclusions: The 6 h post-ROSC window is a critical inflection point for immune dysregulation in PCAS. Early IL-10 elevation and collapse of the Th1/Th2 balance are independently associated with poor neurological recovery and add incremental prognostic information to established brain injury biomarkers. External validation in larger prospective cohorts is required. Full article

Background: Myocardial ischemia–reperfusion during cardiac surgery is associated with complex metabolic alterations that reflect both myocardial injury and recovery. This prospective study aimed to characterize intraoperative lactate, pH, and bicarbonate dynamics in paired coronary sinus (CS) and peripheral blood samples and to explore whether these responses could be integrated into a composite marker of reperfusion-related metabolic burden (RMB). Methods: We prospectively studied 101 patients undergoing cardiac surgery with cardiopulmonary bypass. Simultaneous blood samples from the CS and peripheral circulation were obtained before aortic cross-clamping (T0), immediately after declamping (T1), and 10 min after reperfusion (T2). Temporal changes and transmyocardial gradients of lactate, pH, and bicarbonate were analyzed. RMB was calculated from standardized changes in these variables. As an exploratory analysis, associations with in-hospital mortality were evaluated using receiver operating characteristic (ROC) analysis. Results: Significant temporal variations in metabolic parameters were observed, with the most pronounced transmyocardial disturbances occurring at aortic declamping. Lactate demonstrated the largest gradient during early reperfusion, accompanied by transient acidosis and bicarbonate consumption. The RMB framework integrated these coordinated metabolic responses into a single measure of reperfusion stress. In exploratory outcome analyses, higher RMB values were observed among non-survivors, with the largest observed AUC for peripheral RMB measured 10 min after reperfusion (AUC 0.87). However, these estimates were based on only seven deaths and should be considered hypothesis-generating. Conclusions: Paired CS and peripheral sampling revealed dynamic metabolic adaptations during myocardial ischemia–reperfusion. The exploratory RMB framework integrates coordinated metabolic changes into a single descriptive measure of reperfusion-related stress. Its observed associations with in-hospital mortality remain preliminary and require confirmation through external validation and evaluation in larger independent prospective cohorts. Full article

Background: Patients with coronary artery disease (CAD) receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remain at risk of early adverse outcomes, including in-hospital mortality. Simple risk stratification based on routinely available variables may help identify higher-risk patients, but a limited number of outcome events constrains robust prediction-model development and validation. Aim: This exploratory study aimed to derive a preliminary, interpretable clinical score based on routinely available variables for risk stratification of all-cause in-hospital mortality in CAD patients receiving DAPT after PCI. In the clopidogrel-dominant practice setting of the participating centers, the score was conceived as a hypothesis-generating risk-enrichment framework rather than a validated treatment-selection tool or a surrogate measure of platelet reactivity. Methods: We analyzed a retrospective cohort of 1600 adults with CAD admitted between 2022 and 2024; 36 in-hospital deaths occurred. Twenty demographic, clinical, laboratory, and instrumental variables were evaluated. The primary outcome was all-cause in-hospital mortality during the index hospitalization. For exploratory score derivation, the dataset was randomly divided into a derivation subset (75%; n = 1200) and a hold-out assessment subset (25%; n = 400). Predictors were explored using univariable and multivariable logistic regression with stepwise selection. Continuous variables were categorized using Weight of Evidence binning, and an integer point score was derived. Performance was summarized using ROC analysis, AUC, sensitivity, specificity, and accuracy. Given the small number of deaths and the data-driven modelling workflow, all performance estimates were considered preliminary rather than definitive internal validation. Results: The exploratory six-variable score included age ≥ 57 years, estimated glomerular filtration rate < 45 mL/min/1.73 m², body mass index ≥ 25 kg/m², troponin I ≥ 100, prior myocardial infarction, and current smoking. In the derivation subset, each additional point was associated with higher odds of mortality (OR 1.39; 95% CI 1.29–1.51; p < 0.001), and the AUC was 0.654. A Youden-index threshold of approximately 6 points yielded sensitivity of 0.41, specificity of 0.80, and accuracy of 0.72. In the hold-out assessment subset, sensitivity was 0.53, specificity was 0.70, accuracy was 0.70, and AUC was 0.61. These estimates indicate modest discrimination and should be interpreted cautiously because only 36 outcome events were available. Conclusions: This exploratory clinical score showed modest discrimination for all-cause in-hospital mortality and should be regarded as a preliminary, hypothesis-generating risk-stratification approach. It is not sufficiently validated for routine prognostic classification, platelet-reactivity triage, or antiplatelet treatment selection. Model redevelopment using event-efficient methods, resampling-based internal validation, and subsequent external validation are required before clinical implementation. Full article

Serial presepsin measurements were evaluated for their prognostic value compared with conventional laboratory markers in predicting in-hospital mortality among older adults with hip fractures. This prospective observational study included 85 patients aged ≥65 years admitted with acute hip fractures between December 2025 and May 2026. Residual serum remaining after routine clinical laboratory sampling was obtained on admission (Day 1), Day 3, and Day 5; serum presepsin was measured by commercial ELISA, and routine parameters (C-reactive protein [CRP], white blood cell count, lymphocytes, monocytes, platelets, and liver enzymes) were analysed in the hospital laboratory. Renal function was assessed by serial creatinine and estimated glomerular filtration rate (eGFR). Patients were classified as survivors or non-survivors according to in-hospital outcome. Temporal trajectories were modelled with a linear mixed-effects model fitted to log-transformed presepsin, receiver operating characteristic (ROC) analysis assessed predictive performance, and internal validity was examined by bootstrap resampling. Of the 85 patients, 68 survived and 17 died during hospitalization; all deaths occurred between hospital days 5 and 12. Presepsin diverged progressively between groups, reaching significantly higher concentrations in non-survivors by Day 5 (median 207.70 vs. 147.21 ng/L; p < 0.001), with a Day 5 group-by-time interaction ratio of 1.76 (95% CI 1.38–2.25; p < 0.001). Day 5 presepsin showed the highest predictive accuracy (AUC = 0.868, 95% CI 0.774–0.945; optimism-corrected AUC 0.866), significantly outperforming CRP (AUC = 0.606; p = 0.003) and platelet count (AUC = 0.485; p < 0.001). The association persisted after adjustment for age, ASA class, fracture type, and eGFR, and Day 5 presepsin added discrimination to a baseline clinical model (ΔAUC 0.125; p = 0.015). The Youden-derived cutoff of 169.54 ng/L was unstable across bootstrap resamples (95% range 169.5–207.7 ng/L). Serial presepsin measurement, particularly on Day 5, is associated with in-hospital mortality in this population; these exploratory findings require external validation before any clinical application can be considered. Full article