Search Results (2,632)

There are limited data on the optimal time of renal replacement therapy (RRT) after cardiac surgery, and published results are controversial. In our study, an answer was sought to the question of the correct timing of RRT in diabetic patients with post-cardiac surgery acute kidney injury (AKI). Forty-four adult patients with DM who required postoperative RRT were included in our single-center prospective study. According to the time of onset of RRT, the patients were divided into two groups: those whose RRT was initiated with the early protocol (RRT started before conventional urgent indications developed) or the standard protocol (RRT started after at least one conventional urgent indication developed). The primary endpoint was in-hospital mortality; secondary endpoints were RRT duration, renal recovery, and ICU and hospital length of stay. A total of 54.5% of the 44 participants were female, while the mean age was 65 ± 9. Early RRT protocol was performed on 21(47.7%) and the standard protocol was performed on 23 (52.3%) patients. Twenty-three patients (52.3%) died during follow-up. Patient survival was found to be significantly higher in the group of patients who received the early RRT protocol, based on univariate analysis, binary regression analysis, Cox regression analysis, and log-rank analysis, compared to the standard protocol group (respectively, p < 0.001, p < 0.03, p < 0.01, and p < 0.001). It was found that RRT initiation with an early protocol was advantageous in terms of survival in the post-cardiac surgery AKI group of diabetic patients. We believe that the study results provide guidance on the follow-up of this group of patients. Full article

Background: Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal. Methods: This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed. Results: The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted p = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; p = 0.010). Conclusions: Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions. Full article

Background and Objectives: The 2024 Korean medical–political conflict caused the mass resignation of trainee physicians, raising concerns about the quality of care for time-critical emergencies. This study aimed to assess the impact of workforce disruptions on the management and outcomes of adults presenting to the emergency department (ED) with septic shock. Materials and Methods: This retrospective single-center cohort study was conducted at a tertiary care ED and included adults with septic shock between September 2022 and August 2025. This study compared the pre-conflict period, operating under a resident-supported model, with the conflict period characterized by a specialist-led staffing model. The primary outcome was the all-cause in-hospital mortality. The secondary outcomes included process-related time intervals and clinical course measurements. Multivariate logistic regression was used to identify the independent predictors of mortality. Results: Altogether, 343 patients were included (159 pre-conflict, 184 conflict). During the conflict, ED crowding significantly decreased (average concurrent ED patients: 14.9 vs. 7.6, p < 0.001). Key diagnostic process metrics, including time to blood gas analysis, blood sampling, blood culture, computed tomography, and total ED length of stay, were significantly shortened. Time-critical therapeutic intervals, such as time to empirical antibiotics, remained unchanged. In-hospital mortality did not differ significantly between the pre- and conflict periods. Multivariate analysis demonstrated that the conflict period was not independently associated with mortality; only initial serum lactate levels and Acute Physiology and Chronic Health Evaluation II scores remained significant predictors. Conclusions: The 2024 Korean medical–political conflict was not associated with increased in-hospital mortality among patients with septic shock. Process-related metrics improved, while key therapeutic intervals and overall clinical outcomes remained stable. These findings may reflect reduced ED crowding, organizational adaptation, and continued adherence to established septic shock management practices. Reduced ED volume likely contributed substantially to improvements in diagnostic and throughput-related processes. Full article

Background/Objectives: The rise of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales has led to an increased carbapenem use, raising concerns regarding selection pressure for carbapenem-resistant organisms. Ceftolozane–tazobactam (C/T) is a potential effective carbapenem-sparing alternative. This single-centre retrospective study evaluated the clinical effectiveness and mortality predictors of ceftolozane–tazobactam versus meropenem as definitive targeted therapy for ESBL-producing Enterobacterales bloodstream infections (BSIs). Methods: We conducted a single-center retrospective analysis of adult hospitalized patients between January 2022 and February 2024 who presented with BSIs caused by ESBL-producing Enterobacterales. Patients (N = 185) were included if they received either C/T (n = 73) or optimized high-dose meropenem (n = 112) for at least 48 h. The primary clinical endpoint was all-cause 30-day mortality. Secondary endpoints included clinical success (cure), in-hospital mortality, treatment duration, microbiological eradication, and infection recurrence rates. A multivariable logistic regression model was executed to determine independent predictors of 30-day mortality. Results: Escherichia coli (54.1%) and Klebsiella pneumoniae (35.1%) were the primary pathogens. The raw clinical success rate was higher with C/T than meropenem (83.6% vs. 71.6%, p = 0.078). Unadjusted 30-day mortality was 12.3% for C/T and 19.6% for meropenem (p = 0.342). Zero recurrences occurred with C/T compared to an 8.0% recurrence rate with meropenem (0/73 [0.0%] in C/T vs. 9/112 [8.0%] in meropenem, p = 0.015). In the multivariable logistic regression analysis, definitive targeted treatment with C/T was independently associated with lower odds of all-cause 30-day mortality (Adjusted Odds Ratio [aOR] 0.60; 95% Confidence Interval [CI] 0.33–0.92; p = 0.022). Conversely, independent clinical mortality risks included male gender (p = 0.027), baseline SOFA score (p = 0.001), septic shock (p = 0.001), and an unknown primary infection source (p = 0.001). Conclusions: In this single-center retrospective observational cohort, definitive targeted therapy with ceftolozane–tazobactam was associated with favorable clinical success and lower adjusted 30-day mortality compared to meropenem in patients with ESBL Enterobacterales BSIs. These observational data support further prospective evaluation of C/T as a potential carbapenem-sparing option. Prospective randomized controlled trials are required to confirm these findings before clinical practice algorithms are modified. Full article

Background: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly in low- and middle-income countries. Although elevated cholesterol is a well-established modifiable risk factor for atherosclerotic CVD, the phenomenon known as the “cholesterol paradox” has raised uncertainty regarding the prognostic significance of admission cholesterol levels in patients with acute coronary syndrome (ACS). Therefore, this study aimed to evaluate the association between admission total cholesterol (TC) levels and in-hospital mortality among patients with first-episode ACS. Methods: Data were obtained from the National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry, where this cross-sectional study implemented a consecutive sampling of the nationwide ACS patient database for eligible records from January 2006 to December 2015. The patients were then classified into quartiles according to their TC levels, with the corresponding all-cause in-hospital mortality considered the outcome. Following adjustments for potential confounding factors, multilevel analysis ensued to determine the association between cholesterol groups and mortality. Results: The quartile two (Q2) group (4.50–5.36 mmol/L) was employed as the reference for this study. From the 16,860 ACS cases (mean age = 54.1 years; 83.9% male) analysed, which included 648 in-hospital fatalities, lower cholesterol levels were linked to higher mortality rates, except among patients with unstable angina. Interestingly, patients with non-ST-segment elevation myocardial infarction (NSTEMI) demonstrated a U-shaped trend. The results also revealed adjusted odds ratio (OR) for mortality (95% CI: 1.15–4.03) for Q1 at 2.15 (2.00–4.49 mmol/L), 2.01 (95% CI: 1.01–3.98) for Q3 (5.37–6.25 mmol/L), and 2.15 (95% CI: 1.08–4.26) for Q4 (>6.25 mmol/L), suggesting an increased mortality among patients with low and high cholesterol levels. Conclusions: Among first-episode ACS patients, both low and high cholesterol levels were associated with increased in-hospital mortality. A significant U-shaped relationship was observed among NSTEMI patients. Full article

Background: Acute kidney injury (AKI) is a common complication following cardiac surgery and is associated with increased morbidity and mortality. Contemporary national estimates of its clinical and economic burden in the United States remain limited. Methods: We conducted a retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS) for 2022–2023. Adult hospitalizations undergoing coronary artery bypass grafting (CABG), valve surgery, or combined CABG and valve surgery were identified using ICD-10-PCS codes. Hospitalizations with end-stage kidney disease were excluded. The primary exposure was AKI. Outcomes included in-hospital mortality, length of stay (LOS), non-home discharge, and hospitalization cost. Survey-weighted multivariable regression models were used to evaluate the independent association between AKI and study outcomes. Results: The final cohort included 133,801 hospitalizations, representing an estimated 669,005 cardiac surgery hospitalizations nationally. AKI occurred in 123,240 weighted hospitalizations (18.4%). Compared with hospitalizations without AKI, those with AKI had higher unadjusted mortality (7.21% vs. 0.71%), longer LOS (14.4 vs. 6.3 days), greater rates of non-home discharge (68.1% vs. 41.2%), and higher hospitalization costs ($97,452 vs. $56,253). After adjustment for demographic, socioeconomic, clinical, and procedural characteristics, AKI remained independently associated with in-hospital mortality (adjusted odds ratio [aOR] 9.91, 95% confidence interval [CI] 8.95–11.00), non-home discharge (aOR 2.52, 95% CI 2.42–2.63), prolonged LOS (adjusted rate ratio [aRR] 1.88, 95% CI 1.85–1.91), and increased hospitalization costs (cost ratio 1.59, 95% CI 1.56–1.61). AKI was associated with an adjusted incremental cost of $33,497 per hospitalization, corresponding to an estimated national attributable cost burden of $4.13 billion during the study period. Conclusions: AKI complicates nearly one in five cardiac surgery hospitalizations in the United States and is associated with substantially increased mortality, healthcare utilization, and hospitalization costs. These findings highlight the significant clinical and economic burden of cardiac surgery–associated AKI and support continued efforts to improve prevention, risk stratification, and perioperative management. 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

Adult deep neck infection (DNI) is a potentially life-threatening condition associated with significant morbidity and mortality. Contemporary large-scale data characterizing long-term microbial evolution and clinical outcome trends in adult DNI remain limited. This study aimed to investigate temporal changes in bacterial pathogens, treatment strategies, and clinical outcomes of adult DNI across an 18-year period. This is a retrospective multicenter cohort study using the Chang Gung Research Database (CGRD) and a de-identified nationwide database from Taiwan’s largest medical system. Hospitalized adult patients (aged ≥18 years) with DNI from 2006 to 2023 were identified and stratified into two consecutive 9-year epochs (Epoch 1: 2006–2014, n = 5512; Epoch 2: 2015–2023, n = 6551). Demographics, comorbidities, treatment modalities, disease severity, and microbiological profiles were analyzed. Bacterial isolates were evaluated at genus and species levels, with methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) assessed separately. Among 12,063 adult DNI patients (Epoch 1: n = 5512; Epoch 2: n = 6551), antibiotic-only treatment increased (77.3% to 83.2%) and surgical intervention decreased (22.7% to 16.9%). Descending necrotizing mediastinitis decreased markedly (2.7% to 0.7%) and in-hospital mortality declined (7.7% to 6.4%). Poly-microbial infections increased substantially (45.3% to 53.7%). Among facultative anaerobic and aerobic isolates, the Streptococcus anginosus group (SAG) emerged as a clinically important pathogen. Among anaerobes, Prevotella displaced Peptostreptococcus as the dominant genus, with Peptostreptococcus micros (Parvimonas micra) and Prevotella buccae emerging as prominent species. Over 18 years, adult DNI in Taiwan demonstrated significant improvements in clinical outcomes, with marked reductions in mediastinitis and in-hospital mortality. Concurrently, poly-microbial infections increased, and the SAG, Peptostreptococcus micros (Parvimonas micra), Prevotella, and anaerobic organisms emerged as clinically important pathogens, underscoring the need for empiric antibiotic regimens providing broad aerobic and anaerobic coverage. Although microbiological profiles vary geographically, these findings provide a contemporary evidence base to guide empiric antibiotic selection, inform surgical decision-making, and identify high-risk adult patients with DNI. Full article

Background: COVID-19 is a multisystem disorder associated with inflammatory, metabolic, electrolyte, and endocrine disturbances. However, the clinical relevance of dysnatremia and acute hormonal alterations remains uncertain, particularly when assessed alongside established clinical risk factors. Methods: This prospective cohort study included 252 adults hospitalized with confirmed COVID-19. Clinical, laboratory, hormonal, and metabolic parameters were assessed at admission, and their associations with disease severity, intensive care unit (ICU) admission, and in-hospital mortality were analyzed. Results: The median age was 73 years, 50.4% of patients were female, and severe or critical disease was present in 81.7%. Dysnatremia and/or endocrine alterations were detected in 55.2% of patients, including hyponatremia in 16.7%, while thyroid-function alterations were observed in 40.9%. Dysnatremia was associated with higher glucose levels and inflammatory-cell changes. Several hormonal and metabolic parameters showed statistically significant univariate associations with adverse outcomes; however, their discriminative performance was weak, with AUC values below clinically meaningful thresholds. After adjustment for major clinical confounders, dysnatremia and endocrine alterations were not independent predictors of disease severity, ICU admission, or mortality. Conclusions: These findings suggest that electrolyte and endocrine abnormalities in hospitalized COVID-19 patients primarily reflect systemic stress physiology and acute disease burden rather than functioning as independent prognostic biomarkers. Full article

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with substantial morbidity and mortality, highlighting the need for simple and reliable biomarkers for early risk stratification. The C-reactive protein to albumin ratio (CAR) and the modified Glasgow Prognostic Score (mGPS) reflect systemic inflammation and nutritional status, but their prognostic value in hospitalized patients with AECOPD remains incompletely defined. This study aimed to evaluate the associations of CAR and mGPS with one-year mortality and indicators of disease severity in hospitalized patients with AECOPD. Methods: In this retrospective single-center cohort study, 1556 adult patients hospitalized with a primary diagnosis of AECOPD between January 2020 and January 2026 were included. Patients with concomitant pneumonia and other major inflammatory conditions were excluded. Demographic, clinical, laboratory, arterial blood gas, and pulmonary function data were retrospectively analyzed. CAR was calculated from admission C-reactive protein and serum albumin levels, whereas mGPS was determined according to established criteria. Independent predictors of one-year mortality were identified using multivariable logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminatory performance of CAR. Results: During the one-year follow up, 140 patients (9.0%) died. Compared with survivors, non-survivors had significantly higher CRP levels, higher CAR values, lower serum albumin levels, more severe hypercapnia and acidosis, and higher rates of intensive care unit admission and invasive mechanical ventilation (all p < 0.001). The distribution of mGPS differed significantly according to mortality status, with patients in the mGPS 2 category exhibiting the highest mortality rates (p < 0.001). After adjustment for clinically relevant covariates, age, acidosis, invasive mechanical ventilation, and CAR remained independently associated with one-year mortality. CAR demonstrated excellent discriminatory performance for predicting one-year mortality (AUC 0.907, 95% CI 0.893–0.922; p < 0.001), with an optimal cut-off value of >3.96, yielding 98.6% sensitivity and 84.3% specificity. Increasing mGPS scores were associated with progressively worse clinical outcomes, including higher rates of intensive care unit admission, invasive mechanical ventilation, in-hospital mortality, and one-year mortality. Conclusions: Inflammation and nutrition-based biomarkers are closely associated with disease severity and one-year mortality in hospitalized patients with AECOPD. CAR remained an independent predictor of one-year mortality and demonstrated excellent discriminatory performance, supporting its role as a simple and readily available complementary biomarker for prognostic assessment. Increasing mGPS scores were associated with progressively worse clinical outcomes, suggesting that mGPS may also contribute to risk stratification in hospitalized patients with AECOPD. Prospective multicenter studies with external validation are warranted to confirm these findings and to further define the prognostic value of these biomarkers. Full article

Objective: The aim of this study was to evaluate the efficacy and safety of endovascular and hybrid treatment approaches in patients with aortic arch aneurysms. Materials and Methods. This retrospective study included 68 male and female patients with a confirmed diagnosis of either an aortic arch aneurysm or a descending thoracic aortic aneurysm with a short proximal landing zone (<1.5 cm) who underwent either hybrid or endovascular treatment at the Department of Vascular Surgery between January 2017 and December 2024. Study outcomes included a composite measure of technical success, a composite measure of in-hospital clinical success, and a composite measure of long-term treatment outcomes, including stroke, myocardial infarction, and aortic-related mortality. Results. All 68 patients were divided into two groups: Group I comprised patients who underwent endovascular treatment, whereas Group II included patients who underwent hybrid surgical treatment. The groups were comparable with regard to demographic and anatomical characteristics, clinical presentation, and comorbidities. The composite technical success rate (defined as successful target stent-graft deployment without conversion to open surgery and absence of type I or type III endoleaks) was comparable between the groups at the intraoperative stage (p = 1.000). The composite measure of in-hospital clinical success was achieved in 33 patients (94%) in Group I and 22 patients (67%) in Group II and was significantly higher in the endovascular group (adjusted p = 0.005). This difference was primarily attributable to a higher incidence of complications in the hybrid treatment group, including stroke (9%) and peripheral nerve injury (9%), associated with the open surgical component of the procedure. The mean follow-up duration was shorter in Group I (19.3 ± 10.4 months) than in Group II (63.9 ± 29.5 months), reflecting the fact that most patients in Group I underwent treatment during the later years of the study period. Although a difference in the composite long-term outcome measure was observed before adjustment (p = 0.031), this finding did not remain statistically significant after correction for multiple testing (adjusted p = 1.000). Conclusions. In this preliminary single-centre study, endovascular and hybrid approaches showed comparable technical efficacy in the early postoperative period. However, hybrid surgical treatment was associated with a less favourable safety profile during the early postoperative period, as reflected by the significantly lower in-hospital composite clinical success rate and longer hospital stay than in the endovascular group. These findings remained robust after correction for multiple testing. Long-term results should be interpreted with caution and require confirmation in larger prospective studies with longer and balanced follow-up periods. Full article

Background/Objectives: Chronic kidney disease (CKD) is a recognised risk factor for severe COVID-19, but comparative outcomes between conservatively managed CKD patients and those on maintenance haemodialysis (HD) remain incompletely characterised, particularly in Central Asia. This study evaluated the impact of CKD severity on clinical outcomes, inflammatory profiles, and mortality in hospitalised COVID-19 patients. Methods: This retrospective cohort study reviewed 891 patients hospitalised with COVID-19 at a tertiary infectious disease centre in Almaty, Kazakhstan, between 2020 and 2021. Patients were stratified into three groups: No CKD (n = 598), CKD without HD (n = 116), and CKD on maintenance HD (n = 177). Demographic, laboratory, treatment, and outcome data were extracted from electronic medical records. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality, acute kidney injury (AKI), and intensive care unit (ICU) admission. Model 1 served as the primary prognostic model, while Model 2 explored in-hospital complications. Results: Patients with CKD exhibited significantly higher inflammatory markers, with peak C-reactive protein reaching 168.3 mg/L in the HD group compared to 44.4 mg/L in the No CKD group. In-hospital mortality was highest in the CKD without HD group (34.8%), followed by CKD on HD (21.7%) and No CKD (13.6%). AKI occurred in 35.7% of conservatively managed CKD patients. In multivariate analysis, CKD without HD independently predicted mortality (OR 3.23; 95% CI 1.38–7.63) and AKI (OR 4.12; 95% CI 1.73–10.03). Conversely, established HD status was not a significant independent predictor of mortality after adjusting for age and comorbidities. Conclusions: CKD severity strongly influences COVID-19 prognosis. Paradoxically, conservatively managed CKD patients carry a higher mortality and AKI risk than patients already on maintenance HD, which may be associated with the absence of scheduled volume and metabolic control, although causal inferences cannot be drawn from this observational data. These findings support the need for aggressive monitoring and early nephrological intervention in non-dialysis CKD patients hospitalised with severe viral respiratory infections. Full article

Background and Objectives: Inflammation and nutritional status are closely associated with prognosis in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This study compared the prognostic performance of the conventional Naples score and CRP-modified Naples score for predicting in-hospital mortality. Materials and Methods: This retrospective, single-center study included 921 patients with NSTE-ACS undergoing percutaneous coronary intervention. Multivariable logistic regression, ROC analysis, reclassification indices, restricted cubic spline analysis, and decision curve analysis were performed. Results: In-hospital mortality occurred in 79 patients (8.6%). Patients who died had higher Naples score and modified Naples score values than survivors. In multivariable models adjusted for baseline clinical variables and GRACE score, both the modified Naples score and conventional Naples score remained independently associated with in-hospital mortality. The modified Naples score showed an adjusted-OR of 3.85 (95% CI: 2.71–5.48; p < 0.001), whereas the conventional Naples score showed an adjusted-OR of 4.52 (95% CI: 3.05–6.70; p < 0.001). The addition of the modified Naples score improved model performance, with a C-index of 0.819, NRI of 0.741, and IDI of 0.127. Similarly, the conventional Naples score model showed a C-index of 0.827, NRI of 0.843, and IDI of 0.125. In ROC analysis, the AUC was 0.701 for the modified Naples score and 0.683 for the conventional Naples score, without a statistically significant difference between them (ΔAUC = 0.017; p = 0.300). Decision curve analysis showed positive net clinical benefit for both scores, with no consistent superiority of either score. Conclusions: Both Naples-based scores were independently associated with in-hospital mortality and provided comparable prognostic performance in patients with NSTE-ACS undergoing PCI. 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