Search Results (95)

Background: Sarcopenia, systemic inflammation, and malnutrition are established poor prognostic factors in renal cell carcinoma (RCC). This study investigated the utility of a novel preoperative score combining psoas muscle density (PMD)—an imaging-based indicator of muscle quality—and the albumin–bilirubin (ALBI) grade—a blood-based biomarker of liver reserve and systemic nutritional status—for predicting disease-free survival (DFS) and overall survival (OS) in patients undergoing curative surgery for RCC. Methods: This retrospective observational study included 274 patients with non-metastatic RCC treated with radical or partial nephrectomy. Preoperative computed tomography was utilized to measure PMD, defining “low PMD” as a value below the sex-specific median (males: 47.75 Hounsfield Units [HU]; females: 46.25 HU). “Worsened ALBI” was defined as an ALBI grade ≥ 2. Patients were stratified into three risk categories: Score 0 (both normal, n = 122), Score 1 (either abnormal, n = 114), and Score 2 (both abnormal, n = 38). Results: Kaplan–Meier analysis revealed a highly significant, stepwise decline in both DFS and OS as the risk score increased (log–rank p < 0.001 and p = 0.004, respectively). Multivariate Cox regression identified the combined risk score as a robust, independent prognostic factor for DFS (Score 1: HR 1.93, 95% CI 1.11–3.37, p = 0.020; Score 2: HR 3.58, 95% CI 1.82–7.02, p < 0.001). Furthermore, after adjusting for age and comorbidities, the score remained an independent predictor of poor OS (Score 1: HR 2.35, 95% CI 1.08–5.13, p = 0.032; Score 2: HR 3.01, 95% CI 1.16–7.82, p = 0.024). The combined model synergistically enhanced risk stratification accuracy compared to evaluating either factor independently. Conclusions: The concurrent presence of preoperative low PMD and a worsened ALBI grade is a powerful, independent predictor of poor prognosis in localized RCC. Derived solely from routine preoperative imaging and laboratory tests, this straightforward scoring system effectively captures the structural and immunometabolic dimensions of cancer cachexia and host vulnerability. This tool can significantly aid in personalizing postoperative surveillance strategies and identifying high-risk patients who may warrant closer postoperative surveillance or who might be considered as high-risk candidates for adjuvant therapy discussions. Full article

Background and objectives: Paroxysmal atrial fibrillation (PAF) is a common arrhythmia associated with adverse cardiovascular outcomes. Inflammation and nutritional imbalance contribute to arrhythmogenesis. The Naples Prognostic Score (NPS), derived from inflammatory and nutritional laboratory markers, has shown prognostic value in cardiovascular disease, but its association with PAF in outpatients has not been evaluated. This study assessed whether NPS is independently associated with the presence of PAF in a cardiology outpatient population. Methods: This retrospective case–control study included 429 patients evaluated between January 2023 and January 2025. Among them, 155 had documented PAF and 274 patients in sinus rhythm served as controls. Demographic, laboratory, and echocardiographic data were collected. NPS was calculated using serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Multivariable logistic regression identified variables independently associated with PAF. Results: Among patients with calculable NPS (n = 386), NPS was higher in the PAF group (1.92 ± 0.98 vs. 0.96 ± 0.93; p < 0.001), and high NPS was more frequent (26.0% vs. 7.8%; p < 0.001). In multivariable analysis, NPS remained independently associated with documented prevalent PAF (OR 2.46; 95% CI 1.79–3.36; p < 0.001). Conclusions: NPS was independently associated with documented prevalent PAF in this outpatient cohort. These findings do not establish diagnostic or predictive utility, and prospective longitudinal studies are required to determine whether NPS is associated with incident PAF. Full article

Background: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a simple inflammation–nutrition index that has been associated with adverse outcomes in patients with type 2 diabetes mellitus (T2DM). This study investigated the association between the HALP score and poor glycemic control in older adults with T2DM receiving home health care after excluding patients with malnutrition. Methods: This retrospective, cross-sectional study included 201 patients aged ≥65 years with T2DM whose routinely collected home health care records between 15 December 2025 and 15 March 2026 were retrospectively reviewed after ethics committee approval. Poor glycemic control was defined as HbA1c ≥ 8.0%. Logistic regression analyses were performed to identify factors associated with elevated HbA1c levels. A sensitivity analysis including clinically relevant variables was additionally conducted. The discriminative performance of HALP was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The median age was 83 years, 52.2% were male, and 51 patients (25.4%) had elevated HbA1c levels (≥8.0%). In univariate analysis, high HALP was significantly associated with lower odds of elevated HbA1c levels (OR: 0.27; 95% CI: 0.14–0.52; p < 0.001), whereas dementia showed a borderline association (OR: 0.36; 95% CI: 0.12–1.06; p = 0.065). In multivariable analysis, high HALP remained independently associated with lower odds of poor glycemic control (OR: 0.28; 95% CI: 0.14–0.54; p < 0.001). In a sensitivity analysis adjusted for age, sex, Barthel group, and dementia, high HALP maintained its independent association with lower odds of elevated HbA1c levels (OR: 0.30; 95% CI: 0.15–0.59; p = 0.001). The HALP score demonstrated weak to modest discriminative ability for predicting HbA1c ≥ 8.0% (AUC: 0.645; 95% CI: 0.552–0.739; p = 0.002), with 75.3% sensitivity and 45.1% specificity at a cut-off value of 29.24. Conclusions: High HALP was independently associated with better glycemic control in older adults with T2DM receiving home health care. However, given its weak to modest discriminative ability, HALP should be interpreted alongside clinical assessment and routine metabolic parameters rather than as a standalone diagnostic or predictive criterion. Full article

Background/Objectives: The nutrition transition in low- and middle-income countries has produced a double burden of malnutrition (coexistence of excess weight, undernutrition, and micronutrient deficiencies), with scarce evidence in schoolchildren from vulnerable peri-urban areas of Paraguay. The objective was to characterize, in a multidimensional way, the nutritional status of children and adolescents from Limpio and to explore its associations with anemia and clinical, dietary, and environmental variables, in particular, reported intestinal parasitosis. Methods: Cross-sectional observational study in 90 participants aged 6 to 16 years recruited by convenience at six community settings. Anthropometry, body composition, capillary hemoglobin, dietary patterns, and environment were assessed. Weight status was classified using the WHO 2007 references (z-scores), anemia was described using WHO thresholds, and central obesity was assessed using a waist-to-height ratio > 0.5. Non-parametric tests, Fisher’s exact test, Spearman correlations, and multivariable logistic regression were used. Results: Overweight or obesity affected 39.3% (obesity, 16.7%) and central obesity 22.4%, with no cases of thinness, coexisting with anemia (27.0%), stunting (8.2%), and reported intestinal parasitosis (24.1%). Anemia was more frequent in children with reported intestinal parasitosis (45% versus 20%; adjusted OR 5.44; 95% CI 1.44–20.51). Height-for-age was inversely associated with the number of siblings (ρ = −0.25). Conclusions: This population showed a double burden of malnutrition. The association between reported, non-laboratory-confirmed intestinal parasitosis and capillary-hemoglobin-defined anemia was exploratory and non-causal, given the cross-sectional design. Together with the high burden of anemia, these findings raise the hypothesis of a possible triple burden of malnutrition, which would require confirmation through stool parasitological testing and biomarkers of iron status, inflammation, and other micronutrients. These findings are compatible with integrated community strategies addressing dietary quality, sanitation, and access to safe water; decisions on deworming and micronutrient supplementation should be guided by local parasitological surveillance and biomarker-based assessment rather than by these data alone. Because the study used a convenience sample from a single peri-urban community during one fieldwork period, the findings should not be generalized beyond similar vulnerable settings without further confirmation. Full article

Background: As the population ages, dementia poses a critical public health challenge. This study examined the oral health and nutritional status of institutionalized Portuguese adults with dementia, exploring their interrelated predictors. Methods: This multicenter, cross-sectional study assessed institutionalized patients using the Decayed, Missing, and Filled Teeth (DMFT) index, posterior functional units (PFUs), plaque (PI) and gingival (GI) indices, the Short Xerostomia Inventory (SXI-5), and the Mini Nutritional Assessment (MNA). DMFT was modeled using multivariable ordinary least squares (OLS) regression for demographic and clinical predictors and separate negative binomial models for medication-related predictors. Other outcomes were analyzed using outcome-specific multivariable models. Results: The study included 71 participants (mean age: 82.5 ± 6.9 years). A high dental disease burden (mean DMFT score of 24.3 ± 7.5) was observed, independently predicted by advanced age (β = 0.48, p = 0.002) and residence in public long-term care units (LTCUs) (β = 6.65, p = 0.001). Total edentulism affected 28.2% of the sample. Polypharmacy emerged as a significant predictor of tooth loss; each additional medication was associated with an 18% decrease in the likelihood of retaining natural teeth (OR = 0.82, p = 0.008). Higher cognitive decline (GDS) was associated with increased plaque (p = 0.043), and modified-texture diets were associated with lower plaque levels (β = −0.64, p = 0.021). The mean MNA score (16.9 ± 3.8) indicated a high risk of malnutrition, with a trend toward lower gingival inflammation with better nutritional status (p = 0.061). Conclusions: Institutionalized dementia patients face severe oral and nutritional risks associated with age, polypharmacy and institutional environment. This emphasizes the need for multidisciplinary protocols and caregiver training. Full article

Background/Objectives: Malnutrition affects 20–71% of patients with head and neck cancer (HNC), owing to tumor location, treatment-induced toxicities, and systemic inflammation. Enteral nutrition is preferred when oral intake is inadequate, yet standard powdered formulas require labor-intensive reconstitution and carry a contamination risk. PSU Blen, a ready-to-drink chicken-protein-based polymeric formula, was developed to address these limitations. Methods: In this single-center study, thirty clinically stable patients with HNC on tube feeding were randomized 1:1 to PSU Blen or a commercial powdered polymeric formula (Blendera) for 4 weeks. The primary outcome was change in Patient-Generated Subjective Global Assessment (PG-SGA) score from baseline to week 4, analyzed under a prespecified non-inferiority framework (margin δ = 2 points, selected as a clinically acceptable upper bound based on published PG-SGA data). Secondary outcomes were handgrip strength, body weight, body mass index, serum albumin, hemoglobin, and platelet count. Results: The mean change in PG-SGA score was −1.13 (SD 0.92) and −0.87 (SD 1.36) in the PSU Blen and Blendera groups; the between-group difference was −0.27 points (two-sided 90% CI: −0.99 to +0.45), with the upper bound below the non-inferiority margin. Sensitivity analyses yielded consistent results. No significant between-group differences were observed for secondary outcomes, and both formulas were well tolerated, with no gastrointestinal intolerance or serious adverse events. Conclusions: PSU Blen demonstrated non-inferior nutritional outcomes based on the PG-SGA endpoint over 4 weeks, with comparable tolerability. Longer-term and multicenter studies are warranted to further evaluate its clinical utility and practical advantages in routine enteral nutrition practice. Full article

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

Background/Objectives: Patients receiving maintenance hemodialysis (HD) commonly exhibit chronic low-grade inflammation, nutritional disturbances, altered body composition, and metabolic imbalance. Gut dysbiosis may contribute to these abnormalities through the gut–kidney axis; however, the relationship between the gut microbiota composition and host phenotype in HD patients remains incompletely characterized. This study aimed to characterize the gut microbiota composition in maintenance HD patients and assess its cross-sectional associations with demographic, inflammatory, nutritional, dialysis-related, and bioimpedance-derived body composition parameters. Methods: This single-center cross-sectional study included 96 patients with end-stage kidney disease undergoing maintenance HD. The primary objective was to characterize the gut microbiota composition in maintenance HD patients. Secondary objectives were to assess cross-sectional associations with demographic factors (sex, age) and bioimpedance-derived body composition (specifically VAT). Clinical and laboratory data, inflammatory markers, nutritional indicators, malnutrition–inflammation score (MIS), dialysis-related variables, and bioimpedance-derived body composition parameters were collected. Stool samples were analyzed using full-length 16S rRNA sequencing. The gut microbiota composition was assessed using taxonomic profiling, alpha-diversity and beta-diversity analyses, subgroup comparisons, and exploratory distance-based analyses. Associations were interpreted within a descriptive and hypothesis-generating framework. Results: The gut microbiota composition showed marked inter-individual heterogeneity at the genus level, with dominant taxa including Blautia, Faecalibacterium, Streptococcus, Gemmiger, Ruminococcus, Escherichia-Shigella, and Enterococcus. Chao1 richness was higher in men than in women. Shannon entropy and Chao1 richness were positively associated with age and visceral adipose tissue (VAT), while Faith’s phylogenetic diversity increased with age. In contrast, the Gini index was negatively associated with age and VAT, indicating a more even microbial community structure in older individuals and in those with higher visceral adiposity. Beta-diversity analyses suggested modest differences in microbial community structure according to sex and selected body composition-related categories, particularly in sex-stratified analyses. Exploratory distance-based analysis showed a modest association between overall microbiota dissimilarity and host phenotype dissimilarity, although this finding was limited by reduced sample overlap. Conclusions: The gut microbiota composition in maintenance HD patients was highly heterogeneous and showed cross-sectional associations, mainly with sex, age, visceral adiposity, and broader host phenotype. These findings suggest that microbiota variation in HD reflects multidimensional demographic, inflammatory, nutritional, metabolic, and body composition-related factors rather than a single clinical determinant. Larger longitudinal studies integrating standardized dietary, medication, metabolic, and clinical outcome data are needed to determine the prognostic relevance of these microbiota patterns. Full article

Background: Malnutrition and systemic inflammation are increasingly recognized as important determinants of prognosis in patients with heart failure. Several immunonutritional indices, including the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status (CONUT) score, and the C-reactive protein–albumin–lymphocyte (CALLy) index, have been proposed as markers of nutritional and inflammatory status. However, their prognostic value in elderly patients with heart failure with preserved ejection fraction (HFpEF) remains incompletely defined. This study aimed to evaluate the prognostic significance of these immunonutritional indices in elderly patients with HFpEF over a long-term follow-up period. Methods: This retrospective observational study included 200 elderly patients hospitalized with HFpEF (mean age 86.6 ± 6.5 years). Clinical, laboratory, and echocardiographic parameters were collected at admission. Nutritional status was assessed using PNI, CONUT score, and CALLy index. Patients were followed for mortality during long-term follow-up. Survival analyses were performed using Cox regression models, receiver operating characteristic (ROC) curves, and Kaplan–Meier analysis. Median follow-up was 3.8 years (IQR 2.1–5.9). Results: During follow-up, 123 patients (61.5%) died, while 77 patients (38.5%) were alive at the end of observation. In univariate analysis, PNI, CONUT score, left ventricular ejection fraction (LVEF), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio were significantly associated with mortality. In multivariate analysis, the CONUT score, LVEF, and the TAPSE/sPAP ratio remained independent predictors of mortality. ROC analysis showed strong prognostic performance for the TAPSE/sPAP ratio (AUC 0.932), CONUT score (AUC 0.925), and LVEF (AUC 0.897). Optimal cut-off values for mortality prediction were CONUT ≥ 6, LVEF ≥ 65%, and TAPSE/sPAP ≤ 0.55 mm/mmHg. Kaplan–Meier analysis confirmed significantly reduced survival among patients with higher CONUT scores, higher LVEF, and an impaired TAPSE/sPAP ratio. Conclusions: In elderly patients with HFpEF, nutritional status and cardiopulmonary functional parameters are important determinants of long-term prognosis. The CONUT score emerged as the most informative immunonutritional index, while echocardiographic parameters reflecting ventricular function and right ventricular–pulmonary arterial coupling provided additional prognostic information. Integrating nutritional assessment with echocardiographic evaluation may improve risk stratification in elderly patients with HFpEF. Full article

Background/Objectives: Zinc deficiency has been associated with increased cancer-related mortality, yet its prognostic relevance in patients with breast cancer and comorbid diabetes remains unclear. This study evaluated the association between zinc deficiency and adverse 5-year clinical outcomes in this population. Methods: This retrospective cohort study used the TriNetX database to identify women aged ≥20 years with breast cancer and type 2 diabetes who had recorded serum zinc levels within 3 months before the index date during the period from 1 January 2013 to 4 April 2026. Patients were categorized into zinc-deficiency, normal-zinc, or high-zinc groups. Outcomes included all-cause mortality, hospitalization, intensive care unit admission, and emergency department visits at the 1-, 3-, and 5-year follow-ups. Cox proportional hazards regression models were applied after 1:1 propensity score matching across 12 demographic and clinical variables. Results: Among 648 eligible patients, 282 had zinc deficiency, 311 had normal zinc levels, and 55 had high zinc levels. After matching, 218 remained in each of the zinc-deficient and control groups. Zinc deficiency was associated with higher all-cause mortality at 1 year (hazard ratio [HR], 2.45; 95% CI, 1.41, 4.28), 3 years (hazard ratio [HR], 2.09; 95% CI, 1.34, 3.28), and 5 years (HR, 1.92; 95% CI, 1.27, 2.92), as well as increased risks of emergency department visits, hospitalization, and ICU admission across follow-up periods. No significant differences were observed between the high-zinc and zinc-normal groups, possibly due to limited sample size. Subgroup analyses identified several exploratory subgroup-specific associations. Conclusions: Zinc deficiency was associated with poorer clinical outcomes in women with breast cancer and type 2 diabetes. However, because low serum zinc may also reflect malnutrition, systemic inflammation, frailty, or disease burden, these findings should be interpreted as hypothesis-generating rather than causal. Full article

Background/Objectives: Vitamin D deficiency and malnutrition may lead to poor outcomes in colorectal cancer (CRC) patients. This study aims to perform an integrative analysis of serum vitamin D, nutritional status, anthropometric parameters and biochemical profiles in advanced CRC patients. Methods: The study included 58 advanced CRC patients. Serum vitamin D levels were measured by a chemiluminescence immunoassay. Nutritional status was evaluated with the Mini Nutritional Assessment (MNA). Body composition profiles were assessed using a bioelectrical impedance analyzer, and handgrip strength was measured with a handgrip dynamometer. Biochemical and clinical parameters were retrieved from an electronic database. Correlation, regression and receiver operating characteristic (ROC) analyses were performed. Results: Abnormal nutritional status and vitamin D deficiency were diagnosed in 55.17% and 50.00% of patients, respectively. Sarcopenia was diagnosed in 29.31%. Serum vitamin D concentrations were negatively correlated with absolute neutrophil counts (ANC). MNA scores showed significant negative correlations with ANC, platelet count, alkaline phosphatase and carcinoembryonic antigen. In multivariable regression models, albumin remained statistically associated with both serum vitamin D levels (β 7.049; 95% CI: 1.686–12.413; p = 0.011) and MNA score (β 6.951; 95% CI: 4.623–9.278; p < 0.001). Furthermore, albumin showed exploratory performance in ROC analyses for malnutrition and vitamin D deficiency (AUC^ROC 0.814 and 0.725, respectively), which should be interpreted cautiously given potential overlap with MNA-defined nutritional status and the limited sample size. Conclusions: Vitamin D deficiency, malnutrition and systemic inflammation commonly co-occur and are closely interrelated in patients with advanced CRC. A comprehensive assessment of nutritional status in a CRC supportive care setting is recommended. Full article

Background: Malnutrition is highly prevalent in older adults and is associated with functional decline, systemic inflammation, and increased mortality. However, its prognostic role in relation to major adverse cardiovascular events (MACE), particularly when considered alongside established cardiovascular risk scores, remains insufficiently defined in geriatric populations. Methods: This retrospective cohort study included 291 adults aged ≥65 years who underwent a comprehensive geriatric assessment at a geriatric outpatient clinic. Nutritional status was evaluated using the Mini Nutritional Assessment—Short Form (MNA-sf). Cardiovascular risk was estimated using the Framingham Risk Score, SCORE2, SCORE2—Older Persons (SCORE2-OP), and LIFE-CVD (version 1). The primary outcome was the occurrence of MACE, and the secondary outcome was all-cause mortality. Multivariable logistic regression and Cox proportional hazards models were used to identify independent predictors of outcomes. Results: During a mean follow-up of 16.9 ± 4.7 months, 43 participants (14.8%) experienced MACE, and 11 (3.8%) died. Malnutrition or risk of malnutrition (MNA-sf < 12), present in 24.1% of participants, was significantly more frequent among those with MACE and those who died. In multivariable analyses, nutritional status remained a consistent independent predictor of both MACE and mortality, whereas commonly used cardiovascular risk scores showed limited or inconsistent associations with outcomes. Conclusions: In older adults, malnutrition assessed by the MNA-sf is a strong and independent predictor of both major adverse cardiovascular events and all-cause mortality, beyond traditional cardiovascular risk scores. These findings underscore the importance of incorporating nutritional status, together with frailty-related parameters, into cardiovascular risk assessment to improve risk stratification in geriatric care. Full article

Background: Hematologic malignancies pose a critical threat to global health, with their pathological progression intrinsically linked to metabolic dysregulation and nutrient imbalance. Malnutrition accelerates the trajectory of adverse outcomes while substantially diminishing the quality of survival. Although several nutritional assessment tools are currently used in clinical practice, a significant evidence gap persists regarding their validation in populations with hematologic neoplasms. This study systematically evaluates the prognostic performance of existing nutritional assessment instruments in this cohort. Based on these findings, we further explored the feasibility of a preliminary framework that reflects metabolic characteristics specific to this population. Methods: This prospective cohort study analyzed nutritional assessment data from 1067 patients with hematologic malignancies enrolled in the INSCOC registry. Eight assessment systems were examined: Patient-Generated Subjective Global Assessment (PG-SGA), Modified PGSGA (mPG-SGA), PGSGA Short Form (PG-SGA SF), Abbreviated PGSGA (abPG-SGA), Nutritional Risk Screening-2002 (NRS-2002), Global Leadership Initiative on Malnutrition criteria (GLIM), Scored-GLIM, and Karnofsky Performance Status Scale (KPS). Kaplan–Meier survival curves and multivariate Cox regression analyses were conducted to investigate the association between nutritional status and overall survival (OS) and to determine the prognostic weight of individual components within the nutritional assessment tools. Linear regression models were applied to examine the relationships between nutritional assessment tools, length of hospital stay (LOS), and EORTC QLQ-C30 scores. The predictive performance of the tools was evaluated using the area under the receiver operating characteristic curve (AUC) and the concordance index (C-index). Least absolute shrinkage and selection operator (LASSO) regression was applied to optimize the selection of inflammation-related biomarkers. Results: A total of 1067 participants were analyzed (mean [SD] age, 55.54 [17.4] years; 625 were male [58.6%]). Cox proportional hazards regression demonstrated statistically significant associations for all eight nutritional assessment tools (p ≤ 0.05). However, their prognostic discrimination was limited, as indicated by the AUC analysis. Specifically, the area under the curve (AUC) values for each tool were as follows: mPG-SGA, 0.561; NRS-2002, 0.557; PG-SGA, 0.550; KPS, 0.544; PG-SGA SF, 0.542; abPG-SGA, 0.528; Scored-GLIM, 0.489; and GLIM, 0.473. The concordance index validation further corroborated these findings. Prognostically significant components and inflammation-related biomarkers identified by Cox and LASSO regression were combined to explore a composite assessment approach, termed the Hematologic Marker–Patient Generated Subjective Global Assessment (HMPG-SGA), incorporating the albumin–globulin ratio (AGR). The HMPG-SGA was significantly associated with overall survival (p < 0.001), with an AUC of 0.616 and a C-index of 0.605. Conclusions: Multidimensional validation demonstrated limited prognostic discrimination of eight conventional nutritional assessment tools for overall survival in patients with hematologic malignancies. Based on existing assessment tools and integrated hematologic indicators, the HMPG-SGA was preliminarily explored as a prognostic assessment tool in hematologic malignancies. Full article

Background/Objectives: Nutritional status in hospitalized older adults is usually evaluated using screening tools such as the Mini Nutritional Assessment (MNA). During acute illness, however, these tools may overlook biologically relevant vulnerability related to inflammation and metabolic stress, a condition often described as occult malnutrition. The clinical implications of applying a more stringent biological definition of this phenotype are still poorly defined. Methods: We conducted an observational cohort study including 172 hospitalized older adults (mean age 86.7 ± 6.0 years) in an acute geriatric setting with complete data on MNA, serum albumin, hemoglobin, and C-reactive protein (CRP). Occult malnutrition was defined by the coexistence of at least two abnormal biological markers: hypoalbuminemia (albumin < 3.5 g/dL), anemia (Hb < 12 g/dL), and elevated CRP (>0.5 mg/dL). Prolonged length of stay (LOS) was defined as LOS above the 75th percentile. Associations between occult malnutrition, MNA categories, and prolonged LOS were examined using chi-square tests and multivariable logistic regression models adjusted for age ≥ 85 years, sex, primary reason for hospital admission and comorbidity burden. Results: Among 172 acutely hospitalized older adults (mean age 86.7 ± 6.0 years), hypoalbuminemia, anemia, and elevated CRP were observed in 42.4%, 46.5%, and 72.1% of patients, respectively. Occult malnutrition was identified in 54.7% of the cohort. Prolonged length of stay (LOS > 75th percentile) occurred in 50.0% of patients. Compared with patients without occult malnutrition, those with occult malnutrition were older, had significantly longer hospital stays, and a higher prevalence of prolonged LOS (59.6% vs. 38.5%, p = 0.006). The prevalence of occult malnutrition increased across worsening MNA categories (p = 0.022) and was present in 40.7% of patients with a normal MNA score. Occult malnutrition was independently associated with prolonged LOS in multivariable models adjusting for age, sex, admission reason, comorbidity burden, and MNA (adjusted OR range 1.97–2.14, all p < 0.05), whereas MNA itself was not independently associated with prolonged hospitalization. Conclusions: A stringent biological definition of occult malnutrition identifies a large subgroup of hospitalized older adults at increased risk of prolonged hospitalization, including patients considered nutritionally normal by standard screening. These findings underline the limitations of screening-based assessment alone and support the use of simple biological markers to refine risk stratification in acute geriatric care. Full article

Objectives: Systemic inflammation, malnutrition, and immune dysregulation have emerged as important determinants of long-term outcomes after transcatheter aortic valve implantation (TAVI). The C-reactive protein–albumin–lymphocyte (CALLY) index is a novel immunonutritional biomarker that integrates these pathophysiological domains; however, its prognostic value in TAVI patients has not yet been investigated. This study aimed to evaluate the association between the CALLY index and 1-year mortality after TAVI. Methods: This retrospective observational study included 532 consecutive patients who underwent TAVI at a tertiary-care center between 2014 and 2023. Baseline laboratory parameters were obtained before the procedure, and the CALLY index was calculated as (albumin × lymphocyte count)/(C-reactive protein × 10). The primary endpoint was 1-year mortality. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminative ability of the CALLY index and conventional surgical risk scores. Multivariable regression analyses were used to identify independent predictors of mortality. Results: During the 1-year follow-up period, 85 patients (15.9%) died. Patients who died had significantly lower baseline CALLY index values compared to survivors (p < 0.001). The CALLY index demonstrated good discriminative performance for 1-year mortality (AUC: 0.797), outperforming EuroSCORE II (AUC: 0.705) and the Society of Thoracic Surgeons (STS) score (AUC: 0.619). A CALLY cut-off value of 0.45, derived using Youden’s index, was associated with a more than threefold increased risk of mortality. In multivariable analysis, the CALLY index remained independently associated with 1-year mortality, along with EuroSCORE II and more than mild mitral regurgitation. Conclusions: The CALLY index is a strong and independent predictor of 1-year mortality after TAVI and provides incremental prognostic value beyond conventional surgical risk scores. Given its simplicity and reliance on routinely available laboratory parameters, the CALLY index may serve as a practical tool for long-term risk stratification in patients undergoing TAVI. Full article