Search Results (555)

Background/Objectives: The lymphocyte-to-monocyte ratio (LMR) is an inflammation-based prognostic score (IBPS) that can be easily calculated using routine blood tests. Handgrip strength (HGS), a key diagnostic component of sarcopenia, also predicts survival. Nonetheless, the prognostic role of combined LMR and HGS in patients with pancreatic head cancer undergoing pancreaticoduodenectomy remains unclear. This exploratory study aimed to analyze whether the combination of preoperative LMR and HGS is associated with overall survival. Methods: We retrospectively analyzed 105 patients with pancreatic head cancer who underwent pancreaticoduodenectomy at Chiba University Hospital from January 2016 to December 2020. We examined the prognostic values of IBPSs and HGS and compared combinations of preoperatively measurable factors. Results: Multivariate analysis assessing preoperatively measurable factors demonstrated that low preoperative HGS, low preoperative LMR, and high preoperative carbohydrate antigen 19-9 level were associated with poor overall survival (hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.29–4.51, p = 0.006; HR: 2.05, 95% CI: 1.12–3.76, p = 0.020; and HR: 2.68, 95% CI: 1.25–5.76, p = 0.011, respectively). The combination of low HGS and low LMR was associated with poor overall survival, although only 12 patients were included in this subgroup. Multivariate analysis evaluating clinicopathological factors demonstrated that this combination was associated with poor overall survival (HR: 2.85, 95% CI: 1.06–7.69, p = 0.038). Conclusions: In this single-center exploratory study, the combination of preoperative LMR and HGS was associated with poor overall survival in patients with surgically resected pancreatic head cancer. Further prospective multicenter validation is required before this combined marker can be used for clinical decision-making. Full article

Immune checkpoint inhibitors (ICIs) have improved clinical outcomes in recurrent or metastatic head and neck squamous cell carcinoma (HNSCC), including oral squamous cell carcinoma (OSCC). However, many patients eventually develop resistance to systemic therapy, highlighting the need for novel strategies that can restore or sustain antitumor immunity. Near-infrared photoimmunotherapy (PIT) has emerged as a tumor-selective locoregional treatment that not only induces targeted tumor cell death but also promotes antitumor immune activation through immunogenic cell death. This narrative review summarizes current evidence regarding PIT for recurrent oral cancer and explores the immunological rationale for sequential ICI–PIT–ICI therapy (ICI–PIT–ICI sequence). Within this framework, PIT-induced tumor antigen release and inflammatory activation may reinitiate elements of the cancer-immunity cycle, whereas continued PD-1 blockade may help sustain newly activated tumor-reactive T-cell responses. To illustrate this concept, we present two cases of recurrent oral cancer treated with the ICI–PIT–ICI sequence. Both patients achieved durable clinical and radiological complete responses following PIT and subsequent nivolumab continuation. Longitudinal analyses of peripheral immune surrogate markers demonstrated a biphasic temporal pattern characterized by transient increases in inflammatory markers, including neutrophil-to-lymphocyte ratio, C-reactive protein, platelet-to-lymphocyte ratio, and systemic immune-inflammation index, followed by recovery trends in absolute lymphocyte count and lymphocyte-to-monocyte ratio during continued PD-1 blockade. These observations support the biological plausibility of PIT as an immune-modulating intervention with potential immune-reprogramming effects. Although hypothesis-generating, the ICI–PIT–ICI sequence may represent a promising strategy integrating locoregional tumor destruction with systemic immune modulation in recurrent oral cancer. Further prospective studies incorporating peripheral and tissue-based immune profiling are warranted. Full article

Orthopedic procedures trigger a complex inflammatory response that plays a central role in tissue repair and postoperative recovery. However, excessive or dysregulated inflammation may contribute to complications such as periprosthetic joint infection, thromboembolic events, delayed healing, or systemic organ dysfunction. Therefore, accurate perioperative monitoring of inflammatory activity has become increasingly important in orthopedic surgery. Evidence discussed in this review was identified through a literature search of PubMed, Scopus, and Web of Science databases covering publications from 2000 to 2026. This narrative review summarizes the current evidence regarding both traditional inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and D-dimers, as well as emerging biomarkers derived from complete blood count (CBC), such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI). Particular attention is devoted to the clinical utility of these biomarkers in orthopedic trauma, fracture healing, total joint arthroplasty, and the early detection of postoperative complications. Increasing evidence suggests that composite CBC-derived indices may provide a practical and cost-effective approach for perioperative risk stratification and prognosis assessment. Nevertheless, their interpretation remains challenging due to the lack of standardized cutoff values and the influence of multiple patient-related factors. Current evidence indicates that assessing biomarker kinetics and interpreting multiple inflammatory indices together may be more clinically valuable than isolated measurements. Future research should focus on standardization, validation in prospective studies, and integration of inflammatory biomarkers into personalized perioperative care pathways in orthopedic surgery. Full article

Background and Objectives: Predicting treatment response following transforaminal epidural steroid injection (TFESI) in older adults with lumbar radicular pain (LRP) remains challenging. Hematological inflammatory indices have been proposed as accessible biomarkers; however, their clinical utility remains uncertain. This study aimed to evaluate the predictive value of preprocedural hematological inflammatory indices and determine whether clinical variables provide a more clinically relevant framework for predicting TFESI outcomes. Materials and Methods: This retrospective observational study included 190 patients aged ≥65 years who underwent TFESI for LRP. Pain intensity was assessed using the Numeric Rating Scale (NRS) at baseline and after 3 months. Treatment response was defined as a ≥50% reduction in the NRS (meaningful pain response, [MPR-50]). Pre-procedural hematological parameters and derived indices, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), were calculated. The pain phenotype was categorized as nociceptive, neuropathic, or mixed using the Douleur Neuropathique 4 (DN4) scale. Univariate and multivariable logistic regression analyses were performed, and receiver operating characteristic (ROC) analysis was used to assess the discriminative performance. Results: A meaningful pain response was achieved in 61.1% of the patients. Lymphocyte and monocyte counts were higher in responders; however, effect sizes were small. Importantly, patients with neuropathic pain exhibited significantly higher monocyte counts, SIRI, and AISI, indicating an association between pain phenotype and systemic inflammatory burden; however, these markers were not associated with treatment response. Furthermore, isolated inflammatory indices demonstrated limited standalone discriminative performance in the ROC analysis. In the adjusted hematological model, NLR demonstrated a modest statistical association with MPR-50; however, this association weakened in the final integrated model. Conclusion: Inflammatory indices and pain phenotypes may reflect biological and clinical heterogeneity in older adults with LRP; however, their standalone predictive value for TFESI outcomes appears limited. TFESI responsiveness is likely multifactorial and may be better evaluated using an integrated clinical framework. Full article

Background: Systemic inflammation has been implicated in prognosis of multiple malignancies, yet evidence regarding its role in Wilms Tumor (WT) remains scarce. We investigated the prognostic significance of pre-treatment inflammatory markers in unilateral WT. Methods: We conducted a retrospective analysis of children with unilateral WT treated at our institution between November 2014 and December 2023. Clinical characteristics, treatment, and outcomes were evaluated. Inflammatory markers included a novel pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Optimal cut-off values for Event-Free Survival (EFS) and Overall survival (OS) were determined using data-derived optimization to maximize survival curve separation (surv_cutpoint). Cox proportional hazards models were used for survival analysis, while ROC curves were used to calculate AUC values and confirm optimal cut-off points. Results: We included 91 patients (median age: 3.6 years; 62% female), of whom 34% presented with metastasis. Higher EFS was significantly associated with low PIV (cut-off 288.9), low NLR (cut-off 1.1), and high LMR (cut-off 6.3). Similarly, OS was positively associated with lower PIV (HR 8.56 for high PIV, p = 0.038) and lower NLR (HR 4.63 for high NLR, p = 0.043). ROC analysis confirmed their discriminative ability; when evaluated at the unified survival cutpoints, LMR yielded an AUC of 0.692 for 5-year mortality (at cut-off 6.3), while NLR yielded an AUC of 0.671 for 5-year events (at cut-off 1.1). Conclusions: Pre-treatment inflammatory markers demonstrate significant prognostic value in unilateral WT. Elevated NLR and PIV, along with lower LMR, correlate with poorer survival. These accessible biomarkers provide a valuable, low-cost tool for risk assessment. Our optimal thresholds differed from Western adult cohorts, emphasizing the need for population-specific reference intervals in global pediatric oncology. Full article

Background: Graves’ disease is an autoimmune thyroid disorder that may be accompanied by systemic inflammation and Graves’ orbitopathy. This study evaluated the relationship between readily available hematological inflammatory markers and orbitopathy in patients with Graves’ disease. Methods: This retrospective observational study included 178 adult patients with Graves’ disease. Demographic, clinical, ophthalmological, and laboratory data were analyzed. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), monocyte-to-HDL cholesterol ratio (MHR), and C-reactive protein-to-albumin ratio (CAR) were calculated. Correlation, logistic regression, and ROC analyses were performed. Results: Among the 178 patients, 63 (35.4%) had Graves’ orbitopathy. Patients with orbitopathy had significantly higher NLR, PLR, SII, MHR, and CAR values than those without orbitopathy (all p < 0.001). Thyrotropin receptor antibody (TRAb) and thyroid-stimulating immunoglobulin (TSI) levels were positively correlated with all inflammatory markers. In multivariable logistic regression analysis, current smoking (OR 2.31, p = 0.047), TRAb (OR 1.08, p = 0.009), TSI (OR 1.06, p = 0.041), NLR (OR 1.63, p = 0.034), SII (OR 1.01, p = 0.018), MHR (OR 2.91, p = 0.012), and CAR (OR 3.84, p = 0.008) remained independently associated with Graves’ orbitopathy. Among the individual biomarkers, MHR showed the highest discriminative performance (AUC 0.818, 95% CI 0.754–0.882), while the combined inflammatory model achieved an AUC of 0.891 (95% CI 0.842–0.940), with an optimal predicted probability cut-off ≥ 0.43. Conclusions: Hematological inflammatory markers are associated with thyroid autoimmunity, disease activity, and Graves’ orbitopathy. These inexpensive and easily accessible markers may support clinical risk assessment in patients with Graves’ disease. Full article

Background/Objectives: Catatonia is a severe transdiagnostic neuropsychiatric syndrome for which accessible biological correlates remain insufficiently characterized. This study explored whether complete blood count (CBC)-derived inflammatory indices differ between psychiatric inpatients with catatonia and matched psychiatric controls without catatonia. Methods: This retrospective matched case–control study included 46 patients with catatonia and 46 psychiatric controls selected from the same clinical setting and study period. Controls were frequency-matched by sex, age distribution, and broad psychiatric diagnosis. CBC parameters obtained within the first 24 h of admission were used to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), and systemic inflammation response index (SIRI). Group comparisons, adjusted log–linear regression models, Spearman correlations with documented catatonic signs, and exploratory receiver operating characteristic analyses were performed. Results: SII was higher in patients with catatonia than in controls and remained significant after Bonferroni correction (median 584 [IQR 468–823] vs. 476 [IQR 339–619], Bonferroni-adjusted p = 0.032). In secondary adjusted models, catatonia was associated with higher SII and SIRI after adjustment for body mass index, smoking, antipsychotic exposure, diabetes mellitus, and arterial hypertension. No inflammatory index correlated significantly with the number of documented catatonic signs after correction. Exploratory discrimination was poor to fair, with SII showing the highest AUC (0.665, 95% CI 0.550–0.773). Conclusions: CBC-derived indices, particularly SII, may reflect systemic inflammatory or physiological stress burden in catatonia, but they should be interpreted as exploratory markers rather than diagnostic biomarkers. Full article

Objectives: Testicular torsion is a time-critical pediatric urological emergency in which delayed presentation may increase the likelihood of orchiectomy. However, preoperative estimation of the immediate intraoperative outcome remains challenging. This study aimed to develop and internally validate machine-learning models integrating ischemic timing variables and complete blood count-derived inflammatory indices to predict orchiectomy versus testicular preservation at index surgical exploration in pediatric and adolescent testicular torsion. Methods: We retrospectively analyzed 165 children and adolescents who underwent surgical exploration for confirmed testicular torsion. The primary endpoint was orchiectomy at index exploration versus testicular preservation through detorsion and/or orchiopexy. Clinical timing variables and complete blood count-derived indices, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, white blood cell-to-monocyte ratio, monocyte-to-mean platelet volume ratio, hemoglobin-to-monocyte ratio, systemic inflammatory response index, and aggregate index of systemic inflammation, were evaluated. Five supervised machine-learning algorithms—logistic regression, random forest, XGBoost, LightGBM, and support vector machine—were assessed using nested stratified cross-validation with an outer 5-fold loop and inner 3-fold hyperparameter selection. Model performance was estimated from out-of-fold predictions. Results: Orchiectomy was performed in 37 patients (22.4%), whereas testicular preservation through detorsion and/or orchiopexy was performed in 128 patients (77.6%). Symptom duration was significantly longer in the orchiectomy group than in the preservation group (48.00 [30.00–72.00] vs. 6.00 [2.00–24.00] h, p < 0.001). Monocyte count was also higher in the orchiectomy group (0.92 [0.68–1.23] vs. 0.65 [0.50–0.93] × 10⁹/L, p < 0.001). Among the combined models, XGBoost achieved the highest numerical discrimination, with a ROC-AUC of 0.926 ± 0.066 and a bootstrap 95% confidence interval of 0.856–0.966. Feature-block and interpretability analyses identified symptom duration as the dominant predictor, followed by emergency department waiting time and selected monocyte-centered inflammatory indices. Conclusions: Immediate intraoperative orchiectomy in pediatric and adolescent testicular torsion was most strongly associated with prolonged symptom duration, while selected complete blood count-derived inflammatory indices provided complementary risk information. The combined XGBoost model showed strong internal discrimination and clinically interpretable predictor patterns. However, the model was internally validated only and requires external validation before clinical implementation. Full article

Human immunodeficiency virus and tuberculosis (HIV/TB) coinfection remains a major global health challenge. Immune dysregulation in HIV complicates TB diagnosis. The type of immune response mounted in tuberculosis is a key determinant in deciding the outcome of the infection. Hence, estimating immune markers is critical for developing diagnostic, monitoring and treatment approaches. A study was conducted to evaluate the diagnostic potential of host-based biomarkers in individuals with HIV/TB coinfection in comparison to HIV monoinfection receiving antiretroviral therapy. Host-based biomarkers were quantified using commercially available kits. Receiver operated curve (ROC) analysis was conducted to determine diagnostic performance. Routine investigations showed significantly raised ratios of neutrophils, monocytes, and platelets-to-lymphocytes and alkaline phosphatase levels in HIV/TB coinfection (AUC values > 0.76). Plasma galectin-9 and osteopontin levels had an AUC > 0.8. IFN-γ, TNF-α and IL-12 levels were also significantly raised (AUC values > 0.95) while levels of GM-CSF and IL-6 were significantly low in HIV TB coinfection. The ROC analysis revealed the highest diagnostic accuracy of IL-12, indicating its potential as an adjunct immunological biomarker in identifying TB among HIV-infected individuals. However, a large-scale prospective study is required to confirm the findings and to understand their role in predicting the development of tuberculosis disease in people living with HIV. Full article

Objective: To evaluate the association of routine complete blood count (CBC)-derived inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation response index (SIRI), with disease activity and exploratory neuropsychiatric risk stratification in patients with systemic lupus erythematosus (SLE). Methods: In this multi-center retrospective study, 579 SLE patients and 282 healthy controls (HCs) were recruited from five clinical centers between 2018 and 2025. NLR, MLR, PLR, and SIRI were calculated from routine CBC parameters. Disease activity was assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K), with high activity defined as SLEDAI-2K ≥ 10. The comparison between SLE patients and HCs was performed as an exploratory descriptive analysis to characterize systemic inflammatory profiles, whereas the primary analyses focused on associations with disease activity and NPSLE-related risk stratification. Results: SLE patients exhibited significantly higher levels of SIRI, NLR, PLR, and MLR compared to HCs (all p < 0.001). In this exploratory comparison, MLR showed the largest area under the curve for distinguishing SLE patients from HCs (AUC: 0.849, Cut-off: 0.263). In regression analyses, MLR, NLR, PLR, and SIRI were positively associated with SLEDAI-2K score. In multivariable linear regression analysis, MLR was associated with a higher SLEDAI-2K score (B = 4.600, 95% CI: 2.039–7.160, p < 0.001). In patients with available neuropsychiatric data, MLR, NLR, and SIRI were higher in patients with NPSLE than in those with non-NPSLE, whereas PLR showed no significant difference. SIRI showed modest exploratory discriminatory ability for NPSLE and may provide auxiliary information for NPSLE risk stratification (AUC: 0.710, p < 0.001, Cut-off: 1.438). Conclusions: Routine CBC-derived inflammatory biomarkers, particularly MLR, NLR, and SIRI, are associated with SLE disease activity and may serve as accessible, low-cost adjunctive tools for rapid clinical assessment. SIRI may provide additional auxiliary information for identifying patients at higher risk of neuropsychiatric involvement. However, these biomarkers should be interpreted as complementary screening or risk-stratification tools rather than substitutes for established disease activity indices or organ-specific evaluations. Further prospective studies are warranted to validate their clinical utility. Full article

Background. Hematological inflammatory indices from the complete blood count have been proposed as inexpensive prognostic markers in sepsis. The systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) are the most studied, but the performance of monocyte-containing alternatives (SIRI, AISI) in the elderly, in whom immunosenescence may alter the leukocyte phenotype, remains poorly characterized. Methods. In a single-center retrospective cohort of patients aged ≥65 years admitted to a tertiary ICU with Sepsis-3-defined sepsis (n = 127, 33 deaths), we compared the discrimination of six indices (NLR, PLR, MLR, SII, SIRI, AISI) for 30-day all-cause mortality using AUROC with bootstrap confidence intervals and pairwise DeLong tests. Independent associations were assessed by logistic regression adjusted for APACHE II and age; incremental value over APACHE II was explored using IDI, cNRI, calibration and decision curve analysis, with bootstrap optimism correction. Results. Thirty-day mortality was 26.0%. The monocyte-containing indices (AISI, SIRI, MLR) discriminated better than SII and NLR, and AISI was significantly superior to SII, NLR and PLR on DeLong testing, though not to SIRI, MLR or APACHE II. After adjustment for APACHE II and age, AISI, SIRI and MLR remained independently associated with mortality, whereas SII and PLR did not. Adding AISI to APACHE II improved reclassification and calibration and yielded higher net clinical benefit across clinically relevant thresholds. Conclusions. In this exploratory, single-center analysis, monocyte-containing indices, particularly AISI, were more strongly associated with 30-day mortality in elderly ICU sepsis than SII or NLR. AISI, SIRI and MLR were strongly intercorrelated and near-equivalent, and AISI did not significantly exceed APACHE II in discrimination. These hypothesis-generating findings require prospective external validation before clinical use. Full article

Background/objectives: Catheter-related bloodstream infection (CRBSI) is a frequent and morbid complication in catheter-dependent maintenance hemodialysis, and rapid risk stratification is needed while awaiting cultures. This study aimed to evaluate admission complete blood count-derived indices—neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV)—for identifying CRBSI. Methods: This single-center retrospective study (1 January 2011–31 October 2024) included adult catheter-dependent hemodialysis patients classified as CRBSI or controls. CRBSI required compatible clinical findings and concordant growth of the same microorganism(s) in paired simultaneous catheter and peripheral blood cultures. Controls were hospitalized for non-infectious reasons without infection during the index admission. Indices were calculated from admission blood counts. Discrimination was assessed using ROC analysis, and adjusted associations were evaluated using multivariable logistic regression. Results: Among 286 patients (147 CRBSI, 139 controls), CRBSI cases had higher NLR, SII, and PIV and lower LMR; PLR did not differ. NLR showed the numerically highest discriminatory performance among the evaluated indices (AUC 0.737; cut-off 5.96; sensitivity 68.7%, specificity 68.3%; p < 0.001). SII (cut-off 1189.21; AUC 0.693) and PIV (cut-off 821.62; AUC 0.686) had moderate discrimination, and LMR was modest (cut-off 1.65; AUC 0.642); PLR was not discriminatory (AUC 0.559; p = 0.086). In models adjusted for age, sex, hypertension, and cardiovascular disease, NLR remained associated with CRBSI (OR 1.159; p < 0.001), together with hypertension (OR 2.441; p = 0.017) and cardiovascular disease (OR 2.626; p < 0.001). Conclusions: Admission hematologic inflammation indices, particularly NLR, showed moderate ability to discriminate CRBSI from non-infectious admissions in catheter-dependent hemodialysis patients and may provide rapid adjunctive information while awaiting microbiological confirmation. Full article

Background: Increasing evidence suggests that schizophrenia may be associated with peripheral immune–inflammatory alterations, although the distributional characteristics and heterogeneity of routinely available complete blood count (CBC)-derived inflammatory indices in real-world psychiatric inpatient settings remain insufficiently characterized. The present study aimed to descriptively evaluate the distributional properties of CBC-derived inflammatory markers in hospitalized patients with schizophrenia using an exploratory panel-based analytical framework. Methods: We conducted a retrospective cross-sectional analysis using anonymized CBC laboratory panels obtained from hospitalized patients with schizophrenia at a tertiary psychiatric center. Following panel reconstruction and quality control procedures, 858 structurally valid CBC panels were included in the analyses. Primary inflammatory indices included neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune–inflammation index (SII). Descriptive distributional analyses, threshold-based prevalence estimation, Spearman correlation analyses, and exploratory unsupervised clustering procedures were performed to evaluate inflammatory variability and internal distributional patterns within the dataset. Results: Median NLR was 2.51 (IQR: 1.95–3.55), median MLR was 0.25 (IQR: 0.19–0.31), median PLR was 124.10 (IQR: 100.40–163.94), and median SII was 686.96 (IQR: 484.81–1045.85). Threshold-based analyses demonstrated substantial variability in inflammatory burden distributions, with 35.9% of panels showing NLR > 3 and 27.0% demonstrating SII > 1000. Correlation analyses revealed strong positive associations among NLR, PLR, and SII, whereas RDW-CV and MPV demonstrated weaker and more heterogeneous relationships with the principal inflammatory indices. Exploratory clustering analyses generated two distributional clusters, including a smaller cluster exhibiting relatively higher NLR, MLR, PLR, SII, WBC, and platelet values than the remaining panels. Female panels demonstrated significantly higher PLR and SII distributions following false discovery rate (FDR) correction. Conclusions: The present findings suggest that CBC-derived inflammatory indices demonstrate substantial distributional variability within this panel-based schizophrenia dataset. Although the exploratory design, absence of patient-level linkage, and lack of clinical confounder adjustment substantially limit biological interpretation, routinely available hematological inflammatory markers may still provide a pragmatic framework for descriptive characterization of inflammatory variability patterns in real-world psychiatric populations. Future patient-level longitudinal studies integrating clinical, pharmacological, and molecular variables will be necessary to determine the potential clinical relevance of inflammatory heterogeneity in schizophrenia. Full article

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3 definition), associated with high mortality in intensive care unit (ICU) patients. Composite immune–nutritional indices derived from routine laboratory data have emerged as accessible prognostic tools; however, their comparative value in critically ill septic patients remains insufficiently characterised. This study aimed to compare the prognostic performance of the haemoglobin–albumin–lymphocyte–platelet (HALP) score, pan-immune-inflammation value (PIV), and Naples Prognostic Score (NPS) for predicting in-hospital mortality in ICU patients with sepsis as the primary outcome, and to assess their incremental predictive value as the secondary objective. Methods: In this retrospective, two-centre cohort study, 1020 consecutive eligible adult patients fulfilling Sepsis-3 criteria (suspected or confirmed infection with an acute increase in SOFA score ≥ 2 points) admitted to the ICUs of Necmettin Erbakan University Hospital and Beyhekim Training and Research Hospital between January 2016 and June 2025 were included. HALP was calculated as haemoglobin (g/L) × albumin (g/L) × lymphocyte count (×10⁹/L) ÷ platelet count (×10⁹/L); PIV as (neutrophil × platelet × monocyte) ÷ lymphocyte (all ×10⁹/L). NPS was computed from serum albumin, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio, with the total-cholesterol component imputed due to availability in only 31.7% of patients. Discriminative performance was evaluated by receiver operating characteristic (ROC) analysis, pairwise DeLong tests, bootstrap resampling (1000 iterations), Hosmer–Lemeshow calibration, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analyses. Five pre-specified nested multivariable logistic regression models were constructed. Results: Of 1020 patients (median age 76 years, IQR 67–83; 59.8% male), 521 (51.1%) died during hospitalisation. HALP showed the highest discriminative ability among individual indices (AUC 0.626, 95% CI 0.594–0.658), while PIV was non-discriminatory (AUC 0.504, p = 0.78) and NPS showed limited performance (AUC 0.563, 95% CI 0.531–0.595). HALP remained an independent predictor of mortality after multivariable adjustment (OR 0.98, 95% CI 0.97–0.99, p = 0.002). NRI and IDI analyses showed no incremental value with NPS addition. Conclusions: HALP demonstrated modest but independently consistent discrimination for in-hospital mortality in ICU patients with sepsis, outperforming PIV and NPS. However, an AUC of 0.626 does not support standalone clinical use; external validation and comparison with established severity models are required before integration into risk stratification frameworks. Full article

Metabolically dysfunction-associated steatotic liver disease (MASLD) complicated by type 2 diabetes mellitus (T2DM) represents a clinically aggressive phenotype associated with accelerated hepatic fibrosis progression. The interplay among oxidative stress, systemic inflammation, and the risk of hepatic fibrosis in this context remains incompletely characterised. We conducted a single-centre observational study enrolling 110 adult MASLD patients, stratified into two groups: Group 1 (G1, n = 20), patients with concurrent T2DM, followed longitudinally at three successive time points, and Group 2 (G2, n = 90), non-diabetic controls. Serum oxidative stress biomarkers were assessed using malondialdehyde (MDA) and 8-isoprostaglandin F2α (8-iso-PGF2α). Systemic inflammatory status was quantified through the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR). Hepatic fibrosis risk was estimated using the FIB-4 index. Diabetic MASLD patients exhibited significantly elevated levels of 8-iso-PGF2α (p = 0.014) and NLR (p = 0.016) compared with controls, indicating greater oxidative membrane damage and systemic neutrophilic inflammation. A robust inverse correlation between PLR and FIB-4 was observed across all analytical strata (combined cohort: Spearman r = −0.680, p < 0.001). MLR emerged as the only independent predictor of MDA in G1 (β = 841.78, p = 0.013). Longitudinal analysis demonstrated biomarker stability over time, except for a significant increase in ALT from T1 to T2 (p_adj = 0.014). These findings support the clinical utility of routinely available haematological inflammatory ratios and lipid peroxidation biomarkers for phenotypic characterisation of MASLD in the diabetic context, highlighting the need for larger prospective studies with histological validation. Full article