Search Results (212)

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

Introduction: Chronic inflammation in Crohn’s disease (CD) is associated with systemic alterations, including the loss of skeletal muscle mass. While nutritional deficits are known to impact clinical trajectories, the specific prognostic value of muscle wasting remains underutilised. The primary objective of this study is to construct a composite score integrating sarcopenia with paraclinical parameters to predict an unfavourable disease outcome (UO) more accurately. Materials and Methods: We conducted a retrospective study of patients with CD who were hospitalized at our institution between January 2020 and June 2024 and were treated with biologics or small molecules. Using previous CT scans, we measured skeletal muscle area (SMA) and skeletal muscle index (SMI) to assess their association with disease outcomes. Univariate and multivariate analyses were performed to identify significant predictors of UO, and Area Under the Curve (AUC) values were calculated to assess the predictive performance and to construct a composite prognostic score. Results: Multivariate analysis in the study group (52 patients) identified sarcopenia (low SMI), faecal calprotectin levels >129 μg/g, and complicated disease behaviour (Montreal B2/B3) as independent predictors of UO. Integrating these parameters into a composite risk score resulted in a promising predictive model with an Area Under the Curve (AUROC) of 0.864, significantly outperforming individual biomarkers. Conclusions: We performed a hypothesis-generating study suggesting that nutritional assessment in CD could provide an important benefit in stratifying patients for whom additional nutritional interventions may enhance the long-term outcomes. Full article

Background: The aim of this study was to examine the relationships between dietary intake and two key components of sarcopenia in older, sex- and age-matched men and women: muscle strength and physical performance. Methods: The study included 620 carefully selected community-dwelling adults aged 60 years and more (310 men and 310 women) matched by sex and age (±1 year; median age: 66 years). Body mass and body mass index were assessed. Dietary intake was evaluated using 24 h dietary recall questionnaire and analyzed with Dieta 5.0 software. Handgrip strength (HGS) was measured using a hydraulic hand dynamometer, while physical performance using the Timed Up and Go test (TUG). Results: In men, but not in women, higher intakes of multiple dietary components, especially proteins, were associated with greater HGS. TUG was inversely related to animal protein, some amino acids, folate and vitamin C in men, whereas in women to copper, magnesium, vitamins C and E, riboflavin, and PUFA intakes. After multivariable adjustment, no nutrient remained associated with HGS in both sexes. In women, vitamin C intake remained inversely associated with TUG. Age was the strongest predictor of HGS, while age, physical activity (PA) and chronic diseases were significant factors associated with TUG in both sexes. Conclusions: Our findings show multifactorial nature of muscle physiology, suggesting that in preventive strategies adequate dietary intake integrated with PA and effective management of chronic diseases is required, as nutrition alone appears insufficient to preserve muscle function. The sex-stratified associations suggest that personalized dietary recommendations may be beneficial. Full article

Background/Objectives: Frailty is increasingly recognized as a clinically relevant marker of reduced physiological reserve in surgical oncology. The modified 5-item frailty index (mFI-5) is simple and practical, but its clinical significance in oral squamous cell carcinoma (OSCC) remains incompletely defined. This study evaluated the association between mFI-5-defined frailty and postoperative complications, especially postoperative delirium, as well as survival outcomes in patients undergoing surgery for OSCC. Methods: We retrospectively analyzed 127 patients who underwent surgical resection for OSCC with postoperative high care unit (HCU) management between 2013 and 2021. Frailty was defined as an mFI-5 score of ≥2. Clinical characteristics, postoperative outcomes, HCU stay, length of hospital stay, overall survival (OS), and disease-free survival (DFS) were compared between frail and non-frail groups. Univariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications. An exploratory multivariable logistic regression analysis for postoperative delirium was performed using age ≥65 years and sex as covariates. Delirium was retrospectively assessed from clinical documentation considered consistent with DSM-5 criteria. Results: Twenty-one patients (16.5%) were classified as frail. Postoperative delirium occurred more frequently in frail patients than in non-frail patients (42.9% vs. 19.8%; p = 0.023). In a multivariable logistic regression model adjusted for age ≥65 years and sex, mFI-5-defined frailty was significantly associated with postoperative delirium (adjusted OR, 3.07; 95% CI, 1.08–8.60; p = 0.035). No significant association was observed for pneumonia, surgical site infection, or free-flap reoperation. Frailty was not significantly associated with HCU stay, length of hospital stay, OS, or DFS. Conclusions: mFI-5-defined frailty was associated with postoperative delirium but not with survival outcomes in this OSCC cohort. Because this retrospective study was limited by sample size, comorbidity-driven mFI-5 scoring, non-standardized delirium screening, and potential residual confounding, mFI-5 should be interpreted as a convenient screening marker rather than a stand-alone predictor. Comprehensive perioperative assessment incorporating frailty, nutrition, sarcopenia, cognition, tumor burden, and treatment-related factors may better identify patients at risk. Full article

Background: There is limited evidence regarding sarcopenia in Thailand, especially in southern provinces when applying the AWGS-2019 criteria. Objective: The present study aimed to determine the prevalence and independent risk factors of sarcopenia among community-dwelling older adults in Nakhon Si Thammarat. Methods: A cross-sectional study was conducted involving 246 adults aged 60 years or older. Sarcopenia was defined using the AWGS-2019 criteria. Data collection comprised the Mini Nutritional Assessment-Short Form (MNA-SF), Abbreviated Mental Test (AMT), and physical performance assessments. Multivariable logistic regression analysis was performed to identify independent predictors, incorporating both categorical and continuous variables. Results: The prevalence of sarcopenia was 27.64%. Multivariable analysis identified age of ≥80 years or older (AOR = 4.25, 95% CI: 1.12–16.14; p = 0.033) and body mass index (BMI) below 18.5 kg/m² (AOR = 3.58, 95% CI: 1.20–10.65; p = 0.022) as significant risk factors. Protective factors included attainment of secondary education or higher (AOR = 0.12, 95% CI: 0.02–0.78; p = 0.025), BMI of 23.0 kg/m² or greater (AOR = 0.19, 95% CI: 0.09–0.40; p < 0.001), engagement in regular physical activity (AOR = 0.21, 95% CI: 0.08–0.54; p = 0.001), and normal nutritional status (AOR = 0.24, 95% CI: 0.08–0.71; p = 0.010). Further continuous analysis confirmed that each 5-year increase in age significantly increased the risk of sarcopenia (AOR = 1.52, 95% CI: 1.14–2.03; p = 0.005), while each 1 kg/m² increase in BMI was associated with a protective effect (AOR = 0.78, 95% CI: 0.69–0.88; p < 0.001). Conclusions: Sarcopenia is common among older adults in Southern Thailand. Both categorical and continuous analyses identify advanced age as a primary risk factor. In contrast, higher education, optimal body mass index, regular physical activity, and adequate nutrition serve as important protective factors. These results highlight the importance of community-based screening and targeted interventions that address nutritional adequacy and structured exercise to enhance quality of life in this population. Full article

Background: This study aimed to determine the prevalence of osteosarcopenia and evaluate the diagnostic performance of phase angle, derived from bioelectrical impedance analysis, in identifying osteosarcopenia among older adults with type 2 diabetes mellitus. Method: A cross-sectional study was conducted with 147 participants aged 60 years or older, recruited from an outpatient clinic in Thailand between during 2024. Osteosarcopenia was diagnosed when criteria for both sarcopenia, defined by low skeletal muscle mass and either reduced handgrip strength or impaired physical performance, and osteoporosis, defined by a T-score of −2.5 or lower on dual-energy X-ray absorptiometry, were met. Participant characteristics, physical function, laboratory values, and body composition data were collected. Univariable Firth’s penalized logistic regression identified low body mass index and a lower phase angle as independent predictors of osteosarcopenia. Results: The overall prevalence of osteosarcopenia was 7.5 percent. Receiver operating characteristic curve analysis showed strong diagnostic performance of phase angle, with an area under the curve of 0.865. A cutoff value of less than 4.0 degrees achieved 100% sensitivity, 62.5% specificity, and 100% negative predictive value. These findings suggest that phase angle may be a practical, noninvasive screening tool for identifying older adults with type 2 diabetes mellitus who are at risk for osteosarcopenia. Its application in routine clinical settings could enable earlier intervention and reduce long-term complications associated with musculoskeletal decline in this vulnerable population. Full article

Background/Objectives: Imaging-based markers of sarcopenia have emerged as potential indicators of frailty and predictors of clinical outcomes in patients with lower limb ischemia undergoing revascularization. However, the available evidence remains inconclusive. This systematic review aims to provide a comprehensive overview of current imaging-based approaches to sarcopenia assessment and to evaluate their relationship with clinical outcomes in this population. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) database: ID CRD420251229527. A literature search was performed in PubMed and Scopus to identify studies published between 1 January 2020 and 1 August 2025. Studies assessing imaging-derived markers of sarcopenia in adults undergoing revascularization for lower limb ischemia were included. Due to heterogeneity in imaging methods, sarcopenia definitions and reported outcomes, a narrative synthesis was performed. Results: Nine studies involving 2563 patients were included in this review. Computed tomography (CT) was the predominant imaging modality used for sarcopenia assessment, with muscle measurements most frequently obtained at the level of the third lumbar vertebra (L3). Commonly reported imaging-derived markers included the skeletal muscle index, psoas muscle-based parameters and muscle radiodensity. Assessment strategies varied across studies, particularly with respect to measurement techniques, anatomical landmarks and the thresholds used to define sarcopenia. Most studies reported an association between imaging-derived low muscle mass and increased long-term mortality; however, independent associations after multivariable adjustment were less consistent. Findings regarding postoperative complications and limb-related outcomes were limited and inconsistent. Conclusions: Current evidence suggests that imaging-derived muscle markers may provide additional prognostic information regarding long-term mortality in patients undergoing revascularization for lower limb ischemia, while associations with postoperative complications and limb-related outcomes remain inconsistent. However, the small number of retrospective studies and substantial methodological heterogeneity limit their comparability, highlighting the need for standardization in future research. Full article

Background/Objectives: Sarcopenia involves a gradual decline in skeletal muscle mass that may occur during aging or in association with chronic pathological conditions. It markedly reduces muscle strength and mobility, thereby impairing quality of life. Because sarcopenia’s severity directly correlates with frailty, it represents an important predictor of prognosis and disease risk. Current preventive and therapeutic strategies rely mainly on physical activity, which is not feasible for all patients. This study investigated the biological effects of two independently prepared Tuber borchii (T. borchii) extracts in an in vitro model of sarcopenic stress. Methods: The activity of T. borchii extracts was investigated in a cell-based model of sarcopenia, following previous observations that these preparations influence proliferation-related pathways, including ERK1/2 phosphorylation. Specifically, differentiated myotubes were exposed to D-galactose to reproduce atrophy-associated cellular changes, and the impact of T. borchii extracts on protein synthesis, turnover, and cell morphology was assessed. Results: T. borchii extracts enhanced protein synthesis and turnover in myotubes. Furthermore, the treatment significantly reduced the expression of key galactose-induced sarcopenia and atrophy markers, such as MuRF1. Morphological analysis confirmed this protective effect, showing that treated myotubes maintained greater thickness and exhibited a larger cross-sectional area despite exposure to the sarcopenic stimulus. Conclusions: These results indicate that T. borchii extracts can attenuate selected cellular alterations associated with muscle aging. Future identification of the most active components may support their development as nutraceutical supplements. Full article

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

Background/Objectives: Cranioplasty is a common reconstructive procedure following decompressive craniectomy, yet postoperative complications requiring reoperation remain frequent. Sarcopenia has been associated with adverse surgical outcomes. Temporalis muscle thickness (TMT), readily assessed on routine cranial CT, has been proposed as a surrogate marker of sarcopenia; however, its role in predicting cranioplasty outcomes remains to be established. This study aimed to evaluate the association between TMT and postoperative complications requiring reoperation after cranioplasty. Methods: In this retrospective single-center cohort study, 71 patients undergoing cranioplasty after decompressive craniectomy were included. Patients were stratified according to the occurrence of postoperative complications requiring reoperation into a complication group (n = 28) and an uneventful postoperative course group (n = 43). TMT was measured on preoperative CT scans obtained prior to craniectomy and prior to cranioplasty. Reduced TMT was defined as ≤5 mm. Results: Postoperative complications requiring surgical revision occurred in 39.4% of patients. Reduced TMT (≤5 mm) was significantly associated with greater reoperation risk in univariate analysis (p = 0.003). Patients undergoing surgical revision had significantly lower TMT prior to craniectomy (4.6 mm vs. 5.3 mm; p = 0.03) and TMT remained an independent predictor in multivariate analysis. Conclusions: Reduced TMT is independently associated with an increased risk of postoperative complications after cranioplasty requiring surgical revision and may serve as a simple imaging-based marker for preoperative risk stratification. Full article

Background/Objectives: Functional vulnerability may identify older adults hospitalized with Crohn’s disease flares who are at increased risk for adverse outcomes, but its prognostic significance in this setting remains incompletely defined. We evaluated the association between administratively defined functional vulnerability, identified using administrative diagnostic codes, and short-term clinical outcomes among adults aged ≥65 years hospitalized with Crohn’s disease flares. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Research Network through February 2026. Functional vulnerability was identified using ICD-10-CM codes for frailty, sarcopenia, cachexia, abnormal weight loss, muscle weakness, gait/mobility abnormalities, or reduced mobility within 12 months before or during the index hospitalization. Patients coded only for nonspecific weakness or fatigue were excluded from the functional vulnerability cohort. Patients underwent 1:1 propensity score matching using demographic, comorbidity, Crohn’s disease-related, medication, nutritional, and laboratory variables. The primary outcome was 30-day all-cause mortality. Results: Among 18,420 eligible patients, 2846 met criteria for functional vulnerability, and 15,574 did not. After matching, 2720 patients remained in each cohort. Functional vulnerability was associated with higher 30-day mortality (RR 1.61, 95% CI 1.21–2.14), 90-day mortality (RR 1.40, 95% CI 1.14–1.72), bowel surgery (RR 1.29, 95% CI 1.07–1.56), sepsis (RR 1.41, 95% CI 1.18–1.68), acute kidney injury (RR 1.26, 95% CI 1.10–1.44), ICU admission (RR 1.32, 95% CI 1.13–1.55), TPN use (RR 1.47, 95% CI 1.20–1.79), and 90-day readmission (RR 1.17, 95% CI 1.07–1.29). Functionally vulnerable patients also had longer hospital stays (8.9 vs. 6.7 days; mean difference 2.2 days, 95% CI 1.9–2.5). Conclusions: Administratively defined functional vulnerability identified through diagnostic coding was associated with worse short-term outcomes among older adults hospitalized with Crohn’s disease flares. Although functional vulnerability is a recognized predictor of adverse outcomes across hospitalized populations broadly, these findings quantify its prognostic significance specifically in Crohn’s disease flare hospitalizations and suggest that functional vulnerability may identify a high-risk geriatric IBD phenotype that could benefit from early multidisciplinary assessment, nutritional optimization, rehabilitation planning, and post-discharge care coordination. Full article

Background/Objectives: Recompensation in patients with decompensated cirrhosis has significant prognostic implications. In this study, we aimed to evaluate the incidence and predictors of recompensation in cirrhotic patients, specifically focusing on elucidating the influence of sarcopenia and visceral obesity on achieving recompensation in a cohort of decompensated individuals. Methods: We conducted a retrospective analysis of 195 patients with decompensated cirrhosis from 2021 to 2024. Body composition abnormalities were determined by the skeletal muscle index (SMI) and visceral-to-subcutaneous adipose tissue ratio (VSR) on computed tomography (CT), respectively. Factors related to recompensation, defined using the modified Baveno VII criteria, were identified using multivariate regression. Results: Patients who achieved recompensation exhibited a lower age (62 vs. 67, p < 0.05), a higher body mass index (22.8 vs. 21, p < 0.01), a lower aspartate aminotransferase level (32 vs. 39, p < 0.01), a higher albumin level (35.2 vs. 32.3, p < 0.01), a lower ascites prevalence (60% vs. 74.07%, p < 0.05), a lower Child–Pugh score (6 vs. 7, p < 0.01), and a lower End-Stage Liver Disease score (9 vs. 10, p < 0.05) compared to those with non-recompensated cirrhosis. Body composition abnormalities were significantly more prevalent in non-recompensated patients than in recompensated patients (77.04% vs. 63.33%, p < 0.05), mainly because of a significantly higher prevalence of combined sarcopenia and visceral obesity in non-recompensated individuals (28.29% vs. 6.67%, p < 0.01). Multivariate analysis indicated that combined sarcopenia and visceral obesity was the sole independent risk factor for non-recompensation in this population. Furthermore, in the subgroup of patients aged < 70 years, with normal weight and preserved liver function, differences in recompensation rates among various states of body composition abnormalities were more pronounced. Conclusions: Sarcopenic visceral obesity is an independent risk factor for non-recompensation in patients with decompensated cirrhosis, highlighting the need for targeted interventions to mitigate body composition abnormalities in this vulnerable population. Full article

Background: Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and substantial healthcare utilization. Length of hospital stay (LOS) after lower limb revascularization is influenced by procedural complexity, but patient physiological reserve may also play a role. We evaluated whether CT-derived lean psoas muscle area (LPMA) is independently associated with LOS in patients undergoing revascularization for CLTI. Methods: We retrospectively analyzed 234 consecutive patients treated with endovascular, hybrid, or open revascularization for CLTI (Rutherford 4–5) between 2018 and 2021. Sarcopenia markers were derived from preoperative CT at the L3 level, including psoas muscle area (PMA), muscle density (PMD), and LPMA. Multivariable linear regression models with log-transformed LOS were used to estimate relative effects on hospitalization duration. Results: Median age was 68 years and 65.4% were male; 76.5% of admissions were urgent. Median LOS was 6 days (IQR 4–9). Procedure type was the strongest determinant of LOS: hybrid (β = 0.69, p < 0.001) and open surgery (β = 0.73, p < 0.001) were associated with approximately 99% and 108% longer LOS compared with endovascular treatment. Higher LPMA was independently associated with shorter LOS (β = −0.00049, p = 0.004). Smoking (β = −0.21, p = 0.003) and history of myocardial infarction (β = −0.19, p = 0.030) were associated with shorter LOS, whereas dialysis showed a non-significant trend toward longer hospitalization (β = 0.36, p = 0.056). Conclusions: In patients undergoing lower limb revascularization for CLTI, CT-derived LPMA demonstrated a modest but independent association with hospital stay duration after adjustment for procedural and clinical factors. Given the exploratory nature of this study, these hypothesis-generating findings support further evaluation of imaging-based muscle assessment as an adjunct marker of physiological reserve in this high-risk population. Full article

Background/Objectives: Frailty is a validated predictor of waitlist mortality and perioperative risk in liver transplant candidates, but its association with early post-transplant outcomes in large real-world cohorts remains incompletely characterized. This study evaluated the association between administratively defined pre-transplant frailty and early clinical outcomes following liver transplantation. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Research Network. Adults undergoing first-time isolated liver transplantation through February 2026 were included. Frailty was identified using ICD-10-CM codes for frailty, sarcopenia, cachexia, weakness, abnormal gait/mobility, or reduced mobility documented within 12 months before transplantation; patients coded only for nonspecific weakness were excluded from the frailty cohort. Patients underwent 1:1 propensity score matching using 18 baseline covariates, including demographics, comorbidities, laboratory values, albumin, and MELD-Na. The primary outcome was all-cause mortality at 7, 30, and 90 days. Secondary outcomes included acute kidney injury, prolonged mechanical ventilation, vasopressor requirement/hemodynamic instability, renal replacement therapy, ICU and hospital length of stay, and 90-day readmission. Sensitivity analyses used a restrictive ≥ 2-code frailty definition and substituted MELD 3.0 for MELD-Na in the propensity model. Results: Among 4860 eligible recipients, 742 had administratively defined frailty and 4118 did not. After matching, 730 patients remained in each group with well-balanced covariates. Administratively defined frailty was associated with higher mortality at 7, 30, and 90 days, with numerically smaller relative risks at later time points. It was also associated with higher risks of acute kidney injury, prolonged mechanical ventilation, vasopressor requirement/hemodynamic instability, renal replacement therapy, longer ICU and hospital stays, and 90-day readmission. Findings were directionally consistent in both sensitivity analyses. Etiology-stratified analyses were exploratory and showed no statistically significant heterogeneity across liver disease etiologies. Conclusions: In this large propensity-matched multicenter cohort, administratively defined pre-transplant frailty was associated with worse early outcomes after liver transplantation. Because frailty and several outcomes were identified using structured EHR and administrative data, findings should be interpreted as associative and hypothesis-generating. Prospective studies using validated frailty instruments and granular donor, intraoperative, and center-level variables are needed to confirm these findings. Full article

Objective: This study aimed to evaluate the prognostic value of inflammatory biomarkers and their interaction with nutritional status for risk stratification in patients with chronic limb-threatening ischemia (CTLI). Material and Methods: This was a prospective, single-center observational cohort study including adult patients admitted with CTLI. Clinical outcomes included major amputation, major vascular events (MACE), and all-cause mortality. Multivariate logistic regression analyses were performed using two separate models, one including IL-6 and another including hsCRP, to avoid potential collinearity between biomarkers. Model discrimination was assessed using ROC curves, and Kaplan–Meier survival analyses were performed. Results: A total of 170 patients were included (mean age 72 ± 12 years; 74% male), with high cardiovascular risk and frequent malnutrition and sarcopenia. At 6 months, major amputations occurred in 35.3% of patients, MACE in 35%, and all-cause mortality in 32%. In multivariable analyses, malnutrition was the strongest independent predictor of the composite endpoint. IL-6 (OR 2.90, 95% CI 1.45–5.81; p = 0.003) and hsCRP values above the median (OR 4.22, 95% CI 2.04–8.72; p < 0.001) remained independently associated with adverse outcomes, together with age > 72 years. The hsCRP-based model showed slightly higher discriminative performance than the IL-6 model (AUC = 0.77 VS AUC = 0.75). Kaplan–Meier analyses demonstrated significantly reduced event-free survival in patients with elevated inflammatory biomarkers. Conclusions: In CTLI, systemic inflammation and nutritional status jointly identify patients at extremely high risk of adverse outcomes. hsCRP, given its availability, may be a practical tool for clinical risk stratification. Full article