Search Results (3,901)

Background/Objectives: Subsequent musculoskeletal injuries are frequent among physically active young adults, yet the roles of body composition, training weekly load (TWL), and physical activity intensity in subsequent injury occurrence remain unclear. This study examined the associations of body composition indices and training-related variables with subsequent injuries in university students and explored whether combining key markers from body composition and training exposure improves discrimination compared with single markers. Methods: The analysis included 418 students from two cohorts merged after confirming negligible between-cohort differences. Participants completed questionnaires on injury history and physical activity and underwent standardized anthropometric and body composition assessments. Intrinsic factors included fat mass index (FMI) and skeletal muscle mass index (SMI), while extrinsic factors comprised training weekly load (TWL), total physical activity (TPA), and vigorous activity percentage (VPA%). Subsequent injury (yes/no) served as the primary outcome. Injuries were assessed retrospectively over the preceding 12 months; subsequent injury was defined as ≥1 injury occurring after a previous (index) injury within this recall period. Analyses used univariate and multivariable logistic regression and exploratory Receiver Operating Characteristic (ROC) analyses for individual markers and combined models. Results: SMI was associated with subsequent injury (OR = 1.09, 95% CI: 1.03–1.15). TWL showed a weak, non-significant association (OR = 1.03, p = 0.307). Models combining SMI and TWL, including their interaction, did not meaningfully improve discrimination compared with SMI alone. ROC analyses indicated limited discriminatory ability across models (AUCs < 0.65), suggesting poor accuracy for identifying individuals with subsequent injury based on these markers. Conclusions: The examined body composition, training weekly load (TWL), and physical activity measures alone or combined showed limited discriminatory utility for subsequent injury status in this cross-sectional sample. These findings support the multifactorial nature of injury susceptibility and indicate that simple anthropometric or TWL-based measures are not suitable as standalone screening tools for subsequent injury in active university populations. Full article

Background and Objectives: Acute pancreatitis (AP) is an acute inflammatory disease ranging from mild, self-limiting forms to severe presentations associated with high morbidity and mortality. Early prognostic assessment is crucial for guiding clinical management. This study aimed to evaluate the prognostic value of the red cell distribution width-to-albumin ratio (RDW/Alb, RAR) in relation to clinically relevant outcomes, including intensive care unit (ICU) admission and in-hospital mortality, in patients with AP. Materials and Methods: This retrospective study included 282 patients diagnosed with AP who were hospitalized at Mersin University Hospital between January 2019 and February 2024. Clinical, laboratory, and radiological data were retrospectively analyzed. The predictive performance of RAR was evaluated and compared with established clinical scoring systems, including bedside index for severity in acute pancreatitis (BISAP), systemic inflammatory response syndrome (SIRS), harmless acute pancreatitis score (HAPS), and pancreatitis activity scoring system (PASS). Results: The median RDW-to-albumin ratio (RAR) was 3.9 (range: 2.6–36.7). Receiver operating characteristic (ROC) curve analysis demonstrated that RAR showed good predictive performance for ICU admission (Area Under the Curve (AUC): 0.781; p < 0.001; optimal cut-off: 4.15) and high predictive performance for in-hospital mortality (AUC: 0.927; p < 0.001; optimal cut-off: 5.26). RAR exhibited limited but statistically significant discriminatory performance when compared with the BISAP score (AUC: 0.591; p = 0.017), whereas no significant predictive performance was observed in relation to PASS, HAPS, or SIRS scores. Conclusions: Within the context of this retrospective cohort, RAR is a simple, inexpensive, and readily available biomarker that may be associated with ICU admission and in-hospital mortality in patients with AP. Given the absence of standard severity endpoints such as persistent organ failure or pancreatic necrosis, these findings should not be interpreted as evidence of conventional disease severity prediction but rather as hypothesis-generating observations that warrant validation in larger prospective studies. Full article

Background/Objectives: To develop and validate a predictive model that combines morphological features and dual-energy CT (DECT) parameters to non-invasively distinguish metastatic from benign axillary lymph nodes in patients with breast cancer (BC). Methods: In this retrospective study, 117 patients (median age, 65 years; 111 women and 6 men) who underwent DECT followed by axillary lymphadenectomy between April 2015 and July 2023, were analyzed. A total of 375 lymph nodes (180 metastatic, 195 benign) were evaluated. Two radiologists recorded morphological criteria (adipose hilum status, cortical appearance, extranodal extension, and short-axis diameter) and placed regions of interest to measure dual-energy parameters: attenuation at 40 and 70 keV, iodine concentration, water concentration and spectral slope. Normalized iodine concentration was calculated using the aorta as reference. Univariate analysis identified variables associated with metastasis. Multivariate logistic regression with cross-validation was used to construct two models: one based solely on morphological features and one integrating water concentration. Results: On univariate testing, all DECT parameters and morphological criteria differed significantly between metastatic and benign nodes (p < 0.01). In multivariate analysis, water concentration emerged as the only independent DECT predictor (odds ratio = 0.97; p = 0.002) alongside cortical abnormality, absence of adipose hilum, extranodal extension and short-axis diameter. The morphologic model achieved an area under the receiver operating characteristic curve (AUC) of 0.871. Increasing water concentration increased the AUC to 0.883 (ΔAUC = 0.012; p = 0.63, not significant), with internal cross-validation confirming stable performance. Conclusions: A model combining standard morphologic criteria with water concentration quantification on DECT accurately differentiates metastatic from benign axillary nodes in BC patients. Although iodine-based metrics remain valuable indicators of perfusion, water concentration offers additional tissue composition information. Future multicenter prospective studies with standardized imaging protocols are warranted to refine parameter thresholds and validate this approach for routine clinical use. Full article

Background/Objectives: With the rising incidence of obesity-related endometrial cancer, there is renewed interest in physiologic, low-cost approaches to identify women with hormonally active endometrium who may benefit from early preventive interventions. The progesterone challenge test (PCT), an established clinical tool for evaluating amenorrhea, has been previously proposed as a method to detect endometrial pathology. This study systematically evaluated the diagnostic accuracy of the PCT for detecting endometrial hyperplasia, intraepithelial neoplasia, and carcinoma in asymptomatic postmenopausal women to determine its potential role as a physiologic marker of endometrial cancer risk. Methods: A systematic review and meta-analysis were conducted following PRISMA-DTA guidelines. MEDLINE, EMBASE, EBM Reviews, and CINAHL were searched from inception to 20 January 2025, along with ClinicalTrials.gov and grey literature. Eligible studies prospectively evaluated the PCT with endometrial biopsy as the reference standard. Data extraction and risk-of-bias assessment were performed in duplicate. Risk of bias was assessed using QUADAS-2. Pooled sensitivity, specificity, and predictive values were estimated using hierarchical summary receiver operating characteristic models. Results: Nineteen studies (n = 3902) met the inclusion criteria. The pooled sensitivity and specificity of the PCT for detecting endometrial pathology were 95% (95% CI 86–100%) and 87% (76–96%), respectively. The positive predictive value was 32% (95% CI, 16–50%) and the negative predictive value was 100% (100–100%). When endometrial proliferation was included in the target condition, sensitivity decreased to 82%, but positive predictive value increased to 70%. Conclusions: The PCT shows high diagnostic accuracy for identifying estrogen-driven endometrial pathology in asymptomatic postmenopausal women. Re-evaluating this simple, physiologic test as a functional risk-stratification tool could inform precision prevention strategies for endometrial cancer. Full article

Objective: To investigate factors influencing the anamnestic immune response 9 years after hepatitis B vaccination in elderly people (aged > 60 years). Methods: We quantitatively tested 630 elderly people who participated in the free hepatitis B vaccination program for adults in Zhangjiagang City during 2015 for hepatitis B surface antibody (anti-HBs) titers. Three booster doses of hepatitis B vaccine were given to subjects with anti-HBs titers below 10 mIU/mL, while a single booster dose was administered to those with titers between 10 and 100 mIU/mL, in accordance with their antibody titer measurements. The post-booster anti-HBs titers were evaluated at 2–3 months. A logistic regression model was used to identify factors influencing the anamnestic immune response, and a receiver operating characteristic curve analysis was conducted. Results: Among the 90 participants who received three doses and the 101 participants who received one dose, baseline characteristics did not differ significantly between the two cohorts. Both groups exhibited robust anamnestic immune responses. Significant differences were observed before and after booster vaccination within each group (Z = −8.24, p < 0.001; Z = −8.73, p < 0.001). Multivariate logistic regression indicated that individuals with higher pre-booster anti-HBs titers were less likely to show weak anamnestic responses compared to those with lower pre-booster titers (OR = 0.30, 95% CI: 0.16–0.58). Furthermore, a high anamnestic immune response (>1000 mIU/mL) was significantly more frequent among subjects with pre-booster titers ≥ 4.58 mIU/mL. Conclusions: Booster immunization administered nine years after hepatitis B vaccination induces robust anamnestic immunity, with its magnitude significantly correlated with pre-booster anti-HBs titers. Particular attention should be given to individuals with extremely low pre-booster anti-HBs levels. Full article

Liver fibrosis induced by Schistosoma japonicum Katsurada, 1904 (S. japonicum) infection lacks effective diagnostic markers and specific anti-fibrotic therapies. Although dysregulated iron homeostasis and ferroptosis pathways may contribute to its pathogenesis, the core regulatory mechanisms remain elusive. To unravel the ferroptosis-related molecular features, this study integrated transcriptomic datasets (GSE25713 and GSE59276) from S. japonicum-infected mouse livers. Following batch effect correction and normalization, ferroptosis-related differentially expressed genes (FRDEGs) were identified. Subsequently, core hub genes were screened through the construction of a protein–protein interaction (PPI) network, functional enrichment analysis, immune infiltration evaluation, and receiver operating characteristic (ROC) analysis. The expression patterns of these hub genes were further validated in an S. japonicum-infected mouse model using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The study identified 7 hub genes (Lcn2, Timp1, Cth, Cp, Hmox1, Cbs, and Gclc) as key regulatory molecules. Functional enrichment analysis revealed that these hub genes are closely associated with sulfur amino acid metabolism and oxidative stress responses. Specifically, key enzymes involved in cysteine and glutathione (GSH) synthesis (Cth, Cbs, Gclc) were consistently downregulated, suggesting a severe impairment of the host antioxidant defense capacity. Conversely, pro-fibrotic and pro-inflammatory markers (Timp1, Lcn2, Hmox1) were upregulated. This molecular pattern was significantly associated with a remodeled immune microenvironment, characterized by increased infiltration of neutrophils and eosinophils. In vivo validation confirmed the expression trends of 6 hub genes, corroborating the bioinformatics predictions, while the discrepancy in Cp expression highlighted the complexity of post-transcriptional regulation in vivo. The identified hub genes demonstrated excellent diagnostic potential, with Timp1 achieving an area under the curve (AUC) of 1.000. This study elucidates the molecular link between S. japonicum infection and the ferroptosis pathway, suggesting that these hub genes may drive liver fibrosis progression by regulating sulfur metabolism and the immune microenvironment. These findings offer potential diagnostic biomarkers and novel therapeutic targets for schistosomal liver fibrosis. Full article

Studying the incidence of Kaposi sarcoma in relation to key variables can guide targeted research and subtype-specific clinical interventions. We reviewed the records of all patients who visited our hospital’s dermatology outpatient clinic, and patients who were clinically and histopathologically diagnosed with Kaposi sarcoma were included in the study. The age, gender, lesion location, anti-HIV test results, and comorbidities of the patients were recorded. Thirty-three patients with Kaposi sarcoma were identified. The male/female ratio was 2.7:1. The Kaposi sarcoma lesions were statistically significantly more prevalent in the lower extremities of HIV-negative patients (p = 0.005). Receiver operating characteristic (ROC) curve analysis identified 59 years as the optimal age cutoff for distinguishing between HIV-positive and HIV-negative patients. Anti-HIV positivity was significantly higher in individuals aged 59 and younger compared to those aged 60 and older (p < 0.001). To the best of our knowledge, this is the first study to demonstrate a statistically significant higher prevalence of lower extremity lesions among HIV-negative patients and to identify 59 years as the optimal age cutoff for distinguishing between HIV-positive and HIV-negative Kaposi sarcoma patients using ROC curve analysis. The age-related patterns observed in this study warrant further investigation. Full article

Background: Mucosal malignant melanoma (MMM) is a rare and aggressive malignancy with a dismal prognosis. While the Systemic Immune-Inflammation Index (SII) has emerged as a prognostic marker in various solid tumors, its specific value in MMM remains undefined. This study investigated the association between pretreatment SII and overall survival (OS) in patients with MMM. Methods: We retrospectively analyzed 106 adults with histologically confirmed MMM treated at six oncology centers in Turkey between 2005 and 2025. The baseline SII was calculated as platelet × neutrophil/lymphocyte counts obtained before definitive treatment. A receiver operating characteristic (ROC) analysis identified an optimal SII cutoff of 776 for overall survival (OS), defining low (<776) and high (≥776) SII groups. Results: Gastrointestinal and head and neck mucosa were the most frequent primary sites, and one-third of patients presented with metastatic disease. The median OS for the entire cohort was 23.3 months. Patients with a high versus low SII had a shorter OS (16.2 vs. 35.2 months; HR 2.71, 95% CI 1.67–4.40; p < 0.001). In multivariable analysis, a high SII (HR 1.88, 95% CI 1.12–3.14; p = 0.016), gastrointestinal primary site (HR 1.99, 95% CI 1.23–3.23; p = 0.005), and metastatic disease at diagnosis (HR 4.01, 95% CI 2.32–6.94; p < 0.001) independently predicted a worse OS. Conclusions: The SII is a novel, independent prognostic biomarker in MMM. Elevated pretreatment SII correlates with aggressive clinicopathologic features and inferior survival. As a readily accessible and cost-effective marker, SII may facilitate improved risk stratification in routine clinical practice for MMM patients. Full article

Background: Early recognition of renal allograft dysfunction requires biochemical markers capable of detecting molecular injury before functional decline becomes apparent. Serum creatinine, a late and nonspecific indicator of renal function, has limited value for early diagnosis. Protein biomarkers implicated in tubular injury, inflammation, and immune activation—including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), β2-microglobulin, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α)—have emerged as promising alternatives. This study evaluated early post-transplant serum profiles of these biomarkers and their prognostic relevance for long-term graft outcomes. Methods: Nineteen adult recipients undergoing primary kidney transplantation were prospectively enrolled. Serum creatinine and protein biomarkers were measured 24 h post-transplant using validated immunochemical assays. Biomarker concentrations were compared with values from healthy controls, and correlations with renal function at 12 months were assessed. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance. Results: Significant biochemical alterations were observed at 24 h post-transplant. KIM-1 levels were markedly elevated compared with controls (74.50 ± 98.45 vs. 10.54 ± 17.19 ng/mL; p = 0.01), consistent with early tubular injury. IL-1β and NGAL showed upward trends without reaching statistical significance. β2-microglobulin and TNF-α levels did not differ substantially from control values. Serum KIM-1 correlated with serum creatinine both at 24 h (r = 0.35) and at 12 months (r = 0.40). ROC analysis identified a KIM-1 threshold of 24.5 ng/mL (AUC = 0.68) as a potential indicator of future graft dysfunction, outperforming serum creatinine (AUC = 0.64). Six patients experienced graft dysfunction at 12 months post-transplant, five of whom had serum creatinine values > 5 mg/dL at 24 h. Based on early creatinine levels, patients were stratified into low-risk (creatinine < 5 mg/dL; n = 10) and high-risk groups (creatinine > 5 mg/dL; n = 9). Mean KIM-1 concentrations were significantly higher in the high-risk group (110.68 ± 115.29 vs. 26.67 ± 18.05 ng/mL; p = 0.05), consistent with more severe early tubular injury. Conclusions: Among the evaluated biomarkers, KIM-1 demonstrated the strongest potential as an early biochemical indicator of renal allograft dysfunction. Its rapid post-transplant elevation underscores its sensitivity to early tubular injury. Further prospective validation in larger, multicenter cohorts is warranted. Full article

Background/Objectives: Artificial intelligence (AI) has gained substantial prominence in pediatric dentistry, offering new opportunities to enhance diagnostic precision and clinical decision-making. AI-based systems are increasingly applied in caries detection, early childhood caries (ECC) risk prediction, tooth development assessment, mesiodens identification, and other key diagnostic tasks. This systematic review and meta-analysis aimed to synthesize evidence on the diagnostic performance of AI models developed specifically for pediatric dental applications. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase following PRISMA-DTA guidelines. Studies evaluating AI-based diagnostic or predictive models in pediatric populations (≤18 years) were included. Reference screening, data extraction, and quality assessment were performed independently by two reviewers. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated using random-effects models. Sources of heterogeneity related to imaging modality, annotation strategy, and dataset characteristics were examined. Results: Thirty-two studies met the inclusion criteria for qualitative synthesis, and fifteen were eligible for quantitative analysis. For radiographic caries detection, pooled sensitivity, specificity, and AUC were 0.91, 0.97, and 0.98, respectively. Prediction models demonstrated good diagnostic performance, with pooled sensitivity of 0.86, specificity of 0.82, and AUC of 0.89. Deep learning architectures, particularly convolutional neural networks, consistently outperformed traditional machine learning approaches. Considerable heterogeneity was identified across studies, primarily driven by differences in imaging protocols, dataset balance, and annotation procedures. Beyond quantitative accuracy estimates, this review critically evaluates whether current evidence supports meaningful clinical translation and identifies pediatric domains that remain underrepresented in AI-driven diagnostic innovation. Conclusions: AI technologies exhibit strong potential to improve diagnostic accuracy in pediatric dentistry. However, limited external validation, methodological variability, and the scarcity of prospective real-world studies restrict immediate clinical implementation. Future research should prioritize the development of multicenter pediatric datasets, harmonized annotation workflows, and transparent, explainable AI (XAI) models to support safe and effective clinical translation. Full article

Objectives: This study aimed to compare the predictive performance of the Korean Triage and Acuity Scale (KTAS) and the National Early Warning Score (NEWS) for serious adverse events (SAEs), including mortality and intensive care unit (ICU) admission, during emergency department (ED) stay. We also evaluated whether combining the two systems improves prediction accuracy. Methods: This retrospective study included adult patients (≥19 years) who presented to a university-affiliated ED between October and December 2024. KTAS and NEWS were assessed simultaneously at triage. NEWS2 was calculated retrospectively based on routinely documented vital signs and medical history without performing routine arterial blood gas analysis. The primary outcome was the occurrence of SAE during the ED stay. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and logistic regression models were used to identify independent associations. Results: A total of 4216 patients were analyzed, of whom 255 (6.0%) experienced SAEs. All three scores—KTAS, NEWS and NEWS2—were independently associated with the occurrence of SAEs. The AUCs for KTAS, NEWS and NEWS2 were 0.75 (95% CI, 0.74–0.76), 0.73 (95% CI, 0.71–0.74) and 0.73 (95% CI, 0.71–0.74), respectively. Combining KTAS with NEWS or NEWS2 significantly improved predictive accuracy (AUC 0.81, 95% CI 0.79–0.82; p < 0.001). Conclusions: Both KTAS and NEWS/NEWS2 reliably predicted in-ED adverse outcomes, and their combination further enhanced prognostic performance. Integrating physiology-based early warning scores with structured triage systems may help identify high-risk ED patients earlier and optimize resource allocation. Full article

Ovarian cancer is frequently diagnosed at an advanced stage due to non-specific symptoms, contributing to high mortality. The limited diagnostic performance of current serum assays in early disease underscores the need for complementary circulating biomarkers. Circulating microRNAs and inflammation-related markers are promising candidates. Although miRNAs are implicated in cancer diagnostics, the role of miRNA-29a in ovarian cancer remains underexplored. Given that sST2 is elevated in several malignancies and is a direct target of miRNA-29a, concurrent evaluation may be informative. This pilot study compared serum miRNA-29a and sST2 levels in 23 ovarian cancer patients and 22 healthy female controls. miRNA-29a expression was quantified by real-time PCR (2^−ΔΔCt), and sST2 was measured by ELISA; diagnostic performance was assessed using ROC analysis. miRNA-29a levels were significantly reduced (p < 0.05), whereas sST2 concentrations were significantly increased (p < 0.001) in patients versus controls. ROC analysis showed modest discrimination for miRNA-29a (AUC 0.678) and higher performance for sST2 (AUC 0.825). No significant correlation was observed between the two markers. These findings suggest that circulating miRNA-29a and sST2 may have biomarker potential in ovarian cancer; larger, well-designed studies are required to confirm clinical utility. Full article

Background/Objective: Early detection of metastatic progression remains a major challenge in precision oncology. Conventional radiological imaging cannot reliably identify micrometastatic disease. Although circulating tumor DNA is promising for minimal residual disease detection, organ-derived response biomarkers reflecting tissue adaptation to secreted factors remain unexplored. We hypothesized that integrating such biomarkers with global laboratory parameters would generate a synthetic variable with improved discrimination for de novo metastasis and mortality. Methods: This prospective observational pilot study enrolled 30 patients (median age 64.4 years; 56.7% female) with heterogeneous solid malignancies. Peripheral blood biomarkers responsive to tumor-secreted soluble factors (n = 11) were quantified using a multiplexed beads Luminex immunoassay. Global analytical parameters (n = 20) were derived from routine laboratory assessments. Hierarchical agglomerative clustering analysis generated two synthetic variables: Stigma (Ϛ) and Qoppa (Ϙ). Receiver operating characteristic curve analysis, Kaplan–Meier survival analysis, and Cox regression were used to evaluate the performance. Results: Qoppa demonstrated acceptable discriminatory performance for de novo metastasis (AUC = 0.78). For mortality prediction, performance varied by disease status (overall AUC = 0.78): superior in non-metastatic patients (AUC = 0.98) but negligible in those with baseline metastases. Kaplan–Meier analysis confirmed significant survival differences (p = 0.042 overall survival; p = 0.024 for metastasis-free survival in the non-metastatic subgroup). Differences in biomarker expression and clinical variables (stage, tumor burden, and metastatic burden) were observed between the high and low Qoppa strata. Conclusions: In this small heterogeneous pilot cohort, Qoppa provides a proof of concept that integrating organ-derived response biomarkers with routine laboratory parameters may capture clinically relevant signals for metastatic risk stratification in oncology patients. This composite parameter supports the generation of hypotheses for future biomarker-driven research and clinical test development. External validation in larger multicenter cohorts is required before clinical implementation. Full article

Background/Objectives: Septic arthritis of native joints is an orthopedic emergency in which rapid discrimination from non-infectious arthritis is crucial. Because cartilage damage can occur within hours, urgent irrigation and debridement are often pursued on an emergency basis (ideally within the first 6–8 h) of presentation, underscoring the need for rapidly available biomarkers. The delta neutrophil index (DNI) quantifies circulating immature granulocytes and may complement conventional inflammatory biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and procalcitonin (PCT). We evaluated the diagnostic performance of DNI for native-joint septic arthritis against both microbiologic and clinical reference standards. Methods: We retrospectively analyzed 85 adults who underwent surgical irrigation and debridement for suspected native joint septic arthritis at a tertiary center. Serum CRP, ESR, WBC, DNI, and PCT (available in 67 patients) were recorded together with synovial leukocyte counts. Infection status was defined using either positive synovial culture (microbiologic reference) or clinical adjudication according to the Guideline for management of septic arthritis in native joints (SANJO). Diagnostic performance was assessed using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC); exploratory cut-offs were identified by the Youden index, and pairwise AUCs were compared using DeLong’s test. Results: Synovial leukocyte analysis was highly sensitive but poorly specific (sensitivity 92.9%, specificity 10.3%). Against culture, DNI showed the highest discrimination (AUC = 0.914), exceeding CRP (0.687), ESR (0.643), WBC (0.648), and PCT (0.697); DeLong ΔAUC vs. CRP 0.227 (p < 0.001), ESR 0.270 (p < 0.001), WBC 0.266 (p < 0.001), PCT 0.227 (p = 0.001). At pre-specified cut-offs, DNI showed the most balanced sensitivity/specificity (94.3%/84.0%), corresponding to a negative predictive value (NPV) of 95.5% (42/44) and a positive predictive value (PPV) of 80.5% (33/41) against culture in this cohort. Against clinical infection, DNI outperformed others (AUC:0.921; ΔAUC vs. CRP = 0.204, ESR = 0.343, WBC = 0.244, PCT = 0.295; all p < 0.001). As a rule-in threshold, DNI ≥ 0.6 yielded a specificity of 100% with a sensitivity of 73.2%. In culture-negative patients (infected n = 21, uninfected n = 29), DNI remained discriminatory (AUC 0.80, p < 0.001), whereas other biomarkers were not. Conclusions: DNI demonstrated superior diagnostic accuracy compared with conventional inflammatory biomarkers. As a rapid parameter available with the initial complete blood count, DNI may support early risk stratification and rule-in decisions within the first hours of presentation; however, it should be used as a supplementary indicator alongside synovial fluid analysis and clinical assessment rather than as a stand-alone diagnostic tool. Full article

Background/Objectives: The Rapid Access Chest Pain Assessment Clinic (RACPAC) streamlines the evaluation of low-to-intermediate risk chest pain and helps avoid unnecessary hospitalisation. Biomarkers {low-density lipoprotein cholesterol (LDL-c) and high-sensitivity C-reactive protein (hsCRP)} are established cardiovascular risk markers. Yet, their diagnostic value for stable coronary artery disease (CAD) in RACPAC remains uncertain. Therefore, we aimed to determine the utility of biomarkers in predicting the presence of CAD in the RACPAC setting. Methods: A retrospective cohort study of consecutive adults attending RACPAC between 2012 and 2021. Multivariable logistic regression and receiver operating characteristic analyses, including prespecified subgroup and sensitivity analyses, were used to evaluate the predictive value of hsCRP and LDL-c for the presence of CAD detected on CT Coronary Angiogram (CTCA) or Treadmill Stress Echocardiography (TSE) as the primary outcome. Results: 3569 patients were included in this study, the mean age was 55.4 ± 11.3 years, and 48.8% were female; 37.4% had hypertension, while 39.5% had dyslipidemia. The mean LDL-c was 3.1 ± 0.9 mmol/L, and the median hsCRP was 1.9 mg/L (IQR 0.9 to 3.8). The regression analysis for the primary outcome showed that neither hsCRP nor LDL-c predicted CAD on CTCA (hsCRP OR 1.00, 95% CI 0.99 to 1.02, p = 0.70; LDL-c OR 1.16, 95% CI 0.97 to 1.39, p = 0.11). On TSE, hsCRP was not associated with CAD, while LDL-c showed an inverse association with CAD (hsCRP OR 0.98, 95% CI 0.83 to 1.00, p = 0.78; LDL-c OR 0.44, 95% CI 0.21 to 0.87, p = 0.02). ROC analysis showed AUC 0.553 for log hsCRP (95% CI 0.501 to 0.606) and 0.508 for LDL-c (95% CI 0.450 to 0.566), with p = 0.2756. Conclusions: In a large real-world RACPAC cohort, neither elevated hsCRP nor LDL-c predicted the presence of coronary artery disease in the rapid access chest pain clinic (RACPAC) cohort. In contrast, CT coronary angiography (CTCA) demonstrated superior diagnostic accuracy compared with treadmill stress echocardiography (TSE) in this setting. Full article