Search Results (878)

Background: Multiple organ dysfunction syndrome (MODS) is a serious complication and a leading cause of death in patients undergoing heart valve surgery. The main aim of the present study was to assess the predictive capacity of selected perioperative parameters, including Troponin T levels, to predict the occurrence of postoperative MODS and 30-day mortality in patients undergoing heart valve surgery. Methods: This prospective study included a group of patients with hemodynamically severe symptomatic valvular heart disease who underwent valve surgery. The primary endpoint was postoperative multiple organ dysfunction syndrome (MODS), defined as the dysfunction of at least two organs/systems, including cardiogenic shock, perioperative stroke, respiratory failure requiring prolonged mechanical ventilation, and/or postoperative acute kidney injury requiring renal replacement therapy. The secondary endpoint was death during the 30-day follow-up. Logistic regression was used to assess the relationships between the variables. Results: In total, 739 patients undergoing valvular heart surgery were included in this study. The primary end point was observed in 45 patients. Preoperative hemoglobin level (p = 0.01), red cell distribution width (RDW) (p = 0.001) and troponin T level measured on the first day after surgery (TnT II) (p < 0.001) were independent predictors of the primary endpoint. EuroSCORE II (p = 0.002) and TnT II (p < 0.001) were independent predictors of 30-day mortality. Conclusions: MODS is a clinical condition that is associated with a high risk of death. Troponin T levels measured within the first 24 h postoperatively may be useful in predicting postoperative MODS and 30-day mortality in patients undergoing heart valve surgery as a complement to commonly used risk calculators. Full article

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is associated with adverse outcomes in sepsis, but risk stratification within MASLD remains insufficiently defined. We investigated whether an admission liver–metabolic phenotype framework combining cardiometabolic burden with liver injury/fibroinflammatory risk markers identifies clinically relevant organ-support vulnerability in community-acquired sepsis. Methods: This secondary analysis of the prospective SepsisFAT cohort (378 adults with community-acquired sepsis) classified patients into four phenotypes by cardiometabolic burden (≥2 of: diabetes, hypertension, dyslipidemia, BMI ≥ 30 kg/m²) and liver-risk positivity (FIB-4 ≥ 2.67, APRI ≥ 1.0, liver stiffness ≥ 10 kPa, or FAST ≥ 0.55). The primary outcome was acute kidney injury (AKI), while continuous renal replacement therapy (CRRT), other organ-support outcomes and in-hospital mortality were secondary endpoints. Results: Phenotype distribution was Low-risk 137 (36.2%), Cardiometabolic-only 84 (22.2%), Liver-dominant 88 (23.3%), and Mixed liver–cardiometabolic 69 (18.3%). AKI and CRRT increased across phenotypes (13.9% to 40.6% and 5.1% to 26.1%, respectively), and in-hospital mortality was highest in the Mixed phenotype (26.1%). After Firth-penalized adjustment for age, sex, and admission SOFA, the Mixed phenotype remained independently associated with AKI (aOR 2.82, 95% CI 1.37–5.90) and CRRT (aOR 3.87, 1.50–10.80), confirmed in non-renal SOFA and admission eGFR-adjusted sensitivity analyses. Cardiometabolic burden alone did not confer excess organ-support risk. The same gradient persisted within the MASLD subgroup. Conclusions: Admission liver–metabolic phenotyping identified a renal-vulnerable sepsis subgroup not captured by binary MASLD classification alone. These findings support prospective, multicenter external validation of liver–metabolic phenotyping as a pragmatic approach to renal risk stratification in community-acquired sepsis. Full article

Background: Chronic kidney disease (CKD) is a major public health problem, primarily affecting patients with diabetes mellitus and/or hypertension. Early detection is critical to delay progression to renal replacement therapy. Therefore, this study aims to evaluate the implementation of a digital module for CKD detection in at-risk patients within the Peruvian Social Health Insurance system (EsSalud) during 2024. Materials and Methods: Data were collected through the Renal Health Module (MOSARE), a digital tool integrated into EsSalud’s electronic health record for monitoring patients at risk of CKD. Key indicators were assessed using the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. Quantitative analyses evaluated patient identification, screening, and diagnosis, while qualitative analyses of technical documents identified barriers, facilitators, and stakeholder perceptions. Results: In 2024, MOSARE was implemented in a population of 1,667,856 insured individuals with CKD-related risk conditions, predominantly women (55.7%) and adults aged > 55 years (88.3%). Nationwide, 93,266 patients were screened (5.59% reach), with 34.3% diagnosed with CKD. Screening coverage showed substantial geographic variability (0.35–29.59%). A total of 32,004 CKD cases were identified, with 84.2% in early stages (1–3A). Adoption reached 66.8% of level I and II healthcare facilities, with variability across networks. Regarding maintenance, 65% of trained facilities sustained active use. Implementation gaps were associated with interoperability issues, resource limitations, and training variability. Conclusions: MOSARE proved to be a feasible and operationally sensitive tool for CKD screening and risk identification, improving integration of renal care. However, addressing technical, training, and resource barriers is essential to ensure sustainability and scalability. Full article

Background/Objectives: Tricuspid valve surgery carries a high risk of postoperative acute kidney injury (AKI) due to pre-existing right ventricular dysfunction and congestive end-organ remodeling. We aimed to evaluate the incidence and predictors of postoperative AKI, with particular focus on the prognostic value of the TAPSE/sPAP index. Methods: This retrospective, single-center study evaluated adult patients who underwent tricuspid valve surgery (isolated/concomitant) between 2010 and 2025. The primary outcome was postoperative AKI of any stage, defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Predictors were identified using a pre-specified multivariable logistic regression model including baseline estimated glomerular filtration rate (eGFR), cardiopulmonary bypass time, and EuroSCORE II; TAPSE/sPAP associations with severe renal outcomes were assessed univariably and presented as exploratory. Results: Of 80 patients, postoperative AKI occurred in 32 (40.0%), with 16 (20.0%) requiring renal replacement therapy. The pre-specified multivariable model discriminated any-stage AKI (AUC 0.86, 95% CI 0.77–0.94). Lower baseline eGFR (adjusted OR 1.82 per 10 mL/min/1.73 m² decrease, p < 0.001) and higher EuroSCORE II (adjusted OR 1.53 per point, p = 0.03) were independent predictors. The TAPSE/sPAP index was not associated with any-stage AKI (p = 0.42), but lower values predicted advanced renal outcomes, including KDIGO stage ≥ 2 AKI (OR 2.11, p = 0.03) and the requirement for renal replacement therapy (OR 2.71, p = 0.01). Outcomes did not differ between isolated (n =14) and combined procedures (n = 66; AKI 35.7% vs. 40.9%, p = 0.77). Conclusions: Lower preoperative eGFR and higher EuroSCORE II independently predict any-stage postoperative AKI. In univariable analysis, the TAPSE/sPAP index identified the subgroup with severe renal outcomes; this exploratory finding requires prospective validation. Whether perioperative renal protection depends on addressing right-sided filling pressures rather than augmenting forward flow alone requires prospective testing. Full article

Background: The utilization of renal replacement therapy (RRT) is crucial for the management of patients with acute kidney injury (AKI) in emergency departments (EDs). The prompt initiation of RRT, encompassing both intermittent hemodialysis (HD) and continuous renal replacement therapy (CRRT), is acknowledged as beneficial for critically ill patients. The purpose of this study is to investigate the implementation of RRT within EDs and its impact on ED length of stay (EDLOS) in South Korea. Methods: This retrospective study utilized data from the National Emergency Department Information System (NEDIS) for the year 2019 to assess the utilization of RRT in emergency medical centers (EMCs) across South Korea. The analysis focused on RRT, which includes intermittent HD and CRRT, as identified through insurance billing codes for patients treated during ED visits and subsequent admissions. EMCs were categorized into three groups based on the frequency of RRT sessions, and the median EDLOS was evaluated. Results: Among 5,937,569 ED visits to Level I and II emergency medical centers (EMCs), 40,130 cases (0.68%) received RRT. Of the 162 EMCs, 58 centers (35.8%) did not perform intermittent HD in the ED and 106 centers (65.4%) did not perform CRRT in the ED during the study period. Centers that frequently performed CRRT in the ED showed significantly longer EDLOS compared with centers that seldom or never performed CRRT (588 min [IQR 286–767] vs. 270 min [IQR 147–337] and 205 min [IQR 149–363], respectively; p = 0.01). Regional disparities in the availability of ED-based RRT were also observed across South Korea. Conclusions: The frequency of RRT administration in EMCs in South Korea varied by region and facility. ED-based RRT utilization was associated with longer EDLOS, particularly in centers frequently performing CRRT. These findings suggest that patient acuity, institutional characteristics, and RRT-related resource utilization should be considered when evaluating EMC performance based on EDLOS. Full article

The rising prevalence of chronic kidney disease represents a major global health burden. Limitations of current renal replacement therapies, including donor organ shortages, rejection, and dialysis-related complications, underscore the need for innovative treatment options. This narrative review assesses the feasibility of bioengineered kidneys as an alternative to current treatments by discussing advances in decellularization, recellularization, and the transplantation of cell-on-scaffold kidneys. We propose that the development of functional bioengineered kidneys follows a hierarchical, staged process, in which vascular patency is the primary prerequisite for graft survival, followed by partial restoration of glomerular filtration, with complete tubular function remaining the final and most challenging milestone. Perfusion-based whole-organ decellularization has made significant progress in preserving the extracellular matrix, enabling the production of acellular human kidney scaffolds. However, complete recellularization of whole kidneys has not yet been achieved. Nevertheless, partially repopulated kidney scaffolds have been shown to withstand physiological blood pressure, produce urine, and exhibit filtration in large-animal models. Complete endothelial coverage of the vascular network proved essential for preventing thrombosis after transplantation. Current work on bioengineered kidneys shows promising results regarding feasibility for clinical application. It is important to note that most of the included studies are proof-of-concept, characterized by small sample sizes and short observation periods. Although these findings are crucial for further research, they cannot be generalized, and larger trials are recommended. In addition to cell-on-scaffold kidneys, 3D bioprinting is a promising technique that could eliminate the need for donor scaffolds. Full article

The Kidney Disease: Improving Global Outcomes (KDIGO) CGA framework remains the essential basis for chronic kidney disease (CKD) classification, risk stratification, and guideline-based therapy. However, eGFR and albuminuria do not always explain the physiological mechanism maintaining the current filtration level or the heterogeneity of treatment responses. This narrative review proposes a hypothesis-generating functional–hemodynamic extension of KDIGO CGA that incorporates renal functional reserve (RFR), blood pressure, volume status, proteinuria phenotype, and selected tubular markers. RFR is discussed as a dynamic stress test of nephron reserve rather than as a replacement for eGFR or albuminuria. A low, zero, or negative RFR may suggest reserve exhaustion or relative hyperfiltration, but its interpretation depends on standardized testing conditions and clinical context. We distinguish established evidence-based therapy—RAAS blockade in albuminuric or hypertensive CKD, SGLT2 inhibition for kidney and cardiorenal protection, and non-steroidal MRA therapy in selected patients—from conceptual sequencing hypotheses such as RAASi-prioritized, SGLT2i-prioritized, early dual, or staged triple renoprotection. The review also summarizes albuminuria as a two-compartment phenomenon involving both glomerular passage and proximal tubular handling of filtered proteins. The proposed framework is not a validated treatment algorithm. It is intended to support physiological phenotyping, interpretation of early eGFR changes, and the design of prospective studies that test whether RFR adds independent prognostic or therapeutic value beyond KDIGO CGA. Full article

The endothelin system is critical in chronic kidney disease (CKD) pathogenesis. However, the relative contribution of circulating endothelin-related biomarkers versus genetic variability remains unclear, particularly in diabetic nephropathy (DN) and after kidney transplantation (KTx). This study evaluated plasma concentrations of endothelin-1 (ET-1), endothelin A receptor (ETAR), and anti-ETAR antibodies (ETAR-Ab) in healthy controls, diabetic nephropathy (DN) patients, and DN patients after kidney transplantation (post-KTx). The influence of polymorphisms rs5370 (EDN1) and rs5333 (EDNRA) on endothelin-related parameters was analyzed. Polymorphisms were genotyped via PCR-RFLP, and endothelial-related parameters were determined by ELISA. Significant endothelin system activation was observed in both DN and post-KTx patients. ET-1 and ETAR concentrations were markedly elevated compared to controls, with the highest ET-1 levels detected in the post-KTx group, whereas ETAR-Ab levels were reduced. A sex-specific association for rs5370 was observed in male patients with the TG genotype (a nearly 4.5-fold higher risk of renal replacement therapy than in female patients). In proteinuric DN patients, the TC genotype (rs5333) was associated with elevated ETAR and ETAR-Ab. Endothelin system dysregulation is a prominent and persistent feature of CKD, noted after kidney transplantation. The endothelin activation, observed in transplant patients particularly, highlights the potential clinical relevance of endothelin-related biomarkers and supports the rationale for therapeutic strategies targeting the endothelin pathway, including endothelin receptor antagonists. Full article

Background: Postoperative hyperbilirubinemia is a serious complication after cardiac surgery and has been associated with increased perioperative morbidity and mortality. However, data specifically addressing patients undergoing redo valve surgery remain limited. This study aimed to determine the incidence and risk factors of postoperative hyperbilirubinemia after redo valve surgery, and evaluate its association with early postoperative outcomes. Methods: We retrospectively reviewed 259 adult patients who underwent elective redo valve surgery under cardiopulmonary bypass (CPB) between March 2018 and July 2024. Postoperative hyperbilirubinemia was defined as a serum total bilirubin level > 3 mg/dL at any time after surgery. Patients were divided into a hyperbilirubinemia group and a non-hyperbilirubinemia group. Perioperative variables were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify risk factors for postoperative hyperbilirubinemia. Postoperative complications and in-hospital mortality were also compared. Results: Postoperative hyperbilirubinemia occurred in 101 of 259 patients (39.0%). Compared with patients without hyperbilirubinemia, those with hyperbilirubinemia had longer mechanical ventilation and intensive care unit stay, and higher rates of pneumonia, reintubation, tracheostomy, continuous renal replacement therapy, and in-hospital mortality. Univariable logistic regression showed that higher EuroSCORE II, higher preoperative total bilirubin and direct bilirubin levels, lower hemoglobin and platelet count, pulmonary hypertension, anemia, longer operative time, CPB duration, and aortic cross-clamp time, lower nasopharyngeal temperature, greater intraoperative blood loss, larger red blood cell and plasma transfusion volumes, and concomitant surgery on all three valves were associated with postoperative hyperbilirubinemia. Multivariable analysis identified elevated preoperative direct bilirubin, prolonged CPB duration, and more plasma transfusion as independent risk factors. Receiver operating characteristic analysis showed that peak postoperative total bilirubin had moderate prognostic discrimination for in-hospital mortality, with an optimal cut-off value of 3.95 mg/dL (AUC 0.756, sensitivity 66.7%, specificity 80.2%, p = 0.003). Conclusions: Postoperative hyperbilirubinemia is common after redo valve surgery and is associated with worse early postoperative outcomes and higher in-hospital mortality. In this setting, postoperative bilirubin elevation should be interpreted primarily as a prognostic marker of perioperative stress and hepatic vulnerability rather than a direct causal driver of adverse outcomes. Elevated preoperative direct bilirubin, prolonged CPB duration, and greater plasma transfusion were independently associated with the development of postoperative hyperbilirubinemia in this high-risk population. Full article

Background: Acute kidney injury (AKI) is a frequent and prognostically important complication of cardiac surgery, yet early risk stratification remains challenging. The purpose of this prospective exploratory study was to determine whether preoperative vitamin levels differ in patients who develop cardiac surgery-associated AKI. Methods: Consecutive patients scheduled for cardiac surgery due to coronary artery disease and/or severe aortic stenosis between October 2024 and July 2025 were included. Fourteen patients (16.1%) had preoperative eGFR below 60 mL/min. Preoperative serum levels of vitamin A (retinol), vitamin E (α-tocopherol), and vitamin D (25-hydroxyvitamin D3) were measured. Results: A total of 87 patients (72 males (82.8%) with a median (Q1–Q3) age of 66 (61.5–71) years) were included in the study. Cardiac surgery-associated AKI occurred in 36 (41.4%), as a mild and transient impairment, with only two patients with a more severe stage requiring temporary renal replacement therapy. Patients who developed AKI had significantly higher preoperative retinol levels (p = 0.046). Retinol concentrations correlated positively with preoperative creatinine (Spearman’s rho 0.321, p = 0.002), postoperative day 0 creatinine (Spearman’s rho 0.333, p = 0.002), and postoperative day 1 creatinine (Spearman’s rho 0.268, p = 0.012), and negatively with preoperative eGFR (Spearman’s rho −0.288, p = 0.007). Tocopherol and 25(OH)D3 did not differ significantly between subgroups. No difference in vitamin levels was observed between patients with and without diabetes. Conclusions: Increased preoperative retinol levels were associated with cardiac surgery-associated AKI and correlated with perioperative renal dysfunction. Retinol may reflect impaired kidney handling of retinol and identify increased renal vulnerability in cardiac surgery patients. Retinol may represent a hypothesis-generating biomarker of cardiac surgery-associated AKI risk that warrants confirmation in larger cohorts. Full article

Background/Objectives: Methylene blue (MB) has re-emerged as an adjunctive vasopressor-sparing therapy in vasoplegic shock states, with emerging evidence supporting its hemodynamic benefits; however, its effect on mortality remains uncertain. We systematically evaluated the effectiveness of MB versus standard therapy in adults with circulatory shock. Methods: We performed a systematic review and meta-analysis of randomized controlled trials registered in PROSPERO (CRD420261326534) and reported according to PRISMA. MEDLINE, Embase, and the Cochrane Library were searched through February 2026. An additional AI-assisted supplementary search was conducted to minimize the risk of missing eligible studies. Eligible studies enrolled adults with shock and compared MB with standard therapy or placebo. The primary outcome was 28–30-day all-cause mortality. Secondary outcomes were renal replacement therapy (RRT), hospital length of stay, and intensive care unit (ICU) length of stay. Risk of bias was assessed with RoB 2. Results: Nine randomized trials involving 535 participants met the eligibility criteria; most evaluated septic shock, while one trial included post-cardiac surgery vasoplegic shock. Eight trials contributed to the quantitative synthesis of mortality. MB was not associated with a statistically significant reduction in short-term mortality. Secondary analyses also did not demonstrate significant pooled effects for RRT, hospital length of stay, or ICU length of stay, although several individual trials reported faster hemodynamic improvement and reduced vasopressor exposure with MB. Overall confidence in the pooled estimates was limited by small sample sizes, clinical heterogeneity, imprecision, and risk-of-bias concerns in some studies. Conclusions: Current randomized evidence does not demonstrate a clear mortality or resource use benefit of MB in adult shock, despite signals of hemodynamic improvement. MB appears promising as an adjunctive therapy, but adequately powered, methodologically rigorous trials are required before its routine early use can be recommended. Full article

Background/Objectives: Hypoattenuated leaflet thrombosis (HALT) is a frequent finding after transcatheter aortic valve replacement (TAVR). Although high residual platelet reactivity (HPR) increases thrombotic risk after coronary stent implantation, its role in HALT remains unclear. This study aimed to determine the incidence and predictors of HALT in TAVR patients treated with dual antiplatelet therapy, focusing on the impact of HPR. Methods: This was a prospective, multicenter observational study. Between June 2018 and February 2022 patients with symptomatic severe aortic stenosis undergoing successful TAVR and treated with dual antiplatelet therapy for 3 months were included. Platelet reactivity was assessed 1–3 months post-TAVR using either VerifyNow (72%) or the Multiplate Analyzer (28%). HALT was evaluated using contrast-enhanced multidetector computed tomography. Results: A total of 169 patients were included (mean age 81.5 ± 5 years; 51% female). The incidence of HALT was 22%. Independent predictors of HALT were self-expanding valve (OR 3.05; 95% CI, 1.30–7.14; p = 0.010). Protective factors included larger prosthesis size (OR 0.78; 95% CI, 0.65–0.93; p = 0.007), statin-treated dyslipidemia (OR 0.37; 95% CI, 0.16–0.88; p = 0.024), and higher creatinine clearance (OR 0.98; 95% CI, 0.96–1.00; p = 0.035). HALT incidence was similar in patients with and without HPR (23.7% vs. 33.6%; p = 0.29). No differences in clinical outcomes were observed at 1 year. Conclusions: HALT occurred in nearly one-quarter of TAVR patients treated with dual antiplatelet therapy and was unrelated to platelet reactivity. Valve characteristics, renal function, and statin-treated dyslipidemia were associated with HALT, highlighting the multifactorial nature of its development. Full article

Peritoneal dialysis (PD) has long been an established modality of renal replacement therapy for patients with end-stage kidney disease (ESKD). Despite the modality’s advantages, significant inter-individual variability exists in peritoneal membrane transport characteristics, ultrafiltration capacity, and long-term technique survival. While PD therapy-related factors, such as dialysis solution composition, peritonitis episodes, and duration of therapy, contribute to these outcomes, genetic factors also play important roles in peritoneal membrane biology. Genetic studies have identified polymorphisms in genes involved in angiogenesis, inflammation, fibrosis, and endothelial function that influence PD outcomes. Variants in genes such as vascular endothelial growth factor, interleukin-6, transforming growth factor-β1, angiotensin-converting enzyme, endothelial nitric oxide synthase, and aquaporin-1 have all been reported to be associated with differences in peritoneal transport and susceptibility to membrane failure. These genetic discoveries provide significant insights into the pathways that lead to alterations in the PD membrane structure and function. This review article aims to explore current evidence on key genetic determinants of peritoneal membrane transport, inflammatory responses, and fibrotic transformation in PD, and to discuss their potential implications for personalised dialysis therapy and future research. Full article

Background: Vasoplegic shock (VS) in critically ill patients without microbiological evidence of infection poses a major clinical challenge in intensive care units (ICUs). Extracorporeal cytokine hemadsorption using the oXiris^® membrane—a high-permeability polyacrylonitrile-based (AN69-ST) filter with adsorptive properties against inflammatory mediators—has emerged as a potential adjunct to restore haemodynamic stability. Evidence supporting its use remains limited, particularly regarding timing of initiation and downstream mortality biomarkers. Methods: We conducted a single-centre prospective observational study at the ICU of Istanbul Prof. Dr. Cemil Taşcıoğlu City Hospital between October 2022 and January 2023. Adults aged ≥18 years with VS (CRP ≥ 100 mg/L, procalcitonin [PCT] < 2 μg/L, no positive microbiological culture) requiring continuous renal replacement therapy (CRRT) with the oXiris^® membrane were enrolled (n = 34), of whom 30 completed the study period without microbiological exclusion and comprised the final analysis cohort. Pre- and post-treatment (72 h) clinical and cytokine parameters were compared. The association of VS resolution and 7-day mortality with timing of oXiris^® initiation, cytokine levels, and treatment duration was assessed. This study was conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. Results: Significant changes were observed across all principal haemodynamic and inflammatory parameters at 72 h of oXiris^® treatment, including mean arterial pressure (MAP: 50.8 ± 6.3 to 69.3 ± 17 mmHg, p < 0.001), SOFA score (8.33 ± 2.29 to 4.9 ± 3.22, p < 0.001), IL-6 (767.3 ± 1205.7 to 294.4 ± 686.3 pg/mL, p < 0.001), IL-1β, TNF-α, CRP, lactate, and creatinine. VS resolved in 24/30 patients (80%). Younger age was associated with VS resolution (57.8 ± 19.7 vs. 76.6 ± 13.9 years; p = 0.021). Initiation of oXiris^® within 8 h was associated with significantly shorter VS resolution time (52.5 ± 23.9 vs. 85.9 ± 48.2 h; p = 0.045). Seven-day mortality was 20% (n = 6) and hospital mortality was 50% (n = 15). Post-treatment IL-1β (856.7 ± 548.5 vs. 1086.9 ± 353.6 pg/mL; p = 0.044) and TNF-α (111.0 ± 70.0 vs. 145.4 ± 47.8 pg/mL; p = 0.011) at 72 h were significantly higher in hospital non-survivors, representing exploratory prognostic associations. Conclusions: Changes in haemodynamic and inflammatory parameters were observed during oXiris^®-based CRRT treatment in critically ill patients with non-septic VS. Early initiation (≤8 h) was associated with shorter VS resolution time in this exploratory, uncontrolled analysis. Residual IL-1β and TNF-α at 72 h were associated with hospital mortality in exploratory analyses and may represent hypothesis-generating prognostic signals requiring prospective validation. Randomised controlled trials are warranted to confirm these findings and define optimal timing strategies. Full article

Background/Objectives: Spontaneous bacterial peritonitis (SBP) is a serious complication of decompensated cirrhosis and is associated with acute kidney injury (AKI), organ failure, and death. Intravenous albumin is recommended in SBP because it reduces renal impairment and mortality, particularly in patients at higher risk of circulatory dysfunction and hepatorenal complications. However, the prognostic impact of early albumin administration on clinical outcomes in hospitalized SBP patients remains incompletely characterized in real-world practice. This study aimed to assess the association between early albumin administration and clinical outcomes in patients hospitalized with SBP compared to those without early albumin. Methods: A retrospective cohort study was conducted using the TriNetX US Collaborative Research Network, including adults hospitalized with SBP through February 2026. Patients were divided into those receiving early albumin administration (n = 1248) and those without early albumin (n = 4932) within 24 h of index SBP diagnosis. Propensity score matching (1:1) balanced cohorts (n = 1230 each) for demographics, comorbidities, liver disease severity surrogates, medications, and laboratory values. Relative risks (RR), risk differences (RD), and hazard ratios (HR) were calculated using propensity-matched and Cox proportional hazard models. Results: Early albumin administration was associated with significantly lower all-cause mortality (RR 0.620; 95% CI: 0.441–0.871; p = 0.005 at 5 days; RR 0.770; 95% CI: 0.651–0.910; p = 0.002 at 90 days). Secondary outcomes showed reduced risks for acute kidney injury (RR 0.654; 95% CI: 0.553–0.774; p < 0.001 at 5 days; RR 0.798; 95% CI: 0.706–0.903; p < 0.001 at 90 days), hepatorenal syndrome–AKI (RR 0.598; 95% CI: 0.445–0.804; p < 0.001 at 5 days; RR 0.756; 95% CI: 0.613–0.932; p = 0.009 at 90 days), vasopressor requirement (RR 0.633; 95% CI: 0.489–0.820; p < 0.001 at 5 days; RR 0.712; 95% CI: 0.572–0.887; p = 0.002 at 30 days), and renal replacement therapy (RR 0.533; 95% CI: 0.324–0.878; p = 0.011 at 5 days; RR 0.642; 95% CI: 0.442–0.932; p = 0.019 at 30 days). Cox models confirmed statistically significant risk reductions for all primary and secondary outcomes, including ICU admission (HR 0.82; 95% CI: 0.73–0.92; p = 0.001) and 30-day readmission (HR 0.84; 95% CI: 0.73–0.97; p = 0.015). Associations were strongest in the early period and attenuated over time. Conclusions: Early albumin administration was associated with reduced risks of mortality, AKI, HRS-AKI, and hemodynamic instability in patients hospitalized with SBP, with attenuation over time. These findings support timely implementation of guideline-concordant albumin therapy, although residual confounding cannot be excluded. Full article