Search Results (40,097)

Background/Objectives: The recently proposed revised Dynamic International Prognostic Scoring System (DIPSS-R) excludes age and constitutional symptoms and relies exclusively on disease-related variables. We aimed to externally validate the DIPSS-R and to characterize how it reclassifies patients relative to the DIPSS. Methods: We retrospectively studied 285 patients with primary or secondary myelofibrosis from seven centers. Both scores were calculable in 270 patients (148 deaths). The two systems were compared for discrimination, reclassification, calibration, and robustness across pre-specified subgroups and landmarks. Results: During a median follow-up of 90.3 months, median overall survival (OS) was 66.1 months (5-year OS 52.7%). The two systems showed similar discrimination (C-index 0.691 vs. 0.697; difference −0.006, 95% CI −0.046 to +0.030; p = 0.77) with no significant difference across any subgroup, fibrosis grade, driver mutation, age or sex. The DIPSS-R assigned more patients to higher-risk categories (59.3% vs. 46.3%; p < 0.001). Reclassification was discordant in 57 patients (21.1%); the DIPSS-R up-stratified 46 patients (17.0%) classified as lower-risk by the DIPSS, and these patients had significantly worse survival than concordantly lower-risk patients (5-year OS 57.7% vs. 81.7%; p < 0.001). Among transplant-eligible patients aged ≤65 years, the DIPSS-R up-stratified 26 (22.6%). The reclassification was driven by the DIPSS-R-specific variables (monocytosis, leukocytosis and thrombocytopenia). In multivariable analysis the DIPSS-R remained independently prognostic of the Charlson comorbidity index (CCI), with both retaining independent value (DIPSS-R: HR 1.96 per category, 95% CI 1.58–2.44, p < 0.001; CCI: HR 1.18 per point, 95% CI 1.06–1.32, p = 0.003). In secondary myelofibrosis the DIPSS-R discriminated comparably to the disease-specific MYSEC-PM (C-index 0.659 vs. 0.698; p = 0.44). Conclusions: The DIPSS-R matches the DIPSS in discrimination while identifying additional adverse-risk patients, most relevantly transplant-eligible younger patients, who would otherwise be considered lower-risk by the age-containing DIPSS; in secondary myelofibrosis it performs comparably to the disease-specific MYSEC-PM. Full article

Background: Invasive physiologic assessment is often needed for moderately stenotic coronary lesions, although it remains underused in routine practice. It remains unknown whether GPT-based large language models (LLMs) can estimate coronary physiology from coronary angiographic images, and whether retrieval augmentation can improve this task. Methods: We performed a retrospective pilot study of consecutive cases undergoing coronary angiography with invasive instantaneous wave-free ratio (iFR) assessment between 2023 and 2025. Eligible cases required invasive iFR and two orthogonal end-diastolic still frames of the target vessel at maximal opacification. We compared a baseline GPT-5.2 model without retrieval-augmented generation (RAG), termed No-RAG, with the same GPT-5.2 model using RAG, termed RAG. Both conditions received identical angiographic frames and structured clinical text. The RAG modification added the top five case-specific text chunks retrieved from four coronary physiology/revascularization documents to provide physiologic thresholds, guideline context, and uncertainty framing; no additional angiographic images or lesion-specific iFR information were provided. Frame-level predictions were averaged to derive a case-level predicted iFR. The primary endpoint was agreement between predicted and measured iFR. Results: Of 34 eligible cases screened, 32 vessels were included. The cohort comprised 25/32 cases (78.1%) with significant disease (iFR ≤ 0.89) and 7 cases classified as non-ischemic. Without RAG, mean absolute error (MAE) was 0.064 and the root mean square error (RMSE) was 0.083, with weak correlation with invasive iFR (r = 0.205, p = 0.259). With RAG, point estimates favored improved continuous agreement, with MAE decreasing to 0.029, RMSE to 0.038, and correlation increasing to r = 0.830 (p < 0.001). Threshold-based classification also yielded higher point estimates for accuracy, increasing from 0.750 to 0.906. Conclusions: In this small pilot study, improved point estimates for agreement between LLM-predicted and invasively measured iFR were seen after adding RAG to a GPT-based model for estimating iFR from angiographic imaging. These findings suggest that functionally classifying coronary stenoses is limited by overestimating severity in less severe stenoses, and that a scaling correction is needed. The results, however, require validation in larger, more balanced cohorts. Full article

Background/Objectives: Current hemoglobin management in neurocritical care relies on static transfusion thresholds, which fail to capture the dynamic nature of hemoglobin changes during ICU care. We aimed to determine whether distinct longitudinal hemoglobin trajectory phenotypes exist among neurosurgical ICU patients and whether specific trajectory patterns independently predict unfavorable neurological outcomes. Methods: In this retrospective observational cohort study, we analyzed 8517 patients admitted to the neurosurgical ICU of a tertiary academic medical center between January 2015 and December 2024. A feature-based Gaussian mixture model was applied to trajectory-derived hemoglobin features over the first 14 ICU days to identify distinct hemoglobin trajectory phenotypes. The association between trajectory class and neurological outcomes was evaluated using propensity score matching. Results: Six distinct hemoglobin trajectory phenotypes were identified. The “Rapid Dropper” phenotype (Class 2; n = 351, 4.1%), characterized by the steepest decline velocity and highest variability, showed dramatically worse outcomes: 36.5% unfavorable neurological outcome (Glasgow Outcome Scale 1–3) versus 3.1% in all other classes combined (odds ratio [OR], 18.10; 95% confidence interval [CI], 14.08–23.27). This association persisted after propensity score matching (OR, 2.40; 95% CI, 1.77–3.26; p < 0.001). Hemorrhagic diagnoses were disproportionately concentrated in this high-risk phenotype. A combined prediction model incorporating trajectory-derived features within 72 h achieved an area under the receiver operating characteristic curve of 0.850 (95% CI, 0.829–0.870). This value reflects retrospective full-trajectory phenotyping; in a 72 h landmark analysis, early-feature prediction achieved an AUC of approximately 0.72. Conclusions: Hemoglobin trajectory phenotyping identified a high-risk “Rapid Dropper” subgroup that was significantly associated with worse short-term neurological outcomes. The rate of hemoglobin decline, rather than any single threshold, was associated with prognostic separation; prospective and external validation is required before these associations can inform transfusion strategy. Full article

Background/Objectives: Neuroprognostication after out-of-hospital cardiac arrest (OHCA) remains clinically challenging, particularly when withdrawal of life-sustaining treatment (WLST) is considered. International guidelines recommend delayed, multimodal assessment, but real-world descriptions of how this is operationalised within multidisciplinary pathways remain limited. Methods: We conducted a single-centre retrospective observational cohort study of adults admitted to a tertiary cardiac arrest centre intensive care unit following OHCA between June 2022 and December 2025. Patients were conveyed according to the British Cardiovascular Intervention Society OHCA pathway; therefore, this was a selected cardiac arrest centre cohort enriched for shockable rhythms and suspected reversible cardiac causes, rather than an unselected OHCA population. Patients who remained unconscious at ≥72 h following a sedation hold entered a structured multidisciplinary team (MDT) neuroprognostication pathway. Outcomes included survival to hospital discharge, Cerebral Performance Category (CPC) at discharge, neuroprognostication investigation use, and timing of WLST. Results: Of 406 patients admitted following OHCA, 310 were admitted to ICU and included in the analysis. The cohort was predominantly male (82.3%), with a mean age of 63.8 years; 82.9% had ventricular fibrillation as the initial rhythm. Overall, 182 patients (58.7%) survived to hospital discharge, of whom 160 (87.9%) had a favourable neurological outcome (CPC 1–2). A total of 119 patients entered the neuroprognostication pathway. Of these, 72 underwent WLST after completed MDT review, 10 died before MDT decision-making, and 37 survived to hospital discharge. Among patients undergoing WLST, investigation use was high: CT brain 100%, NSE 91.7%, EEG 90.3%, SSEP 88.9%, and MRI brain 27.8%. Median time to WLST was 5.5 days. Conclusions: In this selected tertiary CAC cohort, enriched for shockable rhythms through BCIS pathway-based conveyance, survival to hospital discharge was high and neurological outcomes among survivors were predominantly favourable. Within this setting, delayed, multimodal neuroprognostication and WLST decision-making were operationalised through a structured MDT pathway aligned with contemporary guideline recommendations. These findings provide contemporary real-world benchmark data on pathway implementation for comparable centres seeking to evaluate or develop structured neuroprognostication services. Full article

Background and Objectives: Three-dimensional (3D) coils offer stable initial framing in intracranial aneurysm embolization, but their utility in pulmonary and visceral vascular lesions has not been well established. The objective of this study was to assess the feasibility, safety, and effectiveness of 3D coils used as the primary framing device in pulmonary and visceral embolization. Materials and Methods: This retrospective study included 13 patients with 14 lesions, comprising seven pulmonary arteriovenous malformations (PAVMs), six splenic artery aneurysms (SAAs), and one hepatic artery pseudoaneurysm (HAP), treated between 2024 and 2025. In all lesions, a 0.018-inch 3D coil was deployed as the initial framing coil, followed by further packing with additional 3D or non-3D coils. Technical success, angiographic success, and clinical outcomes were evaluated. Results: Technical success was achieved in all lesions (14/14, 100%; 95% CI, 78.5–100). Angiographic success was achieved in 13 of 14 lesions (92.9%; 95% CI, 68.5–98.7), and clinical success was achieved in 12 of 13 lesions (92.3%; 95% CI, 66.7–98.6). Post-embolization syndrome (PES) developed in five patients with SAAs and in one patient with HAP; all complications were minor and resolved with conservative management. No coil migration or major complications occurred. Conclusions: When used as the initial framing device, 3D coils were technically feasible and achieved acceptable short-term angiographic and clinical outcomes in this small, heterogeneous series; these preliminary findings require confirmation in comparative studies. Full article

Background: To investigate the diagnostic value of the SPT-to-histamine ratio, casein-specific immunoglobulin E (IgE), and cow’s milk-specific IgE in predicting oral food challenge (OFC) positivity in children with suspected cow’s milk allergy. Methods: In this single-center retrospective observational study, 126 children evaluated for suspected cow’s milk allergy who underwent OFC between January 2019 and July 2024 at a tertiary pediatric allergy and immunology center were included. Demographic and clinical characteristics, SPT parameters, and laboratory biomarkers were analyzed. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis, and independent predictors were identified using multivariable logistic regression. Results: OFC was positive in 66 patients (52.4%). Casein-specific IgE demonstrated strong discriminatory performance (AUC = 0.878), with 80.3% sensitivity and 85.0% specificity at a cutoff value of ≥2.55 kUA/L. The SPT-to-histamine ratio showed moderate discriminatory performance (AUC = 0.758). In multivariable analysis, only casein-specific IgE remained an independent predictor of OFC positivity (adjusted OR = 1.317, p < 0.001). Conclusions: Casein-specific IgE is a strong independent predictor of OFC positivity. Although SPT-derived ratios may provide complementary diagnostic information, their independent predictive contribution appears limited. These findings support the role of component-resolved diagnostics in pre-challenge risk stratification. Full article

Background/Objectives: Cognitive impairment, frailty, and systemic comorbidity burden are common in elderly patients with glaucoma and may influence both visual field (VF) performance and glaucoma severity. This study investigated the associations of comprehensive geriatric assessment (CGA) parameters, including Mini-Cog, G8, and Age-Adjusted Charlson Comorbidity Index (ACCI), with VF sensitivity and VF reliability indices in glaucoma patients. Methods: This retrospective cross-sectional study included 1125 eyes of 622 glaucoma patients who underwent Humphrey VF testing and CGA at a tertiary referral center. Associations between CGA parameters and VF indices, including mean deviation (MD), pattern standard deviation (PSD), foveal sensitivity, fixation loss rate (FL), false-negative rate (FN), and false-positive rate (FP), were evaluated. Generalized linear mixed models were used to assess independent associations after adjustment for demographic, systemic, and ocular covariates. Results: In univariate analyses, lower Mini-Cog and G8 scores and higher ACCI scores were associated with several VF sensitivity and reliability indices. After multivariable adjustment, ACCI remained independently associated with lower MD (estimate = −0.52, p = 0.004), higher PSD (estimate = 0.27, p = 0.04), and lower foveal sensitivity (estimate = −0.36, p = 0.01). Lower G8 scores and higher ACCI scores were independently associated with increased FN rates, whereas higher G8 scores were associated with increased FP rates. Conclusions: Systemic comorbidity burden, assessed using ACCI, was independently associated with both glaucomatous functional impairment and selected VF reliability indices. Frailty, assessed using G8, was associated with VF reliability but not VF sensitivity. Although cognitive function measured by Mini-Cog was associated with VF parameters in univariate analyses, these associations were not retained after multivariable adjustment. Consideration of systemic health status and geriatric vulnerability may improve interpretation of VF results in patients with glaucoma. Full article

Background: Nationwide epidemiologic data on comorbidity burden in early rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are limited. We compared coded diagnoses for concurrent disorders in incident RA and PsA based on administrative healthcare data (AHC). Methods: This retrospective cohort study used AHCs from the National Health Fund between 2009 and 2021. Using composite proxy definitions for RA and PsA diagnosis (combination of ICD-10 codes and prescription data), we identified all new cases of RA and PsA between 2019 and 2021. We utilized a ten-year lookback window for the accrual of concurrent disorder claims. Age-, sex-, serostatus- and calendar year-adjusted models were considered. Crude, relative and adjusted prevalence estimates were calculated using generalized linear models. Results: Using NHF data, we identified 36,285 and 1603 patients with incident RA/PsA, respectively. We estimated the burden of 31 multisystem comorbidities. Most disorders (N = 23, 74.2%) were more frequently coded among RA patients, while only liver diseases were significantly more prevalent in PsA. Chronic back pain (+21.2 pp) and osteoarthritis (+18.3 pp) were tied to the greatest absolute differences, likely mirroring medical contact patterns throughout the differential diagnostic process. Hospitalization due to heart failure and stroke, but not myocardial infarction, was more common in RA vs. PsA. Conclusions: Newly diagnosed patients with RA and PsA show distinct patterns of healthcare utilization for multiple organ disorders. Early RA may be tied to higher comorbidity rates not fully explained by age and sex, as compared to PsA; further studies are necessary to clarify these observations. Full article

Background: Infant wheezing is a common respiratory condition with a significant healthcare burden, yet data from the Middle East remain limited. This study aimed to identify predictors of any wheezing and recurrent wheezing during the first year of life in a Saudi Arabian birth cohort. Methods: This retrospective birth cohort study included infants born at King Saud University Medical City, Riyadh, in 2020. Data were collected from electronic medical records and a structured parental questionnaire administered via WhatsApp at 12 months of age, assessing wheezing episodes, parental atopy, household smoking, pets, home humidity, and nearby pollution sources. Any wheezing was defined as ≥1 wheezing episode during the first year, and recurrent wheezing as ≥3 episodes. Variables with p < 0.25 in univariable logistic regression were entered into multivariable models; adjusted odds ratios (aOR) with 95% confidence intervals are reported. Results: Of 594 infants, 135 (22.7%) experienced any wheezing and 85 (14.3%) had recurrent wheezing. NICU admission was independently associated with both any wheezing (aOR 2.65, 95% CI 1.49–4.73; p < 0.001) and recurrent wheezing (aOR 2.34, 95% CI 1.21–4.56; p = 0.012). Parental allergic rhinitis was independently associated with both outcomes (any wheezing: aOR 1.55, 95% CI 1.01–2.37; recurrent wheezing: aOR 1.67, 95% CI 1.00–2.78), while parental eczema was specifically associated with recurrent wheezing (aOR 1.74, 95% CI 1.00–3.03). Conclusions: NICU admission and parental atopy were associated with infant wheezing in this cohort. These findings provide region-specific data from Saudi Arabia but should be regarded as hypothesis-generating and require confirmation in prospective multicentre studies before informing clinical follow-up strategies. Full article

Background/Objectives: The use of quantitative neuroimaging to establish objective biomarkers in neurodegenerative diseases (NDD) has attracted increasing interest over the last decade. Advanced magnetic resonance imaging (MRI) such as arterial spin labeling (ASL) and diffusion tensor imaging (DTI), as well as [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography (PET), could provide clinically meaningful biomarkers and may support differential diagnosis. The aim of this investigator-initiated, single-center, retrospective comparative study was to implement a framework for multimodal neuroimaging to evaluate cases with rare NDD, using a methodological approach that integrates metabolic, perfusion, and microstructural parameters from simultaneous FDG-PET/MRI, and to investigate its potential to facilitate diagnosis. Methods: Three patients with pathological motor signs (1f/2m; 63, 73, and 52 years) and 19 control subjects with subjective cognitive deficits (SCDs) underwent combined FDG-PET/MRI with pseudo-continuous ASL and DTI. Standardized uptake values (SUVs), relative cerebral blood flow (rCBF), and fractional anisotropy (FA) were calculated to identify pattern alterations in individual patients based on parameterization mapping. The final diagnosis was corticobasal degeneration (CBD, n = 1) or primary lateral sclerosis (PLS, n = 2). Results: At the individual patient level, disease-specific changes in defined brain regions could be demonstrated and quantified compared to control subjects. All three patients showed significantly decreased FA, primarily along parts of the course of the corticospinal tract (CST). In the patient with CBD, asymmetric SUVR and rCBF decreases were observed, mostly overlapping with motor regions. In the two patients with PLS, SUVR revealed mostly unspecific findings (hypothetically due to a slow progression rate or due to potentially early disease stages), while ASL indicated decreased rCBF primarily overlapping within the motor cortex. Changes at the gray matter level were primarily located adjacent to changes in white matter, as indicated by the multimodal analysis approach using simultaneously acquired FDG-PET/MRI data. Conclusions: According to this proof-of-concept study, multimodal neuroimaging by the combination of quantitative MRI and FDG-PET has the potential to guide differential diagnosis in rare NDDs, especially if clinical diagnosis is not straightforward to achieve. Since particularly early diagnosis remains essential for patient counseling, effective treatment, and clinical management, the present framework appears helpful to be developed further until it aligns and integrates with clinical routine. Full article

Background and Objectives: Eustachian tube (ET) dysfunction links adenoidal disease to persistent middle ear dysfunction in children, yet the independent contribution of ET orifice obstruction grade to audiological outcomes and health-related quality of life remains unquantified after adjustment for anatomical and inflammatory confounders. Because conventional anatomical grading (e.g., the Cassano classification) does not directly characterize the degree of ET orifice compromise, it may underestimate the functional threat to middle ear ventilation; this study is the first to quantify the independent predictive value of endoscopic ET obstruction grade. This study aimed to evaluate ET obstruction grade as an independent determinant of hearing thresholds, middle ear pressure, and quality-of-life impairment in children with chronic adenoiditis and otitis media with effusion. Materials and Methods: A retrospective cohort of 236 children (aged 3–12 years) was analyzed. ET orifice obstruction was graded endoscopically as none, partial, or complete. Primary outcomes included pure tone average (PTA), middle ear pressure (MEP), and OSA-18 total score. Multivariate linear and logistic regression models were fitted, adjusting for age, sex, Cassano grade, neutrophil-to-lymphocyte ratio (NLR), allergic status, and acute otitis media frequency. The modifying role of mucosal appearance (edematous versus fibrotic/remodeling) on quality-of-life outcomes was also assessed. Results: ET obstruction was absent in 42 (17.8%), partial in 114 (48.3%), and complete in 80 (33.9%) children. PTA increased progressively across groups (22.2 ± 5.5 to 36.2 ± 6.7 dB; p < 0.001), as did OSA-18 scores (44.9 ± 7.9 to 80.4 ± 10.3; p < 0.001). In adjusted analysis, each obstruction increment independently predicted a 5.57 dB PTA increase (95% CI 4.37–6.77; p < 0.001), a 14.89-point OSA-18 increase (95% CI 12.87–16.92; p < 0.001), and 5.12-fold higher odds of PTA > 30 dB (95% CI 2.84–9.24; p < 0.001). Persistent middle ear dysfunction at six months occurred in 7.1%, 26.3%, and 61.3% across obstruction grades. Among children with complete obstruction, fibrotic mucosa was associated with higher OSA-18 scores than edematous mucosa (82.3 vs. 76.8; p = 0.02). Conclusions: ET obstruction grade independently determines audiological and quality-of-life outcomes in pediatric chronic adenoiditis. Mucosal remodeling further amplifies quality-of-life burden in complete obstruction. These findings support routine ET endoscopic grading in pediatric otorhinolaryngology risk stratification. Full article

Treatment of non-small cell lung cancer (NSCLC) has been transformed by immunotherapy and targeted therapies. We aimed to characterize clinical features, treatment patterns, and healthcare resource use in patients with early and locally advanced NSCLC before incorporation of these therapies. This retrospective observational study included adults diagnosed with stage I–III NSCLC at four Spanish hospitals between 2014 and 2018, with follow-up until 2021, using artificial intelligence to extract data from electronic health records. A total of 951 patients were included (34.7% stage I, 16.7% stage II, 48.6% stage III), with a median age of 66 years and 31.9% female. Surgery was performed in 78.5% of stage I, 74.8% of stage II, and 35.5% of stage III patients. Among surgical patients, 62.5% received adjuvant chemo- and/or radiotherapy, 20.8% neoadjuvant therapy, and 15.7% both; among non-surgical patients, chemoradiotherapy was the most common treatment (50.4%). Beyond hospitalization, outpatient visits were the most frequently used healthcare resource. These findings provide a historical benchmark of NSCLC care before introduction of immunotherapy and targeted therapies in these settings, highlighting treatment variability and the need for earlier diagnosis, structured treatment pathways, and multidisciplinary management. Full article

Background: Diabetic foot osteomyelitis (DFO) poses significant challenges due to its high morbidity and recurring nature. Current treatments involve prolonged antibiotics and often surgical intervention; however, the optimal route of antibiotic administration is unknown. This study evaluated the effect of route of antibiotic administration on treatment failure among patients with diabetic foot osteomyelitis. Methods: The authors conducted a retrospective cohort study among patients with unresected diabetic foot osteomyelitis. A propensity score was used to match the treatment exposure groups. The primary outcome was treatment failure, defined as either (1) treatment with additional antibiotic course or (2) additional surgical debridement/amputation at the original site of infection within 1 year of initial treatment. Secondary outcomes included the impacts of hemoglobin A1c, peripheral arterial disease, obesity, and infection severity on treatment failure. Results: Among 152 patients meeting criteria, 49 matched pairs were analyzed. Treatment failure rates did not significantly differ between oral and intravenous groups (OR 0.98, 95% CI 0.30–3.19, p > 0.9). A time-to-event analysis similarly found no significant outcome disparities between groups (p = 0.3). Conclusions: The study results support the previously published literature that demonstrates comparable treatment outcomes between routes of antibiotic administration when treating diabetic foot osteomyelitis. Full article

Background: The incremental value of iodine-125 (I-125) seed implantation in advanced refractory lung squamous cell carcinoma (LUSC) with hemoptysis treated with bronchial artery chemoembolization (BACE) and immunotherapy remains unclear. Methods: This retrospective cohort study included 90 patients treated between June 2023 and June 2025. Patients receiving BACE plus immunotherapy were classified according to whether I-125 seed implantation was performed within 7 days after BACE: G1, BACE plus immunotherapy (n = 42), and G2, BACE, I-125 seed implantation, and immunotherapy (n = 48). Inverse probability of treatment weighting (IPTW) served as the primary adjustment method. Results: After IPTW, baseline covariates were well balanced; propensity score matching yielded 26 patients per group. Compared with G1, G2 was associated with longer hemoptysis-free survival (not reached vs. 11 months; HR = 0.34, 95% CI 0.18–0.64, p < 0.05), overall survival (19 vs. 14 months; HR = 0.26, 95% CI 0.15–0.44, p < 0.05), and progression-free survival (12 vs. 9 months; HR = 0.34, 95% CI 0.21–0.56, p < 0.05). The 6-month objective response rate (ORR) and disease control rate (DCR) were higher in G2, whereas no significant difference in 24-h hemostasis or recorded grade 3 or higher adverse events was observed. Conclusions: Adding I-125 seed implantation to BACE plus immunotherapy was associated with improved outcomes in selected patients, and prospective validation is warranted. Full article

Background: Mutations in the KRAS oncogene occur in approximately 40% of colorectal cancers, predominantly within exon 2. Non-exon 2 mutations are less common and remain poorly characterized in terms of their clinical and biological significance. Systemic inflammatory markers are well-established prognostic indicators in colorectal cancer, yet whether their prognostic value differs across KRAS mutation subtypes has yet to be defined. We aimed to characterize and compare the clinicopathological and inflammatory profiles of patients with exon 2 versus non-exon 2 KRAS-mutated colorectal cancer and evaluate their prognostic implications. Methods: This retrospective cohort study analyzed 272 patients with microsatellite stable metastatic colorectal cancer with KRAS mutations, comprising 236 exon 2 and 36 non-exon 2 cases. Clinical, molecular, and laboratory data, including baseline systemic inflammatory markers, were extracted from electronic medical records. Survival outcomes and the prognostic impact of these variables were evaluated with Kaplan-Meier curves and univariable and multivariable Cox proportional hazards regression analyses. Results: Non-exon 2 mutations were significantly more frequent in female patients (64% vs. 45%, p = 0.048) and in left-sided primary tumors (83% vs. 64%, p = 0.035). Median overall survival was 45.7 months for the non-exon 2 group compared to 32.4 months for the exon 2 cohort; KRAS mutation subtype was not significantly associated with overall survival on univariable or multivariable analysis (univariable HR 1.36, 95% CI 0.85–2.16, p = 0.2; multivariable HR 1.376, 95% CI 0.794–2.383, p = 0.255). Systemic inflammation demonstrated distinct prognostic value, with elevated white blood cells, absolute neutrophil count, platelets, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and low albumin levels demonstrating association with worse overall survival in the exon 2 cohort. Conversely, only an elevated neutrophil-to-lymphocyte ratio predicted worse survival in the non-exon 2 group. Conclusions: KRAS exon 2 and non-exon 2 mutated metastatic colorectal cancers exhibit distinct clinical and inflammatory characteristics. Systemic inflammation exerts a significantly greater prognostic impact in exon 2 disease. As the therapeutic landscape for KRAS-mutated CRC continues to evolve, these findings hold promise for informing KRAS mutation-specific approaches to patient stratification and treatment planning. Full article