Search Results (2,550)

Background: PEG-Asparaginase and Erwinia asparaginase are enzyme-based anticancer therapies used in the treatment of acute lymphoblastic leukaemia (ALL) and lymphoblastic lymphoma (LBL), where adequate plasma enzyme activity is required for therapeutic efficacy. In many study groups, therapeutic drug monitoring is routinely applied due to pharmacokinetic variability and the risk of hypersensitivity reactions followed by increased clearance and insufficient treatment. In clinical practice, samples may be exposed to prolonged transport and variable pre-analytical conditions. Knowledge on pre-analytical stability is important for correct interpretation of PEG-Asparaginase and Erwinia asparaginase activity in plasma. This study aimed to evaluate the in vitro stability of PEG-Asparaginase and Erwinia asparaginase under pre-analytical conditions. Methods: Three experimental stability studies were conducted at two activity levels. Enzyme stability in plasma was assessed during storage at 4 °C and 20 °C for up to 14 days and following three freeze–thaw cycles. Stability in whole blood prior to centrifugation was evaluated over 24 h. Enzyme activity was measured using a validated spectrophotometric assay, and stability was defined as a deviation within ±15% of baseline activity. Results: Both enzymes remained stable in plasma for up to 14 days at 4 °C and 20 °C, and no clinically relevant reduction in enzyme activity of freeze–thaw cycling was observed. In whole blood, Erwinia asparaginase and high-activity PEG-Asparaginase remained stable for 24 h at 20 °C, whereas low-activity PEG-Asparaginase showed a reduction in activity of approximately 22%, mainly within the first two hours. Conclusions: PEG-Asparaginase and Erwinia asparaginase are stable in plasma for up to 14 days at room temperature, enabling shipment of plasma samples by mail. However, prompt centrifugation is recommended for samples with low PEG-Asparaginase activity to ensure accurate therapeutic drug monitoring. Full article

Background/Objectives: Hand hygiene is a cornerstone of infection prevention, yet the extent to which multimodal institutional hand hygiene interventions translate into measurable reductions in healthcare-associated infections (HAIs) remains uncertain. This systematic review aimed to evaluate the association between hospital-wide or multi-ward multimodal hand hygiene interventions and clinical HAI outcomes in acute care hospitals. Methods: A structured literature search was conducted in PubMed, Scopus, Embase, and Google Scholar using a combination of Medical Subject Headings (MeSH) and free-text terms related to hand hygiene, healthcare-associated infections, hospital settings, and intervention strategies. Eligible studies were quasi-experimental designs, including before–after, controlled before–after, and interrupted time-series studies, evaluating multimodal hand hygiene interventions implemented at hospital-wide or multi-ward level and reporting clinical HAI outcomes. Two reviewers independently assessed risk of bias using the ROBINS-I tool, and certainty of evidence across major outcome categories was summarized using GRADE. Results: twelve studies met the inclusion criteria. Overall, multimodal hand hygiene interventions were generally associated with favorable directional trends in clinical outcomes. Reductions were most consistent for broader institutional HAI measures and some device-associated infections, particularly central line-associated bloodstream infections. In contrast, organism-specific outcomes, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridioides difficile, were more heterogeneous across studies and settings. All included studies were judged to be at serious or critical overall risk of bias, primarily because of confounding, lack of contemporaneous controls, co-interventions, and phased implementation. Conclusions: Multimodal hand hygiene programs in acute care hospitals may be associated with improvement in selected clinically relevant HAI outcomes, particularly at the institutional level. However, the overall certainty of evidence remains low to very low, and the strength of inference is limited by the non-randomized nature of the available studies and the difficulty of isolating the independent effect of hand hygiene within complex infection-prevention strategies. Full article

Natural disasters such as floods and earthquakes cause severe physical, social, and economic losses, highlighting the critical need for timely and reliable early warning systems. Conventional water level and structural health monitoring technologies are often costly, limiting deployment to high-priority infrastructure only. This paper presents the development and validation of two low-cost Internet of Things (IoT) systems for multi-hazard disaster monitoring and early warning, explicitly supporting UN Sustainable Development Goals 9 (Industry, Innovation, and Infrastructure) and 11 (Sustainable Cities and Communities) by enabling equitable monitoring of rural or minor bridges. The proposed system achieves a significant cost reduction (approximately $300 compared to conventional systems typically exceeding $5000), highlighting its potential for scalable and sustainable deployment. The first system integrates a Raspberry Pi, Pi Camera, Lidar Lite V3, and ADXL355 accelerometer to simultaneously capture floodwater images, measure water levels, and record bridge vibrations, with distance measurements recorded at user-defined intervals and vibration data sampled up to 100 Hz. Laboratory repeatability and uncertainty analyses of the Lidar Lite V3 indicate a root mean square error of ~2.4 cm over a 0–25 cm range, demonstrating stable performance for flood monitoring and sufficient accuracy for early warning applications using low-cost sensing systems. The ADXL355 accelerometer is validated through harmonic excitation tests (0.1–2 Hz) and real earthquake recordings, confirming its suitability for low-frequency structural response monitoring. The second system combines a Raspberry Pi, an HX711 amplifier, and a CDP25 displacement transducer to measure bridge-bearing displacements up to 25 cm, with data acquisition at sampling rates of up to 80 Hz, with laboratory tests demonstrating consistent and repeatable measurements during both loading and unloading cycles. The IoT framework is resilient, incorporating solar power and local data storage to ensure operation during power or network outages. Unlike prior studies focusing on individual sensors, this work delivers a fully integrated multi-sensor platform with formalized early warning logic based on predefined thresholds. The results demonstrate the feasibility of scalable, real-time, low-cost monitoring for disaster risk reduction and infrastructure resilience, providing a sustainable solution for community-scale early warning applications. Full article

Introduction: The role of Collis gastroplasty has traditionally been reserved for patients with a shortened esophagus due to chronic gastroesophageal reflux disease (GERD). However, its necessity has been questioned, leading to a decline in popularity. This systematic review and meta-analysis aimed to evaluate the efficacy of hiatal hernia repair with fundoplication, with versus without Collis gastroplasty. Methods: A systematic search of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and the Cochrane Library (via Wiley) was performed in May 2025. Studies were included if they compared outcomes or the safety profile of Collis gastroplasty versus no Collis gastroplasty during fundoplication for hiatal hernia repair. Meta-analyses were conducted using a random-effects model and restricted maximum likelihood. Results: Of 664 unique results, 17 studies comprising 4048 patients were included. There was a female predominance (65.4%), with a weighted mean age of 58.9 ± 14.0 years and follow-up of 43.5 ± 43.1 months. Patients who underwent Collis gastroplasty represented 35.8% of the cohort. Nissen fundoplication was the most common procedure in both the Collis (91.9%) and non-Collis (84.5%) groups. Most studies had selection bias, in which only patients who did not have sufficient intraoperative intra-abdominal esophageal length underwent Collis gastroplasty. Recurrence rates were similar (13.5% vs. 13.2%). Collis gastroplasty was not associated with a reduction in hiatal hernia recurrence (OR 0.53, 95% CI 0.23–1.22). Symptom outcomes, including regurgitation (OR 0.53, 95% CI 0.05–5.39), reflux (OR 0.81, 95% CI 0.03–22.12), dysphagia (OR 1.12, 95% CI 0.62–2.04), and use of antireflux medication on follow-up (OR 1.15, 95% CI 0.62–2.15), were not significantly different. However, Collis gastroplasty was associated with a higher risk of complications, including overall complications (OR 2.63, 95% CI 1.55–4.46), leak (OR 3.35, 95% CI 1.11–10.05), and surgical site infection (OR 8.28, 95% CI 1.16–59.10). There were no significant differences in abscess formation (OR 5.97, 95% CI 0.77–46.49), length of stay (mean difference 0.36 days, 95% CI −0.30 to 1.01), readmission (OR 1.13, 95% CI 0.36–3.60), reoperation (OR 1.24, 95% CI 0.64–2.41), or mortality (OR 1.08, 95% CI 0.45–2.57). Conclusions: Collis gastroplasty was not associated with a decreased risk of hiatal hernia recurrence or improvement in other efficacy measures, but this is in the context of a strong component of selection bias. In this context, there may be a role for Collis gastroplasty in difficult cases if the rate of recurrence does not differ from those with sufficient length, but this must be balanced against a significantly increased risk of complications. Full article

Background: Prehabilitation aims to optimise patients before cardiac procedures through interventions including exercise training, respiratory conditioning, nutritional support, psychological preparation and multimodal lifestyle programmes. Evidence from systematic reviews and meta-analyses is increasing but remains heterogeneous due to variation in intervention design, patient populations and overlap of primary studies. Methods: We conducted an umbrella review of 17 systematic reviews and meta-analyses evaluating prehabilitation prior to cardiac surgery and structural heart interventions in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of included reviews was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Outcomes of interest were postoperative pneumonia, hospital length of stay (LOS), and mortality. Results: Across pooled analyses, the most consistent finding was a reduction in postoperative pneumonia, particularly in studies incorporating inspiratory muscle training (IMT), with relative risk reductions of approximately 55–62%, corresponding to a modest absolute risk reduction. Reductions in hospital LOS were also reported, although effect sizes were smaller and more variable. In contrast, no consistent reduction in short-term mortality was demonstrated, likely reflecting low event rates. The evidence base was limited by substantial overlap between reviews and predominantly low or critically low methodological quality. Conclusions: Prehabilitation, particularly when incorporating IMT, is consistently associated with a reduction in postoperative pneumonia and may contribute to modest reductions in hospital LOS. However, the evidence base is constrained by heterogeneity, study overlap and low methodological quality. Further high-quality, adequately powered randomised trials are required to define the role of prehabilitation in contemporary cardiac surgical and structural intervention practice. Full article

The integration of environmental, social and governance (ESG) criteria into corporate and financial decision-making has become one of the most significant transformations in today’s financial markets. Growing regulatory pressure, stakeholder expectations and increased awareness of sustainability challenges have led companies and investors to incorporate ESG considerations into strategic and investment decisions. Despite the rapid spread of ESG practices, the academic literature presents conflicting and sometimes contradictory evidence regarding their economic implications and practical effectiveness. This article provides a review of the literature on the main academic contributions to ESG integration, focusing on three key dimensions: the economic benefits associated with ESG practices, the methodological and credibility challenges relating to ESG measurement, and the organisational and technological factors that enable effective ESG implementation. The findings indicate that ESG integration is generally associated with positive organisational outcomes, including improved financial performance, lower cost of capital, greater stakeholder trust and a reduction in firm-specific risk. However, the realisation of these benefits is not automatic and depends to a large extent on the credibility of ESG practices and information. Rather than endorsing the widely held view that ESG criteria are inherently capable of creating value, the analysis shows that the value-creating effect of ESG criteria depends crucially on the credibility of ESG practices and the quality of their implementation. The literature highlights significant methodological challenges, including rating divergence, the lack of standardised metrics, methodological opacity and the growing risk of greenwashing, which can undermine the reliability of ESG information. This paper proposes an deductive conceptual framework in which ESG effectiveness emerges from the interaction between value creation mechanisms, credibility constraints, and enabling organisational and technological factors. Full article

Accurate precipitation forecasting is essential for water resource management, flood early-warning systems, and agriculture, but remains difficult because of the nonlinear and highly variable spatiotemporal nature of rainfall. This paper compares four deep learning architectures—a standalone LSTM, a standalone CNN, a hybrid CNN–LSTM, and a Transformer encoder—against three classical baselines (persistence, day-of-year climatology, and per-grid-point ARIMA) for daily precipitation forecasting over Washington State at lead times of one to four days. A 40-year ERA5 dataset (1985–2024) of near-surface air temperature, mean sea-level pressure, and total precipitation is split into training (1985–2012), validation (2013–2015), and test (2016–2024) periods, with the test years held out completely. Each (model, horizon) is trained with three random seeds and evaluated in physical units (mm/day). On the held-out test period, the hybrid CNN–LSTM achieves the lowest RMSE at every horizon $h\ge 2$, with $R^2=0.576\pm 0.007$ and RMSE $=15.08\pm 0.07$ mm/day at $h=4$. Diebold–Mariano tests, paired t-tests, and bootstrap 95% confidence intervals confirm that the CNN–LSTM advantage over the LSTM is statistically significant at horizons 2–4 (but not at $h=1$), while CNN–LSTM is significantly better than every classical baseline and the Transformer at every horizon. The headline result is reproduced under a rolling-origin temporal cross-validation across three non-overlapping splits ($R^2\in [0.576,0.590]$). Practically, the sub-millisecond inference cost of the CNN–LSTM makes it directly deployable in operational forecasting pipelines used for flood early-warning, irrigation scheduling, and reservoir management, where even modest improvements in 3–4-day-ahead RMSE translate into measurable risk reduction and improved decision lead time for water managers and emergency planners. Full article

Low levels of high-density lipoprotein cholesterol (HDL-C) are strongly associated with increased cardiovascular risk. However, under various pathological conditions, high-density lipoprotein (HDL) particles may undergo structural and functional modifications, leading to a progressive loss of antioxidant capacity and a shift from a cardioprotective to a proatherogenic phenotype. In this cross-sectional study, we investigated differences in HDL particle distribution and antioxidant function between individuals with elevated lipoprotein(a) [Lp(a)] levels (≥30 mg/dL) and those with low Lp(a) levels (<10 mg/dL). Serum low-density lipoprotein (LDL) and HDL subfractions were analyzed in twenty subjects with high Lp(a) and ten low-Lp(a) controls using non-denaturing polyacrylamide gel electrophoresis (PAGE, Lipoprint system). Enzymatic activities of paraoxonase-1 (PON1) and HDL-associated lipoprotein-associated phospholipase A₂ (HDL-Lp-PLA₂) were measured. Electrophoretic analysis revealed a significant increase in small HDL (S-HDL) in the high-Lp(a) group compared to the controls (34.1 ± 13.2% vs. 21.5 ± 2.7%, p = 0.01), alongside a reduction in large HDL (L-HDL) (19.6 ± 9.9% vs. 33.4 ± 3.8%, p < 0.001). Furthermore, the high Lp(a) group exhibited significantly lower HDL-PON1 activity (55 ± 12 vs. 67 ± 7 U/mL, p < 0.001) and HDL-Lp-PLA₂ activity (2.6 ± 1.0 vs. 3.6 ± 1.2 nmol/min/mL, p < 0.02) compared with the controls. These findings suggest that markedly elevated Lp(a) levels are associated with a shift toward a more proatherogenic HDL subfraction profile and impaired antioxidant functionality, which may reflect mechanisms linked to increased atherosclerotic cardiovascular disease (ASCVD) risk. Full article

Air pollution represents a public health threat; it is co-responsible for millions of premature deaths annually and economic losses. Mega-events create abrupt changes in air pollution providing quasi-experimental settings to investigate related health impacts. This systematic review synthesizes the evidence on air pollution level changes during mega-events and associated short-term health effects, including mortality, hospitalizations and early biological responses. A literature search was conducted in PubMed, Embase, Scopus and Web of Science up to 7 April 2025. Study quality was evaluated using the EPHPP Quality Assessment Tool for Quantitative Studies. Thirty-one studies met the inclusion criteria. Mega-events without effective air pollution control measures were associated with increased pollutant levels and higher risks of respiratory and cardiovascular morbidity. Biomarker studies demonstrated rapid and reversible changes in oxidative stress and inflammatory biomarkers in response to short-term variations in air pollution. Instead, significant reductions in air pollution during mega-events were observed upon emission control measures. The evidence is predominantly from Asian countries, no Europe/Africa studies and only one from North America, limiting generalizability. Findings indicate that mega-events may influence air quality which affects human health, reinforcing the value of temporary emission control measures strategies for future mega-events. The systematic review was registered with Prospero (CRD420251032553). Full article

Relapse in substance use disorders remains a persistent clinical challenge. Identity reconstruction, the psychological transition from an internalized “addict” identity to a recovery-oriented self, may be a core coping mechanism for abstinence maintenance. This exploratory pilot stratified randomized controlled trial examined the feasibility and preliminary effects of a Narrative Therapy (NT) group intervention, delivered within an evidence-based practice framework. Forty-five male residents of a closed rehabilitation facility were randomly assigned (n = 15 each) to an 8-week NT intervention, standard psychoeducation (TAU), or waitlist control (WLC). The Self-Identity Scale and an abbreviated four-item Stimulant Relapse Risk Scale served as outcomes. The Self-Concept Clarity Scale assessed a candidate process variable. A 3 (group) × 3 (time) repeated-measure ANOVA showed significant group × time interactions for self-identity (F = 64.215, p < 0.001, and η²p = 0.754) and relapse-risk indicators (F = 62.131, p < 0.001, and η²p = 0.747). For self-identity, only the NT group showed significant within-group gains. For relapse-risk indicators, NT scores were significantly lower than both control groups at post-test and follow-up (all pairwise p ≤ 0.008), with these reductions maintained at two-month follow-up. Within-group self-concept clarity gains emerged for NT, though between-group differences were nonsignificant. Because the study was conducted in a custodial setting, the relapse-risk findings reflect psychological vulnerability rather than observed behavior. Larger adequately powered trials are needed. Full article

Wearable sensors like inertial measurement units (IMUs) can quantify sport technique in natural settings, yet field hockey-specific skill analyses remain limited. This exploratory study investigated how relative foot placement, stick orientation, and lower body kinematics at impact relate to performance of the field hockey sweep skill. Eight experienced female participants performed sweeps under three foot positions relative to the ball (in front, in line, and behind) while IMUs recorded body segment and stick motion. Sweep performance was characterized by accuracy, bounciness, and ball speed. Placing the foot in front of the ball was associated with reduced ball speed and a trend toward lower accuracy relative to the in-line reference, whereas placing the foot behind the ball did not differ from in line on any outcome. Stick roll at impact emerged as a consistent trial-level predictor, with a more open face associated with a greater likelihood of a bouncy sweep and slightly increasing ball speed. Stick pitch and lower limb joint angles were not significant within-participant predictors. However, between-participant analyses indicated that larger knee angles and smaller hip angles were associated with greater accuracy, while smaller average pitch was associated with faster ball speed. Together, these findings indicate that some aspects of sweep performance are amenable to immediate technique adjustments whereas others reflect stable individual movement tendencies. These findings provide a foundation for future work on offering evidence-based guidance for technique refinement and potential implications for injury risk reduction. Full article

Background/Objectives: Communicating genetic risk has been proposed as a motivational tool for weight control, but evidence remains limited. Methods: We conducted a randomized controlled trial among 53 overweight or obese young adults in South Korea. Participants were randomized to receive either their obesity-related genetic results with tailored lifestyle recommendations (intervention, n = 27) or genetic results limited to beauty traits (control, n = 26). Body weight and body composition were measured at baseline, 6 months, and 18 months. Primary outcome was change in body weight; secondary outcomes included body fat mass, body fat percentage, and skeletal muscle mass. Analyses used general linear and mixed models. Exploratory analyses examined effects among participants carrying ≥2 risk alleles across FTO, MC4R, and BDNF. Results: Overall, body weight and composition changes did not differ significantly between groups at 6 or 18 months. In exploratory subgroup analysis conducted among participants with obesity-related genetic risk, body weight increased in the intervention group (model-adjusted mean change, 2.68 kg; 95% CI, 2.28 to 3.09) but decreased in the control group (model-adjusted mean change, −11.58 kg; 95% CI, −1.99 to −1.18) over 18 months. Among participants with obesity-related genetic risk in the intervention group, those who reported behavior changes after receiving their genetic test results experienced modest weight reductions over 6 months compared with non-changers. Conclusions: Disclosure of obesity-related genetic information with tailored advice did not improve weight outcomes overall, but may benefit a subset of genetically susceptible individuals. Larger trials are warranted. Full article

Background: Radical cystectomy (RC) remains associated with substantial perioperative morbidity despite advances in minimally invasive surgery and reconstructive techniques. Comparisons between intracorporeal reconstruction, robotic-assisted approaches, and urinary diversion strategies are frequently confounded by clinical heterogeneity and patient selection. This study aimed to perform a stratified surgical systematic review evaluating perioperative outcomes across distinct reconstructive pathways following RC. Methods: A PRISMA-guided systematic review identified comparative studies evaluating intracorporeal versus extracorporeal/open orthotopic neobladder reconstruction, robotic-assisted versus open radical cystectomy in frail patients undergoing ureterocutaneostomy, and ileal conduit versus orthotopic urinary diversion. Analyses were performed within predefined clinical modules to preserve surgical context. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), complemented by rare-event sensitivity analyses and exploratory absolute risk metrics, including number needed to treat or harm (NNT/NNH). Continuous outcomes such as estimated blood loss and length of hospital stay were assessed descriptively. Results: Three comparative observational cohorts met inclusion criteria. Intracorporeal neobladder reconstruction and robotic-assisted cystectomy demonstrated consistent reductions in transfusion rates and favourable trends in perioperative morbidity. In frail patient populations, robotic surgery showed reduced intraoperative burden without increased readmission or mortality. Ileal conduit diversion was associated with increased wound-related complications and infectious outcomes; however, these findings likely reflect baseline differences in patient frailty and selection. Rare-event sensitivity analyses confirmed directional consistency of treatment effects despite wide confidence intervals. Integration of absolute risk differences and NNT/NNH metrics provided clinically interpretable context for stratified outcomes. Conclusions: Minimally invasive and intracorporeal strategies following radical cystectomy may reduce perioperative burden, whereas diversion type primarily influences complication patterns rather than overall morbidity. A stratified analytical framework integrating relative and absolute effect measures may offer a more clinically meaningful approach to evaluating reconstructive strategies in heterogeneous surgical populations. Full article

Background/Objectives: Glioblastoma (GBM) comprises a contrast-enhancing (CE) mass and peritumoral hyperintensity on fluid-attenuated inversion recovery (FLAIR) on magnetic resonance imaging (MRI). Although a smaller residual FLAIR lesion volume (FLV) after gross total resection (GTR) is associated with longer survival, the clinical observation of rapid FLV reduction within the first postoperative month remains unknown. We evaluated the independent prognostic contributions of early and late FLV reduction in patients with newly diagnosed GBM, isocitrate dehydrogenase (IDH)-wildtype, who underwent GTR. Methods: In a retrospective cohort of 51 adults with GBM, IDH-wildtype, who underwent GTR and standard chemoradiotherapy, semi-automated FLV was measured on MRI preoperatively, immediately postoperatively (FLV0), at 1 month (FLV1), and at 3 months (FLV3). FLV changes were expressed as percentage changes relative to the preceding timepoint (ΔFLV0-1, ΔFLV1-3). Using a 3-month landmark analysis, multivariable Cox models for overall survival (OS) were fitted, adjusted for age, O6-methylguanine-DNA-methyltransferase promoter (pMGMT) methylation, and postoperative Karnofsky Performance Status (KPS). Results: In the multivariable 3-month landmark analysis, each 10-percentage-point early FLV reduction (∆FLV0-1^[10-pp]) was associated with lower mortality risk (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.82–0.99, p = 0.037) whereas a late FLV reduction (∆FLV1-3^[10-pp]) showed a smaller association with OS (HR 0.99, 95% CI 0.98–1.00, p = 0.043). In an exploratory dichotomized analysis at a 20% reduction threshold, early responders (∆FLV0-1 ≥ 20%) had markedly better OS (HR 0.33, p = 0.010). Conclusions: In selected patients with GBM, IDH-wildtype, who achieved radiographic GTR and received standard chemoradiotherapy, early postoperative FLV reduction at 1 month independently predicted longer OS, with a substantially larger effect than late reduction. Prospective multi-center validation is required before clinical implementation. Full article

Background/Objectives: Sepsis is a dynamic clinical syndrome characterized by a rapidly evolving inflammatory response, where early identification of patients at risk for adverse outcomes remains a major challenge. While inflammatory biomarkers are widely used, their prognostic value at baseline is limited. This study aimed to evaluate whether early changes in inflammatory biomarkers, particularly the neutrophil-to-lymphocyte ratio (ΔNLR), provide additional prognostic value in predicting short-term outcomes in patients with sepsis. Methods: A retrospective longitudinal observational study was conducted, including 168 adult patients admitted with sepsis at a tertiary infectious diseases hospital. Inflammatory biomarkers (CRP, procalcitonin, leukocyte subpopulations, and NLR) were assessed at admission and at 48–72 h. Early changes (Δ values) were calculated and analyzed in relation to a composite adverse outcome, including ICU admission, vasopressor requirement, mechanical ventilation, or in-hospital mortality. Logistic regression and ROC curve analyses were used to evaluate predictive performance. Results: Patients with adverse outcomes had significantly higher baseline inflammatory markers and severity scores. Early reductions in CRP and NLR were more pronounced in survivors, whereas non-survivors showed persistently elevated or minimally decreasing values. In multivariate analysis, ΔNLR remained independently associated with in-hospital mortality (OR 0.91, 95% CI 0.84–0.98, p = 0.015), alongside Sequential Organ Failure Assessment (SOFA) score and septic shock. ΔNLR demonstrated better discriminative performance (AUC 0.74) compared to baseline markers and improved predictive accuracy when combined with SOFA score (AUC 0.81). Higher baseline NLR quartiles were associated with a stepwise increase in adverse outcomes. Conclusions: Early changes in inflammatory biomarkers, particularly ΔNLR, provide clinically relevant prognostic information beyond baseline measurements and severity scores in sepsis. Dynamic assessment of immune response may improve early risk stratification and support more individualized clinical decision-making. Full article