Search Results (5,764)

Thoracic aortopathies, including aneurysm and dissection, are complex vascular disorders characterized by structural alterations of the aortic wall that disrupt normal haemodynamics. Altered shear stress, turbulent flow, and endothelial dysfunction promote thrombus formation and modulate systemic hemostasis via platelet activation and the von Willebrand factor–ADAMTS13 axis. The Total Thrombus-Formation Analysis System (T-TAS) is a microfluidic, flow-dependent assay that quantitatively evaluates thrombus formation under physiological shear conditions. Although studied in various cardiovascular contexts, its application in aortopathies remains largely unexplored, and no prospective studies have validated its clinical utility. Integrating T-TAS with computational haemodynamic approaches, such as two-way fluid–structure interaction simulations, enables assessment of the interplay between blood flow, vessel wall mechanics, pulse wave propagation, and local shear patterns. Patient-specific modelling, including individualized flow profiles, pressure distributions, and wall properties, may enhance mechanistic insights. Genetic variants in Fibrillin-1 gene (FBN1), Transforming Growth Factor Beta Receptor 1/2 (TGFBR1/2), Actin Alpha 2 (ACTA 2), and Myosin Heavy Chain 11 (MYH11) further contribute to structural vascular heterogeneity and diverse systemic haemostatic phenotypes, highlighting the need for personalized assessment. T-TAS should currently be considered an exploratory research tool rather than a validated diagnostic or prognostic method. This narrative review proposes a hypothesis-generating framework integrating structural, haemodynamic, molecular, and functional perspectives. Combining flow-based thrombosis assays with advanced modelling may inform future translational studies, improve mechanistic understanding of thrombus formation, and support personalized risk stratification and management in patients with thoracic aortopathies. Full article

This review evaluates the emerging role of circulating tumour cells (CTCs) as clinically meaningful, minimally invasive biomarkers for oral squamous cell carcinoma (OSCC). Despite advances in management, OSCC continues to demonstrate high morbidity and mortality, largely due to late diagnosis and the absence of validated biomarkers for early detection or real-time monitoring. Conventional diagnostic tools, tissue biopsy, and imaging provide only static snapshots and fail to capture tumour heterogeneity or evolving biological behaviour. CTCs offer a novel and significant opportunity to address these limitations. Key findings from recent studies highlight that CTC enumeration correlates with tumour burden, nodal metastasis, recurrence, and overall prognosis. Molecular and phenotypic characterisation further reveals dynamic traits such as epithelial–mesenchymal transition, stemness, and therapy resistance, providing insights into metastatic potential and treatment failure. Technological advances, including immunocytochemistry, microfluidic capture platforms, PCR-based assays, and next-generation sequencing, have enhanced the sensitivity and specificity of CTC detection and enabled detailed multi-omic profiling. Collectively, evidence suggests that integrating CTC analysis into OSCC clinical workflows could improve early detection, refine risk stratification, personalise therapeutic strategies, and support longitudinal monitoring of disease dynamics. As research progresses, CTC-based diagnostics represent a promising frontier in shifting OSCC management toward more precise, adaptive, and biologically informed care. Full article

Background: Acute cholecystitis, a leading cause of urgent surgical intervention, poses challenges in predicting severity and operative complexity. This study characterized the immuno-inflammatory profile distinguishing acute from chronic cholecystitis and assessed whether blood-derived ratios—neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR)—correlate with histologic severity and surgical difficulty. Methods: The study retrospectively analyzed 759 patients undergoing cholecystectomy from 2016 to 2024. Inflammatory indices from preoperative bloodwork were compared across histopathologic subtypes (catarrhal, phlegmonous, gangrenous), clinical features, and surgical outcomes, including conversion to open procedure. Logistic regression and ROC analyses identified predictors of acute inflammation and conversion. Results: Acute cholecystitis patients showed elevated NLR (7.0 vs. 3.1), MLR (0.44 vs. 0.26), and PLR (194 vs. 142; all p < 0.001). NLR was the only independent predictor of acute disease (OR = 1.29, 95% CI 1.203–1.390, p < 0.001), with superior discrimination (AUC = 0.806, cut-off = 3.56; sensitivity 73.1%, specificity 80.4%). NLR and PLR rose progressively from catarrhal to phlegmonous and gangrenous subtypes (p < 0.05), mirroring conversion rates (0% catarrhal, 3.2% phlegmonous, 10.5% gangrenous; p = 0.001). Conclusions: Routine hematologic ratios capture systemic immune activation in acute cholecystitis, reflecting histologic severity and operative risk. NLR, integrating innate and adaptive immune dynamics, offers a practical biomarker for preoperative risk stratification in acute care surgery. Full article

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a leading cause of mortality in intensive care units (ICUs). Although the Sequential Organ Failure Assessment (SOFA) score is widely used for prognostic stratification, organ dysfunction represents a downstream manifestation of sepsis, whereas immune and inflammatory dysregulation may precede overt organ failure. Monocyte distribution width (MDW) is a novel hematological parameter reflecting monocyte activation and is approved for the diagnosis of sepsis; however, its prognostic value and potential role within composite biomarker models in critically ill surgical patients with sepsis remain incompletely defined. Methods: We conducted a prospective, observational, single-center pilot study in two surgical intensive care units between November 2022 and December 2023. Adult patients with sepsis defined according to Sepsis-3 criteria were enrolled. Laboratory and clinical variables—including MDW, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), and SOFA score—were measured on admission and during the first five days of ICU stay. Patient-level median values across five days were used for analysis. The primary outcome was in-hospital mortality. Prognostic performance was assessed using receiver operating characteristic (ROC) curve analysis and logistic regression. A composite bioscore was constructed by combining dichotomized MDW, NLR, CRP, and PCT values. Results: Sixty patients were included; 24 (40%) died during hospitalization. Non-survivors were older and had significantly higher SOFA scores. MDW, NLR, CRP, and PCT were significantly higher in non-survivors. SOFA demonstrated the strongest discriminative ability for mortality prediction (AUC 0.839, 95% CI 0.730–0.948). Among biomarkers, NLR (AUC 0.741) and PCT (AUC 0.714) showed good discriminative performance, while MDW (AUC 0.690) and CRP (AUC 0.662) showed moderate discrimination; MDW exhibited the highest specificity (80.6%). In multivariable analysis with individual biomarkers, only SOFA remained an independent predictor of mortality. The composite bioscore demonstrated good discriminative ability (AUC 0.805) and, when evaluated alongside SOFA, remained independently associated with fatal outcome (OR 11.92, 95% CI 1.76–80.75); however, given the modest sample size and wide confidence intervals, this finding should be interpreted with caution. Repeated-measures correlation analysis revealed no strong collinearity among biomarkers. Conclusions: A composite bioscore incorporating MDW, NLR, CRP, and PCT provides prognostic information comparable to SOFA and remains independently associated with mortality. This approach may complement organ dysfunction-based assessment and support early risk stratification in sepsis. Full article

Introduction: Oral squamous cell carcinoma (OSCC) is a frequent head and neck malignancy with high morbidity and mortality. Locoregional recurrence is the main determinant of long-term prognosis, yet reliable predictive models remain limited. This study aimed to identify clinicopathological predictors of recurrence and to develop a nomogram-based recurrence risk score (RRS) for patient stratification. Materials and Methods: A retrospective study was conducted including 332 patients with histologically confirmed OSCC treated surgically between 2012 and 2022. Clinical and pathological variables were analyzed. Statistical analyses included Chi-squared tests, Cox regression, Kaplan–Meier survival analysis, and multivariate modeling to construct a predictive nomogram and derive the RRS. Results: Close or involved surgical margins were observed in 33.4% of patients, and 66.9% presented moderately or poorly differentiated tumors. Locoregional recurrence occurred in 34.6% of cases, mainly within 24 months. Close margins and poor differentiation were independent predictors of recurrence (p < 0.005). The RRS effectively stratified patients into low-, intermediate-, and high-risk groups, with recurrence rates of 21.6%, 50.6%, and 82.1%, respectively (p < 0.001). Conclusions: The RRS is a practical tool for predicting OSCC recurrence and may support personalized follow-up and adjuvant treatment strategies. Prospective validation is warranted. Full article

Background/Objectives: Multiple myeloma (MM) is an incurable plasma cell neoplasm in which diagnosis and prognostication rely on invasive bone marrow examinations that may not capture biological heterogeneity across different disease sites. There is a clinical need for non-invasive biomarkers that can accurately predict treatment outcomes. Methods: We performed a global proteomic profiling of bone marrow-derived extracellular vesicles (EVs) from nine MM patients and ten controls. A total of 8839 proteins were identified, of which 14 met predefined selection criteria. These candidates were quantified in serum-derived EVs using targeted proteomic analysis. Prognostic relevance of selected proteins was evaluated in newly diagnosed MM (NDMM) patients treated with daratumumab-containing frontline regimens (n = 26) and healthy individuals (n = 60). Progression-free survival (PFS) was analyzed using univariable and multivariable models. Results: IL5RA (p = 0.003) and BCMA (p < 0.001) were significantly elevated in serum EVs from MM patients compared with controls. Higher serum EV-IL5RA and EV-BCMA were associated with a trend toward shorter PFS. Combined assessment of these biomarkers enabled clear stratification of MM patients into three prognostic groups, including a cohort with markedly inferior outcomes, with a 20-month PFS of 0 (p = 0.001). In multivariable analysis, the combined serum EV-IL5RA and EV-BCMA signature suggests an independent prognostic potential (HR = 38.49 [95% CI, 1.51–47.79], p = 0.015). Conclusions: Serum EV-IL5RA and EV-BCMA are novel non-invasive biomarkers, measurable through routine blood testing, with strong potential to improve risk stratification in NDMM patients in the era of daratumumab-based frontline therapy. Full article

Yellow fever remains a major public health threat in endemic and re-emerging regions of Africa and South America, with recent outbreaks highlighting persistent gaps in prevention and surveillance. Pregnant women represent a particularly vulnerable population, yet the epidemiology, clinical impact, and preventive strategies for yellow fever in pregnancy are insufficiently characterized. Physiological and immunological changes during gestation may influence host responses to infection; however, current evidence does not demonstrate increased susceptibility to or severity of yellow fever during pregnancy. Adverse materno-fetal outcomes, including miscarriage, stillbirth, preterm birth, and, in rare cases, perinatal transmission, have been reported but remain poorly characterized. Diagnostic challenges, overlapping clinical presentations with other arboviral and hepatic diseases, and limited access to specialized care further complicate clinical management in many endemic settings. This perspective provides a comprehensive overview of yellow fever in pregnancy during the 2024–2026 outbreak in the Americas, including a risk-stratification framework for prevention. We summarize current evidence on epidemiology, pathophysiology, diagnosis, and supportive care, and examine prevention strategies with particular emphasis on vaccination. Accumulated observational evidence and substantial real-world experience have not demonstrated an increased risk of serious adverse events and generally support the effectiveness of yellow fever vaccination during pregnancy when administered with appropriate clinical judgment. In high-risk settings, the benefits of maternal immunization clearly outweigh theoretical concerns, supporting a flexible, risk-based approach, despite relatively limited evidence. We also discuss national and international policies, post-pregnancy booster recommendations, and the importance of integrating vaccination assessment into antenatal care. Finally, we highlight critical knowledge gaps and research priorities, including the need for prospective registries and strengthened pharmacovigilance. Coordinated clinical and public health strategies are essential to protect maternal and neonatal health and to reduce the burden of yellow fever in endemic and re-emerging settings. Full article

Traumatic Brain Injury (TBI) is a major contributor to mortality among older adults, with geriatric patients facing disproportionately high risk due to age-related physiological vulnerability and comorbidities. Early and accurate prediction of mortality is essential for guiding clinical decision-making and optimizing ICU resource allocation. In this study, we utilized the MIMIC-III database and identified a final analytic cohort of 667 geriatric TBI patients, on which we developed a machine learning framework for 30-day mortality prediction. A rigorous preprocessing pipeline—including Random Forest-based imputation, feature engineering, and hybrid selection—was implemented to refine predictors from 69 to 9 clinically meaningful variables. CatBoost emerged as the top-performing model, achieving an AUROC of 0.867 (95% CI: 0.809–0.922), with a sensitivity of 0.752 and a specificity of 0.888 on the independent test set. SHAP analysis confirmed the importance of the GCS score, oxygen saturation, and prothrombin time as dominant predictors. These findings highlight the potential value of interpretable machine learning tools for early mortality risk stratification in elderly TBI patients and support further validation for future clinical use. Full article

Background/Objectives: Non-classical congenital adrenal hyperplasia (NCCAH) due to 21-hydroxylase deficiency represents the mildest form of congenital adrenal hyperplasia and is frequently diagnosed only after the onset of clinical signs in childhood. Newborn screening programs for CAH are primarily designed to detect classical forms and show limited sensitivity for NCCAH. The clinical significance of neonatal 17-hydroxyprogesterone (17-OHP) values below recall thresholds remains incompletely defined. Methods: We retrospectively analyzed clinical, auxological, hormonal, and genetic data from pediatric patients diagnosed with NCCAH between 2018 and 2023 at a tertiary referral center. Neonatal screening 17-OHP concentrations, basal and ACTH-stimulated 17-OHP levels at diagnosis, bone age advancement, pubertal status, and hydrocortisone treatment were evaluated. Correlations between hormonal parameters, age at onset, and treatment dose were assessed. Results: Thirty-five patients (30 females) were included, with a mean age at clinical onset of 7.52 ± 0.36 years for females and 6.25 ± 0.29 years for males. Premature pubarche was the most frequent presenting sign (94.3%), and central precocious puberty was diagnosed in 31.4% of cases. The mean neonatal screening 17-OHP level was 4.53 ± 0.7 ng/mL; only two patients exceeded the screening recall cut-off. At diagnosis, mean basal and ACTH-stimulated 17-OHP levels were 15.1 ± 3.35 and 55.2 ± 11.3 ng/mL, respectively. Age at clinical onset was inversely correlated with both basal and stimulated 17-OHP levels, while hydrocortisone dose correlated positively with biochemical severity. Bone age advancement was observed in all patients. Conclusions: Most children with NCCAH display mildly elevated neonatal 17-OHP values that do not trigger screening recall. Higher biochemical severity is associated with earlier clinical presentation and higher glucocorticoid requirements. Neonatal 17-OHP concentrations, even when below cut-off values, may represent an early indicator of disease severity and warrant further investigation. Full article

Sepsis is a life-threatening complication among patients with liver cirrhosis and is associated with high morbidity and mortality. Early diagnosis is challenging due to immune dysfunction, chronic systemic inflammation, and overlap between clinical and laboratory findings during infection and hepatic decompensation. Therefore, there is a need to identify routinely available predictors that may enable the stratifying of patients at risk of developing sepsis in this population and facilitate intensive monitoring, antibiotic treatment, and potentially reduce mortality. The aim of this study is to evaluate the association between routine laboratory parameters and the development of sepsis among cirrhotic patients. A total of 171 cirrhotic patients met the inclusion criteria and were followed at a tertiary liver clinic between February 2015 and February 2022. Sepsis was defined according to Sepsis-3 criteria. Univariate analyses were performed to compare sepsis patients versus non-sepsis patients. Multivariable logistic regression was conducted to identify independent predictors of sepsis. Among 171 patients, 41 (24%) developed sepsis and 130 (76%) did not. Baseline characteristics were similar between groups: patients with sepsis were slightly older (67.5 ± 10.9 vs. 64.5 ± 12.3 years, p = 0.172), with no significant differences in sex (53.7% vs. 56.2%, p = 0.78) or ethnicity (Arab ethnicity 56.1% vs. 39.1%, p = 0.055). Ascites was more frequent in the sepsis group (53.7% vs. 26.2%, p = 0.001), whereas esophageal varices were less common (12.2% vs. 35.4%, p = 0.006). Rates of hepatic encephalopathy and acute kidney injury did not differ significantly. Higher creatinine (1.35 (0.80–3.35) vs. 0.80 (0.70–1.49) mg/dL, p < 0.001), INR (1.50 (1.20–1.80) vs. 1.30 (1.10–1.50), p = 0.011), and total bilirubin (1.90 (0.61–2.85) vs. 0.90 (0.59–1.70) mg/dL, p = 0.049) was observed in the sepsis group. In the multivariable model including age, sex, ethnicity, ascites, esophageal varices, INR, creatinine, neutrophil-to-lymphocyte ratio, and CRP, baseline serum creatinine was the only independent predictor of sepsis (adjusted OR 1.58 per 1 mg/dL increase, 95% CI 1.08–2.33, p = 0.01). Receiver operating characteristic (ROC) analysis demonstrated that the multivariable model had acceptable discriminative ability for prediction of sepsis, with an area under the curve (AUC) of 0.741 (95% CI 0.647–0.835). Among ambulatory patients with liver cirrhosis, baseline serum creatinine was independently associated with the development of sepsis. These findings highlight the need for dedicated risk-stratification tools in the outpatient setting. Further external validation in independent cohorts is required. Full article

Uveal melanoma (UM) lacks minimally invasive and reproducible biomarkers to support clinical risk stratification, motivating the need for molecular profiling of aqueous humor (AH) as an alternative to fine-needle tumor aspiration (FNAB). This study aimed to generate a calibrated AH protein concentration map to identify tumor-associated signals present at clinically measurable levels and assess their associations with established molecular and clinical features. AH samples from 70 UM eyes were analyzed using next-generation sequencing-based proximity extension assays (PEAs), and leftover AH from 27 samples was further assessed using qPCR-based PEA to obtain reference concentration values. Regression models derived from overlapping proteins enabled extrapolation of calibrated pg/mL-level concentrations across the full cohort. Twenty-three proteins had median modeled concentrations above 5 pg/mL and were examined for clinical relevance and translational feasibility. Several proteins, including CXCL8, CXCL10, VEGFA, HGF, PDCD1, FLT1, FLT3LG, and CCL2, showed progressive increases from GEP1/PRAME− to GEP2/PRAME+ tumors and from AJCC Stage I/II to Stage III/IV, with Stage IV tumors demonstrating significant elevations in CXCL8, VEGFA, and PDCD1. Pathway analysis revealed activation of inflammatory and tumor microenvironment pathways, and upstream regulator analysis identified VEGFA and CCL2 as potential drivers. These findings demonstrate that calibrated AH proteomic profiling can identify clinically measurable protein changes associated with UM risk and stage, supporting its potential utility for biomarker development. Full article

Background/Objectives: Cervical cancer remains a global health burden. The loop electrosurgical excision procedure (LEEP) is effective for cervical intraepithelial neoplasia. Positive margins often complicate decisions about repeat conization. HPV testing is standard in post-treatment surveillance, but its limited specificity shows the need for additional, cost-effective biomarkers. This study evaluated whether changes in systemic inflammatory indices—platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII)—can predict residual high-grade lesions after incomplete excision. Methods: This multicenter retrospective study included 125 patients who underwent repeat surgery after LEEP due to positive margins. Changes in preoperative inflammatory indices (ΔPLR, ΔSIRI, ΔSII) between the first and second procedures were analyzed by the histopathological findings of the second surgery. Group differences were assessed using the Mann–Whitney U test, and receiver operating characteristic (ROC) analysis was used to evaluate discriminatory performance. Results: Significant differences were found in ΔPLR (p = 0.032) and ΔSII (p = 0.048) between patients with and without residual high-grade lesions or invasive cancer. ΔSIRI showed borderline significance (p = 0.050). For invasive cancer alone, ΔSIRI was significantly associated with malignancy (p = 0.035). ROC analysis showed modest predictive performance (AUC ≈ 0.60). Conclusions: Dynamic changes in PLR, SIRI, and SII may be as inexpensive adjunct biomarkers to support risk stratification after incomplete LEEP and can complement HPV testing in certain clinical settings. Full article

Background: Conventional urothelial carcinoma (UC) requires accurate risk stratification, particularly differentiation between non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC) and between low- and high-grade tumors. This study evaluated immunohistochemical (IHC) expression of vitamin D receptor (VDR), β-catenin, and Ki-67 index in Egyptian patients with conventional UC. Methods: A cross-sectional study was conducted on 58 archived conventional UC cases diagnosed in 2023 at Al-Azhar University Hospitals. VDR positivity was defined as ≥10% cytoplasmic and/or nuclear tumor cell staining. Membranous β-catenin was considered preserved when >80% of tumor cell membranes were stained; otherwise, it was reduced. Nuclear β-catenin was considered positive when ≥5% of tumor nuclei were stained. Ki-67 was categorized as high using a ≥30% cutoff. Associations with grade, muscle invasion status, and lymphovascular invasion (LVI) were analyzed. Results: Mean age was 65.3 ± 9.3 years; 86.2% were males; 51.7% were MIBC. Compared with NMIBC, MIBC was significantly associated with high grade, non-papillary architecture, LVI, and high Ki-67. VDR positivity was detected in 82.7% of cases and showed no significant association with grade, muscle invasion, or LVI. Preserved membranous β-catenin was seen in 34.5% and was significantly associated with tumor grade but not with muscle invasion or LVI; nuclear β-catenin was absent. High Ki-67 (60.3%) was significantly associated with high grade and MIBC, with no association with age, sex, or LVI. Conclusions: In Egyptian conventional UC, Ki-67 was a significant marker for aggressive clinicopathologic features, while VDR lacked discriminatory associations and β-catenin findings were mainly grade-related. Full article

Background: Metabolic syndrome (MetS) and alcohol-related liver disease (ALD) are increasingly recognized as interconnected disorders linked by shared mechanisms of lifestyle-driven metabolic reprogramming. Alterations in systemic and hepatic metabolic pathways—including insulin signaling, lipid metabolism, mitochondrial bioenergetics, and redox homeostasis—reduce hepatic resilience to alcohol exposure and accelerate liver disease progression. Objective: This narrative review aims to integrate clinical, epidemiological, and mechanistic evidence published over the past two decades to examine how modifiable lifestyle factors contribute to metabolic reprogramming linking metabolic syndrome and alcohol-related liver disease with prioritization of high-level clinical evidence (cohort studies, meta-analyses, and guidelines). Key Findings: Modifiable lifestyle exposures such as alcohol consumption, cigarette smoking, unhealthy dietary patterns, and physical inactivity converge on common metabolically mediated pathways, including insulin resistance, dysregulated lipid metabolism and lipotoxicity, mitochondrial dysfunction, oxidative stress, chronic low-grade inflammation, and gut–liver axis perturbations. These processes are reflected in altered metabolite profiles involving lipid species, bile acids, tricarboxylic acid cycle intermediates, and microbiota-derived metabolites, shaping a metabolic–hepatic continuum. Among these, alcohol consumption and metabolic dysfunction show the strongest and most consistent associations with liver disease progression, with evidence supporting synergistic rather than additive effects. Conclusions: The coexistence of metabolic dysfunction and alcohol exposure is consistently associated with synergistic worsening of liver-related outcomes, including fibrosis progression, cirrhosis, and hepatocellular carcinoma. Recognition of metabolic alcohol-related liver disease (MetALD) underscores the need for integrated lifestyle-based strategies targeting alcohol consumption, smoking cessation, dietary quality, and physical activity to modulate shared metabolic and inflammatory pathways. A metabolically informed, systems-level approach may improve risk stratification, prevention, and management across the metabolic–hepatic continuum. Full article

Background/Objectives: The aim of this study was to assess whether preoperative pulmonary function testing (PFT) is related to postoperative complications after open thoracoabdominal aortic aneurysm (TAAA) repair. Methods: This study was conducted as a retrospective cohort analysis of 205 patients undergoing open TAAA repair (2006–2024) with preoperative spirometry and body plethysmography with at least one value available. Patients were classified by ventilation patterns: obstructive (n = 85, 45.2%), restrictive (n = 26, 14.1%), and hyperinflation (n = 56, 30.3%). Primary endpoints included in-hospital mortality, pulmonary complications (pneumonia, ARDS), and multi-organ outcomes. Associations were analyzed using chi-square and Spearman correlation tests and multivariable linear regression adjusted for age, smoking status, COPD, emergency operation, and time period. Results: Postoperative pulmonary complications occurred in 126 patients (61.5%), including pneumonia (46.8%) and ARDS (15.1%). Reduced vital capacity and FEV₁ expressed as a percentage of the lower limit of normal (%LLN) were related to postoperative pneumonia (p = 0.031 and p = 0.003) and ARDS (p = 0.038). Both obstructive and restrictive ventilation patterns were related to acute kidney injury after surgery (all KDIGO stage) (p = 0.044 and p = 0.043, respectively). Hyperinflation was related to atrial fibrillation (p = 0.039) and stroke (p = 0.034). FEV₁ < 2.0 L was related to increased mortality risk (p = 0.037), and FEV₁ < 1.5 L predicted acute kidney injury (p = 0.017), spinal cord ischemia (p = 0.035), and mortality (p = 0.023). Prolonged mechanical ventilation correlated with reduced preoperative lung function (VC %LLN ρ = −0.288, p = 0.002; FEV₁ %LLN ρ = −0.286, p = 0.001). During median follow-up of 6.35 years, patients in the highest FEV₁ quartile demonstrated substantially reduced long-term mortality (HR 0.27, 95% CI 0.10–0.73, p = 0.01). These associations between lower FEV₁ and VC (expressed as %LLN) with pneumonia, ARDS, in-hospital mortality, and prolonged ventilation remained significant after multivariable analysis. Conclusions: Preoperative pulmonary function assessment may help identify TAAA patients at increased risk of postoperative complications and mortality. Combining percentage-predicted spirometry, ventilation patterns, and hyperinflation markers may support individualized treatment selection, prehabilitation, and perioperative monitoring based on each patient’s specific risk profile. Full article