Search Results (968)

Objectives: Testicular torsion is a time-critical pediatric urological emergency in which delayed presentation may increase the likelihood of orchiectomy. However, preoperative estimation of the immediate intraoperative outcome remains challenging. This study aimed to develop and internally validate machine-learning models integrating ischemic timing variables and complete blood count-derived inflammatory indices to predict orchiectomy versus testicular preservation at index surgical exploration in pediatric and adolescent testicular torsion. Methods: We retrospectively analyzed 165 children and adolescents who underwent surgical exploration for confirmed testicular torsion. The primary endpoint was orchiectomy at index exploration versus testicular preservation through detorsion and/or orchiopexy. Clinical timing variables and complete blood count-derived indices, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, white blood cell-to-monocyte ratio, monocyte-to-mean platelet volume ratio, hemoglobin-to-monocyte ratio, systemic inflammatory response index, and aggregate index of systemic inflammation, were evaluated. Five supervised machine-learning algorithms—logistic regression, random forest, XGBoost, LightGBM, and support vector machine—were assessed using nested stratified cross-validation with an outer 5-fold loop and inner 3-fold hyperparameter selection. Model performance was estimated from out-of-fold predictions. Results: Orchiectomy was performed in 37 patients (22.4%), whereas testicular preservation through detorsion and/or orchiopexy was performed in 128 patients (77.6%). Symptom duration was significantly longer in the orchiectomy group than in the preservation group (48.00 [30.00–72.00] vs. 6.00 [2.00–24.00] h, p < 0.001). Monocyte count was also higher in the orchiectomy group (0.92 [0.68–1.23] vs. 0.65 [0.50–0.93] × 10⁹/L, p < 0.001). Among the combined models, XGBoost achieved the highest numerical discrimination, with a ROC-AUC of 0.926 ± 0.066 and a bootstrap 95% confidence interval of 0.856–0.966. Feature-block and interpretability analyses identified symptom duration as the dominant predictor, followed by emergency department waiting time and selected monocyte-centered inflammatory indices. Conclusions: Immediate intraoperative orchiectomy in pediatric and adolescent testicular torsion was most strongly associated with prolonged symptom duration, while selected complete blood count-derived inflammatory indices provided complementary risk information. The combined XGBoost model showed strong internal discrimination and clinically interpretable predictor patterns. However, the model was internally validated only and requires external validation before clinical implementation. Full article

Background: Routine full blood count (FBC) testing is part of the haematological workup in diabetes management. There is limited information regarding the contributions of individual haematological parameters to regression models for glycated haemoglobin (HbA1c), estimated whole-blood viscosity (eWBV) and the resulting blood viscosity complications. Importantly, because association and prediction represent distinct concepts, this study extends previous work with a focus on comparative and exploratory relationships. The objective was to compare FBC parameters between higher and lower HbA1c and eWBV groups and identify variables contributing to the Akaike Information Criterion (AIC)-based regression model among diabetics. Methods: This laboratory-based mixed quantitative study involved cross-sectional and regression analyses. Fifteen parameters were evaluated, including the following: red blood cell count (RBC) and indices (MCV, MCH, MCHC); platelet count and derived ratios (PRR, PWR, RPR); and white blood cell count (WBC) with lymphocyte ratios (MLR, NLR, PLR). HbA1c and eWBV data were used to create dichotomous subgroups for univariate comparison, followed by exploratory AIC-based model identification of variables. Results: HbA1c, RDW, MCV, and RPR, differed significantly between HbA1c groups (p < 0.1). Regression analysis identified RDW, MCV, RPR, MCH and RBC as contributors to the HbA1c model. For eWBV, five out of seven parameters (HCT, HB, RBC, WBC, and MLR) showed a significant association. Conclusions: These findings highlight haematological parameters with potential values for future predictive model development. Overall, the study supports the usefulness of selected FBC variables as adjuncts in diabetes monitoring with potential utility in understanding glycaemia control and blood viscosity-related complications. Full article

Weaning stress and immune challenges can negatively affect the health and performance of young pigs by inducing inflammatory responses. Functional protein sources, such as enzymatically hydrolyzed whole blood (EHB), may help alleviate inflammation and improve immune status during stressful conditions. A total of 20 late-weaned pigs [Landrace × Yorkshire × Duroc], 42 days of age, with an initial body weight of 15.34 ± 1.17 kg, were used in a 2-week experiment. Pigs were allotted to a 2 × 2 factorial arrangement with two dietary protein sources [plasma protein (PP) and/or EHB] and two immune challenges (saline or LPS). The four experimental groups were as follows: (1) Plasma-Sal, PP diet + saline injection; (2) Plasma-LPS, PP diet + LPS injection (100 μg/kg BW); (3) EHB-Sal, EHB diet + saline injection; and (4) EHB-LPS, EHB diet + LPS injection (100 μg/kg BW). Each treatment consisted of five replicate pens with one pig/pen. Pigs fed either protein diet with and without LPS showed no (p > 0.05) difference in their nutrient digestibility and microbial population. However, pigs challenged with LPS exhibited a higher (p < 0.05) rectal temperature, with significant differences observed at 6 h and 12 h post-injection (p < 0.001). Dietary effects (p < 0.05) were observed for IL-6 and TNF-α concentrations, with pigs fed EHB exhibiting lower values compared with those fed the PP diet following LPS challenge. Consistent with an inflammatory response, pigs challenged with LPS showed elevated (p < 0.05) IL-6 and TNF-α concentrations, together with increased white blood cell and lymphocyte counts, at 12 h post-challenge. Moreover, significant (p < 0.05) diet × LPS interactions were detected for IL-6 and TNF-α concentrations at 6 h post-challenge, indicating that dietary EHB attenuated the inflammatory response induced by LPS. In summary, a diet formulated with EHB showed a reduced effect of LPS challenge in pigs, making it promising as a functional dietary protein source for improving immune resilience in weaned piglets. Full article

Supportive care is essential during chemotherapy for head and neck cancer, yet the role of traditional Japanese medicine (kampo) remains unclear; therefore, we investigated whether Ninjin’yoeito (NYT) could reduce adverse events during cisplatin-based chemotherapy. We retrospectively analyzed 47 patients treated between June 2022 and June 2024, dividing them into an NYT group and a control group. Hematological toxicities, including decreases in white blood cells, neutrophils, hemoglobin, and platelets, as well as gastrointestinal disorders such as nausea, were evaluated. Compared with controls, patients receiving NYT showed significantly lower incidences of decreased white blood cell counts (p = 0.04), decreased hemoglobin levels (p = 0.03), and gastrointestinal disorders (p = 0.04). Trends toward reduced neutropenia and thrombocytopenia were also observed, although these did not reach statistical significance. These findings suggest that NYT may help mitigate hematological and gastrointestinal toxicities associated with cisplatin-based chemotherapy in patients with head and neck cancer. However, given the retrospective design and limited sample size, prospective studies are needed to confirm the efficacy and safety of NYT in this setting. Full article

Objective: Restless leg syndrome (RLS) has been associated with an increased risk of vascular disorders, which suggests that endothelial dysfunction plays an important role in the pathogenesis of RLS. In this study, we aimed to evaluate coronary endothelial dysfunction in RLS patients using coronary flow velocity reserve (CFVR) and compared it with healthy controls. Methodology: In this study, the participants were divided into two groups as group RLS (n = 42) and group HC (n = 41). The primary outcome was the CFVR compared between groups. The number of participants with a CFVR value below 2.0 was also evaluated. In addition, a correlation between the international restless legs scale (IRLS) and CFVR, white-blood-cell-count (WBC), and C-reactive protein (CRP) was analyzed. Secondary outcomes were the WBC, hemoglobin, CRP, blood glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and creatinine compared between the two groups. Results: In the group RLS, CFVR was measured lower than healthy controls (p < 0.001). When the groups were compared in terms of the number of participants with a CFVR less than 2.0, the difference between the groups was significant (p < 0.001, 0/41 in group HC and 14/42 in group RLS). Patients with RLS had higher WBC and CRP values. There was a negative correlation between CFVR and IRLS (p < 0.001). The relationship between WBC, CRP, and IRLS was not statistically significant (p = 0.691). Conclusions: In this exploratory study, RLS patients had lower CFVR compared with healthy controls and a negative correlation was observed between RLS severity and CFVR. These findings warrant confirmation in larger, prospectively designed studies with multivariable adjustment. Therefore, we think that it may be beneficial to follow-up patients with RLS in terms of coronary heart disease. Clinical trial number: not applicable. Full article

Background/Objectives: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Understanding its epidemiological characteristics is essential for guiding public health strategies. In this study, we characterized the epidemiological profiles that may contribute to the risk of ALL in children in southern Brazil. Methods: Clinical and epidemiological data from 71 children (1–15 years old) admitted and newly diagnosed with ALL at four hospitals in Curitiba, Paraná, Brazil, were retrieved and analyzed. Results: Among the 71 children with ALL, the majority were male (n = 43, 60.6%), with an age range of 1–3 years (n = 26, 36.6%), self-identified as White (n = 47, 66.2%), and were born in Paraná state (n = 61, 85.9%). Nearly half had a family history of cancer (n = 33, 46.5%), primarily among grandparents (n = 36, 61%). Parental environmental exposures included smoking (n = 30, 42.3%) and occupational exposure to chemicals or radiation (n = 17, 23.9%). At diagnosis, most patients (n = 43, 60.5%) had a bone marrow blast count > 70%, and 27 patients (38%) had a peripheral blood blast count > 70%. B-cell ALL was the predominant subtype (n = 61, 85.9%). In B-cell ALL cases, the most frequent molecular subtype was high hyperdiploidy (n = 17, 23.9%). White blood cell counts differed significantly between the B-cell ALL and T-cell ALL groups (p = 0.029). Conclusions: Our findings provide insights into ALL epidemiology in southern Brazil and highlight regional differences across the country. Full article

Background/Objectives: In case of EDTA-induced pseudothrombocytopenia (PTCP), MgSO₄-anticoagulated tubes are recommended for platelet counting, requiring the collection of an additional tube. The aim of this study was to analyze whether complete blood count (CBC) and differential performed on MgSO₄-anticoagulated tubes were comparable to the results obtained on K₃-EDTA samples, and to characterize the stability of the CBC over a 24 h period. Methods: In 355 patients (70 with a confirmed PTCP and 285 without PTCP), we compared CBC results obtained on K₃-EDTA- and MgSO₄-anticoagulated tubes, using DxH800 analyzers. In 33 cases, a differential was available for both anticoagulants, and for 10 patients, samples were re-analyzed 6, 12, and 24 h after the first determination. Results: In the presence or absence of clumps, white blood cell (WBC) count, hematocrit, and mean corpuscular volume (MCV) were slightly lower in MgSO₄ than in K₃-EDTA tubes, whereas mean corpuscular hemoglobin concentration (MCHC) was slightly higher. Mean platelet volume (MPV) was significantly lower on MgSO₄- than on K₃-EDTA-anticoagulated tubes. Values were highly correlated between both anticoagulants, and mean relative biases (MRBs) were below Ricos’s recommendations, except for MCHC and MPV. For differential, neutrophils were significantly lower on MgSO₄- in comparison to K₃-EDTA-anticoagulated tubes (MRB = −2.9%, below Ricos’s optimal bias). The morphology of white blood cells (WBCs) was similar on both anticoagulants. During storage at room temperature, MCV and red cell distribution width increased slightly, but the increase was more pronounced in K₃-EDTA than in MgSO₄ tubes. Conclusions: CBC and differentials obtained with the DxH 800 analyzer on MgSO₄-anticoagulated samples are similar to those obtained with K₃-EDTA, except for MPV. Full article

Liver fibrosis is a severe but common disease without an easy-to-access option for efficient treatment. Mesenchymal stem cells (MSCs) of different origins have been tested for antifibrotic effects in vitro, in vivo, and in clinical studies over the two last decades, although the comparative efficiency of different subtypes remains not fully understood, especially for long-term survival. In this study, we aimed to compare the long-time persistence of favorable effects in male Wistar rats with liver fibrosis treated using MSCs derived from white adipose tissue (AdMSCs) and bone marrow (BMSCs). Liver fibrosis was induced by carbon tetrachloride. We studied the survival rate; oxidative index, assessed via laser Doppler flowmetry; hepatic markers in blood plasma—albumin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase; the ratio of liver to body mass; histological parameters—the number of adipocytes, lymphocytes, siderophages, and Ki67⁺ cells; and the relative areas of connective tissue proper and reticular fibers. Extra mortality was only typical for fibrotic animals subjected to the sham treatment in the first two weeks. Up to Day 270 of this study, both MSC-treated groups showed barely any differences from animals undergoing the sham treatment in terms of the oxidative index and blood markers, although AdMSC-treated rats presented a more favorable histological pattern than BMSC-treated ones, considering the relative area of reticular fibers and the Ki67 cell count. This study suggests that AdMSC treatments may be more appropriate than BMSC treatments in animal liver fibrosis models, with the results showing better potential for liver tissue regeneration 9 months after treatment. Full article

Background and Objectives: Brucellosis remains a significant zoonotic disease in endemic regions such as Saudi Arabia, with children being particularly vulnerable. Pediatric brucellosis often presents with nonspecific symptoms, and hematological abnormalities can serve as important yet underrecognized diagnostic clues. This study aimed to evaluate the demographic, clinical, microbiological, treatment, and hematological characteristics of patients with pediatric brucellosis in the Hail region of Saudi Arabia and to assess the diagnostic value of hematological parameters. Methods: This retrospective observational study included children aged ≤15 years who were diagnosed with brucellosis at a tertiary care hospital in Hail between 2014 and 2025. Demographic, clinical, laboratory, microbiological, and treatment data were analyzed. Hematological parameters were compared between culture-confirmed and non-culture-confirmed brucellosis cases using multivariate and receiver operating characteristic (ROC) analyses. Results: A total of 38 pediatric patients were included (mean age 8.6 years; 57.9% male). Positive culture results were observed in 42.1% of the cases, with Brucella melitensis being the predominant species (68.75%). Fever (89.5%) and bone/joint pain (71.1%) were the most frequent symptoms. Culture-confirmed brucellosis patients had significantly lower hemoglobin levels (10.8 vs. 12.1 g/dL; p = 0.020), white blood cell counts (p = 0.046), and absolute neutrophil counts (p = 0.037). ROC analysis revealed a fair diagnostic performance for hemoglobin (AUROC = 0.695), WBC (0.699), and ANC (0.680). Leukopenia demonstrated high specificity (95.5%) and positive predictive value. Conclusions: Pediatric brucellosis is commonly associated with anemia, leukopenia, and neutropenia. Although no single hematological parameter independently predicts infection, the combination of these abnormalities may support early clinical suspicion, particularly in resource-limited endemic settings. Full article

Objective: Maternal substance use during pregnancy is an increasing public health concern worldwide. However, data on neonatal abstinence syndrome (NAS) remain limited in many regions, including Turkey. This study aimed to evaluate the clinical and laboratory characteristics of neonates exposed to maternal substance use and to assess the association between Finnegan score severity and laboratory findings. Methods: This retrospective study was conducted in a tertiary neonatal intensive care unit. Neonates with prenatal substance exposure were divided into two groups according to their Modified Finnegan scores (<8 and ≥8). Demographic characteristics, clinical outcomes, and laboratory parameters, including acute phase reactants and liver enzymes, were compared between the groups. Maternal substance exposure was mainly determined by maternal self-report, with toxicological confirmation available in only two infants. Results: A total of 25 neonates were included. Higher Finnegan scores were associated with increased white blood cell counts, plateletcrit and liver enzyme levels (AST and ALT), although only the ALT association remained significant after correction for multiple comparisons. Infants placed under state care had longer hospital stays than those discharged to their families (p = 0.02). No mortality was observed. Conclusions: In this small retrospective cohort, greater withdrawal severity was associated with higher aminotransferase levels, particularly ALT, and longer hospitalization was observed among infants placed under state care. These findings should be regarded as preliminary and require confirmation in larger prospective multicenter studies. Full article

Background: The diagnosis of urinary tract infection (UTI) remains a clinical challenge, with urine culture as the gold standard. In developing countries like Bosnia and Herzegovina, a high prevalence of antimicrobial resistance and frequent empirical treatment pose significant clinical challenges. Automated urine flow cytometry has emerged as a rapid tool to optimize diagnostic processes. Objectives: To determine the correlation of age, gender, and laboratory parameters—such as white blood cell (WBC) count, neutrophil count, and C-reactive protein (CRP)—with both urinary bacterial counts and urine culture results. Methods: This retrospective study analyzed 200 adult patients (≥18 years) with symptoms suggestive of UTI at the University Clinical Center Tuzla. Data on age, gender, WBC, neutrophils, CRP, and urine flow cytometry (Sysmex UF-4000) were collected. Statistical analysis was performed using R software (version 4.5.1), utilizing logistic regression models via the ‘glm’ function to identify independent predictors, with statistical significance set at p < 0.05. Results: The mean age of the population was 68.61 ± 15.19 years. Logistic regression demonstrated that WBC count (OR = 1.06, p = 0.004), neutrophil count (OR = 1.04, p = 0.014), and patient age (OR = 1.03, p = 0.001) were significant independent predictors of UTI. Furthermore, patients with a urinary bacterial count > 1200/μL had 83 times higher odds of a positive urine culture (OR = 83, 95% CI 32.25–200, p < 0.001). Conversely, CRP levels and gender were not significant predictors (p > 0.05). Conclusions: Patient age, WBC, and neutrophil counts are key factors for predicting UTIs. Integrating these parameters with urine flow cytometry bacterial counts can significantly enhance diagnostic accuracy and rapid screening in clinical practice. Full article

Background/Objectives: The Duffy (Fy) blood group system, encoded by the ACKR1 gene, plays a key role in transfusion medicine and host susceptibility to malarial infections such as Plasmodium vivax. The Duffy-null phenotype [Fy(a−b−)] is associated with lower baseline white blood cell (WBC) and absolute neutrophil count (ANC) values despite a benign clinical course. This study aimed to establish specific reference intervals for WBC and ANC in Duffy-null individuals to improve diagnostic accuracy and reduce unnecessary clinical interventions. Methods: We conducted a retrospective analysis of 1695 adult patients who underwent complete blood count testing and red blood cell phenotyping between 1 January 2020 and 1 January 2026. Among these, 122 healthy individuals with confirmed Fy(a−b−) phenotype met inclusion criteria. Reference intervals were established using 95% reference interval nonparametric methods in accordance with Clinical Laboratory Standards Institute (CLSI) guidelines. Results: The median WBC and ANC values in the Duffy-null cohort were significantly lower than institutional reference medians (3.24 vs. 6.65 × 10³/µL and 1.45 vs. 4.45 × 10³/µL, respectively; p < 0.01). The derived 95% reference intervals (WBC: 2.43–7.05 × 10³/µL; ANC: 1.01–4.34 × 10³/µL) fell below conventional thresholds, with the lower ANC bound below the standard neutropenia cutoff. Conclusions: These findings support the need for Duffy-null-specific hematologic reference ranges. Adoption of such intervals may reduce misclassification, avoid unnecessary diagnostic procedures, and promote personalized clinical care. Full article

Endothelial dysfunction is an early step in atherogenesis, and adhesion molecules such as E-selectin may serve as biomarkers or therapeutic targets. This study aimed to evaluate the relationship between E-selectin and inflammatory, nutritional, and mineral–bone metabolism markers in hemodialysis (HD) patients, as well as its association with endothelial function assessed by flow-mediated dilation (FMD). We conducted a cross-sectional study including 68 HD patients (mean age 59.7 ± 12.5 years). Clinical and laboratory parameters were assessed, including inflammatory, nutritional, and mineral–bone disorder markers. Associations with E-selectin were analyzed using bivariate and multivariable models. Endothelial function was evaluated using FMD. In multivariable analysis, alkaline phosphatase (ALP) (p = 0.002), intact parathyroid hormone (iPTH) (p = 0.001), white blood cell count (WBC) (p = 0.015), and soluble CD163 (sCD163) (p = 0.042) were independently associated with E-selectin. In the subgroup with high hs-CRP values, a significant increase was observed in both E-selectin levels and adiposity tissue markers (adipose tissue mass and waist circumference). In younger patients with inflammation, E-selectin was inversely correlated with FMD (ρ = −0.64, p = 0.008). In conclusion, E-selectin was associated with markers of inflammation, mineral–bone disorder, and endothelial dysfunction in hemodialysis (HD) patients. Novel associations of E-Selectin with sCD163 and ALP were identified. Full article

Background: Hematological parameters derived from complete blood count (CBC) are inexpensive and widely available markers with potential utility in risk stratification of acute coronary syndrome (ACS). However, their incremental prognostic value when used alongside contemporary risk stratification tools such as the Troponin-only Manchester Acute Coronary Syndrome (T-MACS) score remains unclear. Methods: In this prospective, single-center cohort study, 521 patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina were enrolled. Admission CBC parameters (white blood cell count, neutrophils, monocytes, red cell distribution width, mean platelet volume) and derived inflammatory indices (neutrophil-to-lymphocyte ratio, white blood cell-to-mean platelet volume ratio, lymphocyte-to-monocyte ratio, mean platelet volume-to-platelet ratio, and red cell distribution width-to-platelet ratio) were recorded. T-MACS risk scores were calculated, and patients were followed for 30-day major adverse cardiac events (MACE), mortality, and coronary interventions. Associations were assessed using univariate and multivariate logistic regression analyses. Results: Patients experiencing 30-day MACE or mortality had significantly higher white blood cell counts, neutrophil counts, and WMR values (all p < 0.05). Several hematological indices showed significant associations with T-MACS risk categories. In multivariate analysis, intermediate- and high-risk T-MACS classifications independently predicted 30-day MACE (OR 4.49, 95% CI:1.46–13.77, p = 0.009; OR 9.34, 95% CI:3.00–29.03, p < 0.001, respectively), whereas white blood cell count, neutrophil count, and WMR did not demonstrate independent prognostic value beyond T-MACS classification. Conclusions: Admission white blood cell count, neutrophil count, and WMR are associated with short-term adverse outcomes and T-MACS risk severity in patients with NSTE-ACS. However, these markers do not provide additional prognostic value beyond T-MACS classification. These findings suggest that CBC-derived inflammatory markers primarily reflect disease severity rather than incremental prognostic information in the contemporary high-sensitivity troponin era. Full article

Background: Acute respiratory distress syndrome (ARDS) remains one of the most serious causes of respiratory failure and mortality in critically ill patients. Although the Berlin Definition provides a standardized framework for diagnosis, it offers limited predictive value for clinical outcomes. In this context, there is growing interest in the use of routinely available hematological markers as practical tools for early risk stratification. This study aimed to examine the association between hematological parameters and mortality in patients with ARDS, with particular emphasis on complete blood count-derived inflammatory indices. Methods: This multicenter retrospective cohort study included 404 adult patients with a confirmed diagnosis of ARDS who were admitted to intensive care units in Saudi Arabia. Demographic, clinical, and laboratory data were collected from electronic medical records. In addition to standard hematological parameters, the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and hemoglobin–albumin–lymphocyte–platelet (HALP) score were calculated from admission laboratory findings. Comparisons between survivors and non-survivors were performed using non-parametric statistical tests, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the prognostic performance of these indices for in-hospital mortality. Results: Of the 404 included patients, 295 survived, and 109 died during hospitalization. Non-survivors demonstrated significantly higher white blood cell and neutrophil counts, alongside significantly lower lymphocyte, eosinophil, hemoglobin, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and albumin levels. The derived inflammatory indices further demonstrated clear differences between outcome groups, as NLR and SII were significantly higher in non-survivors, whereas HALP scores were significantly lower. In ROC analysis, NLR showed the strongest discriminatory ability for mortality (AUC = 0.80, 95% CI 0.74–0.85), followed by SII (AUC = 0.76, 95% CI 0.71–0.81) and HALP (AUC = 0.76, 95% CI 0.70–0.81). The optimal cutoff values were 4.26 for NLR, 958 for SII, and 2.15 for HALP. No significant correlations were identified between age and any of the three indices. Upon applying multivariable regression analysis, only NLR maintained its prognostic ability for ARDS-related mortality. Conclusions: Routine hematological parameters, together with derived inflammatory and nutritional indices, were significantly associated with mortality in patients with ARDS. Among the evaluated markers, NLR demonstrated the strongest prognostic performance, both in univariate and multivariate analysis, followed by SII and HALP. As these indices are derived from inexpensive, readily available laboratory tests, they may offer practical value for early risk stratification and clinical decision-making, particularly in resource-limited settings. Full article