Search Results (690)

Background: Wrong blood in tube (WBIT) is a critical pre-analytical error in laboratory medicine in which a blood sample is mislabeled with the wrong patient identity. These errors are often undetected due to the limitations of current detection strategies (e.g., delta checks). Methods: We evaluated Random Forest models for WBIT detection and conducted a detailed analyte importance analysis. In total, 799,721 samples from a German tertiary care center were analyzed and filtered for applicability. Model input features were derived by pairing consecutive same-patient samples for non-WBIT cases, simulating WBIT by pairing samples from different patients, and computing per-analyte first-order differences for each pair. We exhaustively searched all subsets of nine CBC analytes and evaluated models using F1 score, AUC, sensitivity, and PPV. Analyte importance was assessed via SHAP, permutation, and impurity decrease. Results: Models using as few as three analytes (MCV, RDW, MCH) reached F1 scores above 90%, with performance plateauing beyond six analytes. MCV and RDW were consistently top-ranked. Two-dimensional and three-dimensional visualizations revealed interpretable decision boundaries. Conclusions: Findings demonstrate that robust WBIT detection is achievable using a minimal subset of CBC analytes, offering a practical, interpretable, and broadly generalizable ML-based solution suitable for diverse clinical environments. Full article

Background/Objectives: Alcohol-associated hepatitis (AH) is an acute inflammatory condition of alcohol-associated liver disease (ALD) with rapid progression and high mortality. The Age-Bilirubin-INR-Creatinine (ABIC) score is a static algorithm that predicts survivability in AH. The roles of alcohol drinking patterns and nutritional status in AH progression and risk of death are understudied. This study evaluates the impact of alcohol drinking patterns and nutrition on AH progression and mortality. Methods: Sixty-one adult patients diagnosed with AH were stratified by the Model for End-Stage Liver Disease (MELD) as non-severe (MELD < 20, n = 26, Gr.1) and severe (MELD ≥ 20, n = 35, Gr.2). Each group was further subdivided by ABIC: low- (<6.71), intermediate- (6.71–9), and high- (>9) risk categories. We assessed different demographics: nutrition using the Controlling Nutritional Status (CONUT) score; lifetime drinking history (LTDH); recent alcohol use (AUDIT); laboratory measures (complete metabolic panel, complete blood count, and coagulation), and clinical measures (Maddrey DF, Child–Turcotte–Pugh, and Lille). Results: All patients showed a significant and positive correlation between ABIC and LTDH (r = 0.538, p = 0.004), particularly in Gr.2 (r = 0.554, p = 0.011). The low-risk Gr.2 exhibited the highest AST:ALTs. AST:ALTs were significantly associated with LTDH, AUDIT, and CONUT (R² = 0.539, p = 0.031). In all AH patients with intermediate mortality risk, AST:ALTs were strongly linked to CONUT and LTDH (R² = 0.657, p = 0.017). Conclusions: Severe AH demonstrates rapid liver injury progression even when the mortality risk is low. Chronic and recent heavy alcohol consumption and poor nutrition adversely impact AH severity and mortality risk. Alcohol intake and nutritional assessments in routine clinicals could identify high-risk patients, thereby improving treatment and a favorable prognosis. Full article

Background: Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. Despite advances in diagnosis and treatment, recurrence and mortality remain significant concerns. The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, has shown prognostic value in several malignancies, but its utility in EC remains underexplored. Objective: To evaluate the prognostic significance of the preoperative NLR in patients with endometrial cancer undergoing primary surgical treatment. Methods: We conducted a retrospective cohort study including 398 patients with histologically confirmed endometrial adenocarcinoma surgically treated at a tertiary cancer center. Preoperative complete blood counts were used to calculate NLR, and a cutoff value of 2.27 was determined through Receiver Operating Characteristic (ROC) analysis. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards modeling. Results: Patients with NLR ≥ 2.27 had significantly reduced median overall survival (OS) compared to those with NLR < 2.27 (72.3 vs. 92.8 months, p = 0.008). In multivariate analysis, elevated NLR remained an independent predictor of poorer OS (HR = 1.87; 95% CI: 1.156–3.017; p = 0.011), alongside age ≥ 64 years, lymphovascular space invasion (LVSI), lymph node involvement, and distant metastases. ROC analysis yielded an Area Under the Curve (AUC) of 0.646 for NLR. Notably, vaginal brachytherapy was associated with improved survival (HR = 0.53; p = 0.026), while other adjuvant therapies were not independently significant. Conclusions: Preoperative NLR is an accessible, independent prognostic biomarker in endometrial cancer and may serve as a surrogate indicator of tumor-promoting inflammation and immune dysregulation. Its integration into preoperative assessment could enhance risk stratification and guide personalized treatment strategies. However, findings should be interpreted in light of the study’s retrospective design, single-center setting, and lack of molecular classification data. Prospective validation is warranted to confirm its clinical utility. Full article

Background: Placenta accreta spectrum (PAS) is a serious pregnancy complication associated with significant hemorrhaging and elevated maternal morbidity. Timely prenatal diagnosis is critical for reducing the risk of adverse outcomes. In this study, we aimed to investigate the association between PAS and first-trimester maternal serum screening markers, as well as selected hematological and inflammatory indices, in pregnancies complicated by placenta previa (PP). Methods: A retrospective study was conducted at a tertiary care center. Pregnant women with singleton pregnancies who had been diagnosed with PP and undergone first-trimester aneuploidy screening and delivered at the same institution were included. The participants were divided into two groups: those diagnosed with PAS (including placenta accreta, increta, and percreta) and those with PP without placental invasion. Data on maternal demographics, the first-trimester serum levels of pregnancy-associated plasma protein-A (PAPP-A), and free β-human chorionic gonadotropin (β-hCG), as well as pre-delivery complete blood count parameters, were collected. Associations between these markers and abnormal placental implantation were analyzed. Results: In total, 181 participants were included in this study, corresponding to 15 cases of PAS and 166 cases of non-invasive PP. The women in the PAS group were significantly younger than those in the non-invasive-PP group (25.3 ± 5.1 vs. 30.0 ± 6.3 years, p < 0.001). The serum levels of PAPP-A and free β-hCG were significantly higher in the PAS cases (p < 0.05). The mean platelet volume (MPV) was significantly lower inF the PAS group (p < 0.05). We did not observe any significant differences in other hematological parameters, including hemoglobin concentration, white blood cell count, neutrophil and lymphocyte counts, platelet count, red cell distribution width, and inflammatory ratios such as the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Conclusions: Elevated first-trimester levels of PAPP-A and β-hCG, along with a reduced MPV, may serve as early indicators of PAS in pregnancies complicated by PP. These biomarkers may assist in early risk stratification and help inform perinatal management strategies. Full article

Background/Objectives: This study examined the effects of 2 weeks of betaine versus placebo supplementation (3 g/d) on 60 km cycling performance, gut permeability, and shifts in plasma metabolites. Methods: Participants included 21 male and female non-elite cyclists. A randomized, placebo-controlled, double-blind, crossover design was used with two 2-week supplementation periods and a 2-week washout period. Supplementation periods were followed by a 60 km cycling time trial. Six blood samples were collected before and after supplementation (overnight fasted state), and at 0 h, 1.5 h, 3 h, and 24 h post-exercise. Five-hour urine samples were collected pre-supplementation and post-60 km cycling after ingesting a sugar solution containing lactulose 5 g, ¹³C mannitol 100 mg, and ¹²C mannitol 1.9 g in 450 mL water. Other outcome measures included plasma intestinal fatty acid binding protein-1 (I-FABP), muscle damage biomarkers (serum creatine kinase, myoglobin), serum cortisol, complete blood cell counts, and shifts in plasma metabolites using untargeted metabolomics. Results: The time to complete the 60 km cycling bout differed significantly between the betaine and placebo trials (mean ± SE, 112.8 ± 2.3, 114.2 ± 2.6 min, respectively, (−1.41 ± 0.7 min) (effect size = 0.475, p = 0.042). No trial differences were found for I-FABP (interaction effect, p = 0.076), L:¹³CM (p = 0.559), the neutrophil/lymphocyte ratio (p = 0.171), serum cortisol (p = 0.982), serum myoglobin (p = 0.942), or serum creatine kinase (p = 0.694). Untargeted metabolomics showed that 214 metabolites exhibited significant trial treatment effects and 130 significant trial x time interaction effects. Betaine versus placebo supplementation was linked to significant increases in plasma betaine, dimethylglycine (DMG), sarcosine, methionine, S-adenosylhomocysteine (SAH), alpha-ketoglutaramate, and 5′methylthioadensone (MTA), and decreases in plasma carnitine and numerous acylcarnitines. Conclusions: Betaine supplementation modestly improved 60 km cycling performance but had no effect on gut permeability. The metabolomics data supported a strong influence of 2-week intake of betaine on the one-carbon metabolism pathway during the 24 h recovery period. Full article

Background and Objectives: Systemic inflammatory markers from an ordinary complete blood count (CBC) may foreshadow where non-small-cell lung cancer (NSCLC) will first spread, but organ-specific signatures remain poorly defined. Materials and Methods: We retrospectively reviewed 302 adults (mean age 60.7 ± 13.4 years; 80.8% men) with stage IV NSCLC managed at OncoHelp Medical Center, Timișoara, between January 2022 and December 2024. Eligibility demanded a single radiologically confirmed distant site at diagnosis and pre-treatment CBC. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-monocyte (LMR) ratios were compared across pleural (n = 52), bone (n = 86), liver (n = 66), and brain (n = 98) metastases using Kruskal–Wallis tests with Bonferroni adjustment; z-standardized logistic models identified independent predictors. Results: Metastases clustered most often in brain (32.5%), followed by bone (28.5%), liver (21.9%), and pleura (17.2%). Median PLR rose selectively in pleural disease (274 vs. 217–253 in other sites; p = 0.006). LMR fell to 2.0 in bone but climbed to 2.8 in brain lesions (p = 0.032 and 0.008, respectively). NLR was globally elevated (6.7–7.6), yet differed significantly only for bone and liver deposits. Logistic modeling showed that each standard-deviation rise in absolute neutrophil count quadrupled the odds of hepatic involvement (Odd Ratio (OR) 4.26; 99% Confidence inerval (CI) 2.20–6.25), monocytosis nearly doubled bone risk (OR 1.83; 1.01–3.33), while higher erythrocytes, eosinophils, and lymphocytes independently protected against pleural seeding (all p < 0.01). Age-stratified analysis revealed that osseous and cerebral metastases predominated in patients ≤ 50 years, whereas inflammatory indices were age-invariant. Conclusions: Routine CBC ratios encode distinct “inflammatory fingerprints” that mirror the first metastatic destination in NSCLC: platelets herald pleural spread, neutrophils favor liver and bone, and divergent lymphocyte–monocyte balances separate bone from brain. Although no substitute for cross-sectional imaging, these low-cost markers could refine clinical suspicion, guide targeted work-up, and illuminate the biology of organ-selective dissemination, particularly in resource-limited settings. Full article

Background/Objectives: This study aimed to determine the occurrence of vitamin D and iron deficiency in children with autism spectrum disorder (ASD) in Singapore and identify correlates of the presence of these deficiencies, if any. Methods: This is an observational, cross-sectional, retrospective review of children with a diagnosis of autism, aged 1 to 10 years old, seen at a tertiary developmental paediatric centre from January 2018 to December 2022, with blood investigations completed. Autism diagnosis was determined either clinically by a developmental paediatrician using DSM-5 criteria or using the Autism Diagnostic Observation Schedule (ADOS-2). Children with genetic disorders and chronic medical conditions were excluded. Logistic regression was used to evaluate associations with the deficiencies, and the Bonferroni method was applied on post hoc comparisons. Results: The overall sample comprised 241 children (79% males, mean age 4.2 years [SD 2.25]. There were 222 and 236 children who had blood investigations for vitamin D and iron levels performed, respectively. Out of the 222 children whose vitamin D tests were performed, 36.5% had vitamin D insufficiency/deficiency. Iron deficiency occurred in 37.7% for children who had their iron levels tested. There were 122 observations for both iron levels and complete blood count. Out of these, 19 (15.6%) had iron deficiency anaemia. There were no significant correlates for iron deficiency, with picky eating included. Conclusions: Vitamin D and iron deficiencies were common in this sample. Clinicians should consider testing for vitamin D and iron for children with ASD, especially for vitamin D in children of Indian ethnicity and older age. Full article

Background/Objectives: This study was designed to investigate the relationship between peripheral hematological inflammation markers, namely, neutrophil/lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune inflammation index (SII), and systemic inflammatory response index (SIRI) and high-grade cervical lesions (CIN2+). Methods: A retrospective cohort analysis was conducted on 358 patients who underwent cervical excision procedures. Patients were divided into two groups: <CIN2 and CIN2+. Preoperative complete blood count data were used to calculate the inflammation indices. HPV genotypes were also recorded. Logistic regression and ROC analyses were performed to evaluate the predictive performance. Results: CIN2+ lesions were detected in 69.6% of participants. In the univariate analysis, only age and HPV 16 positivity (p < 0.005) showed a significant association with the presence of CIN2+. NLR, PLR, MLR, SII, and SIRI values did not show significant differences between groups (all p > 0.05). In the multivariate analysis, increasing age was independently associated with a decrease in the risk of CIN2+ (OR = 0.96, 95% CI: 0.94–0.99), while HPV 16 positivity was associated with an increase in risk (OR = 2.44, 95% CI: 1.43–4.18). ROC analysis showed that combining age and HPV 16 status improved the specificity (85.1%) of predicting CIN2+ compared to using age alone (42.2%). Conclusions: Peripheral haematological inflammation markers (NLR, PLR, MLR, SII, and SIRI) did not show predictive value in predicting CIN2+ lesions. However, age and HPV 16 infection were found to be independent predictors. These findings suggest that haematological indices may reflect systemic inflammatory responses but are not sufficient on their own for the detection of CIN2+. HPV genotyping is of critical importance for the early detection of high-grade lesions. Full article

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, spread rapidly across the globe in 2020, with most countries experiencing two distinct waves of infection. In Brazil, the second wave was marked by the emergence of the P.1 (Gamma) variant, which disproportionately affected younger individuals and was associated with increased mortality. This study aimed to evaluate the epidemiological profile and post mortem histopathological lung findings, correlate them with laboratory results, and compare the first and second waves of COVID-19. To investigate neutrophil extracellular traps (NETs), we performed immunohistochemistry for citrullinated histone H3 (cit-H3) and myeloperoxidase (MPO). Our cohort included patients who died in the intensive care unit (ICU) of a single center in southern Brazil. The study included 42 patients, 24 from the first wave and 18 from the second, who died between March 2020 and August 2021. Laboratory data included complete blood counts and D-dimer levels. Histopathological analyses were conducted using H&E-stained slides and reviewed independently by two blinded pathologists. MPO and cit-H3 immunohistochemistry were performed to evaluate NETs markers. All cases exhibited varying degrees of inflammation and diffuse alveolar damage (DAD), with frequent microvascular thrombi. Neutrophilic infiltration was significantly higher in the second wave. Additionally, cases with intense neutrophilic infiltration showed a stronger association with thrombosis. NETs were identified in 10 cases. No significant correlation was found between histopathological findings, NETs, and laboratory blood count results. The histopathological findings were consistent with those reported globally. The second wave of COVID-19 showed higher neutrophilic infiltrate in the lung tissue. Neutrophils play a key role in the inflammatory response and NET formation might indicate an increased risk of mortality. Further studies can consider NET-targeted therapies as potential strategies. Full article

Background/Objectives: Chronic low-grade inflammation drives cardiometabolic risk; functional SNPs may influence individual cytokine and hematologic phenotypes. We investigated genotype-specific relationships between circulating immuno-inflammatory biomarkers and routine blood indices in apparently healthy adults. Methods: In this cross-sectional study, 155 fasting volunteers (26–72 years) were genotyped for IL1RN rs1149222 and TNF-proximal rs2071645. Serum IL-1β, TNF-α, oxidized LDL (oxLDL) and C-reactive protein (CRP) were quantified by ELISA, and complete blood counts were recorded simultaneously. Genotype effects were tested with ANOVA/Kruskal–Wallis; Spearman correlations and age-, sex-, BMI-adjusted linear models explored genotype-stratified associations. Results: Among 155 adults, IL1RN rs1149222 significantly affected IL-1β (TT > TG ≈ GG; ANOVA p = 0.042) and oxLDL (overall p = 0.036), with the clearest difference between heterozygotes and major-allele homozygotes. The same variant produced a modest fall in erythrocyte count and hemoglobin restricted to heterozygotes (RBC p = 0.036; Hb p = 0.041). TNF-proximal rs2071645 strongly raised TNF-α (GG > GA > AA; p < 0.0001) and led to a moderate oxLDL increase, driven by GA versus AA carriers (pairwise p = 0.013), while leaving red-cell indices and CRP unchanged. Baseline leukocyte counts, differentials and derived ratios showed no genotype dependence, and multivariable models revealed no epistatic interaction between the two loci. Conclusions: IL1RN rs1149222 and TNF-related rs2071645 generate two independent inflammatory signatures—an IL-1β-oxidative axis linked to mild erythropoietic suppression and a TNF-lipid axis without hematologic shift. Integrating targeted genotyping with inexpensive hematologic ratios may refine early risk stratification and guide tailored preventive strategies in ostensibly healthy populations. Full article

A new human pathogen triggering a pandemic can impact health directly through disease resulting from infection and indirectly through health system disruption. The COVID-19 pandemic is hypothesised to have impacted pathology testing by impacting healthcare and pathology operations and reducing healthcare attendance for fear of infection. The impacts of COVID-19 incidence and pandemic control measures on non-COVID pathology testing were assessed in four Australian states/territories using pathology data (histology, prostate-specific antigen, gynaecological cytology, complete blood count, haemoglobin A1c, and human immunodeficiency virus) from a large national private pathology provider (January 2019–December 2024). Weekly testing volumes from lockdown periods were compared to the equivalent weeks in 2019. All pathology tests demonstrated a substantial decline during the initial national lockdown in March 2020. Subsequent lockdowns were also associated with disruption. For example, complete blood count testing in Victoria was −22% in March 2020 and −5% in the second wave that year. Total annual testing volumes were lower for all tests in 2020 compared to 2019, excluding haemoglobin A1c, and reduced testing persisted through to 2024. The findings indicate substantial and sustained negative pandemic impacts on pathology testing. Reductions in pathology testing signal heightened risk of delayed disease diagnosis, disrupted chronic disease management, and poorer health outcomes. Full article

Background/Objectives: Increased blood pressure variability (BPV) was found in adults with primary (essential) hypertension (PH) and is associated with increased cardiovascular risk. Our study aimed to analyze the relation between BPV and low-grade inflammation in children with primary hypertension. Methods: In 56 treatment-naive pediatric patients with PH (15.1 ± 2.1 years) and 30 healthy children (14.9 ± 1.4 years), we evaluated BPV: BP dipping, standard deviation (SD) of ambulatory blood pressure measurements (ABPMs), pulse pressure (PP)/systolic blood pressure ratio (24 h PP/SBP), rate–pressure index (24 h RPI), 24-h weighted BPV (24 h WSBPV, 24 h WDBV, 24 h WMAPV), coefficient of variation (24 h CoVSBP, 24 h CoVDBP, 24 h CoVMAP), ambulatory arterial stiffness index (AASI), and morning BP surge. We also analyzed indices of subclinical inflammation (markers derived from complete blood count, high-sensitivity C-reactive protein (CRP), interleukin 18), and office and ambulatory BP. Results: Patients with PH had significantly higher hsCRP, neutrophils, monocytes, and platelets, neutrophil-to-lymphocyte (NLR), platelet-to-mean platelet volume (PMPVR), and lower monocyte-to-neutrophil (MNR) ratios, and higher BPV: 24 h ABPM SBP SD, 24 h ABPM MAP SD, 24 h RPI, 24 h WSBPV, 24 h WDBV, 24 h WMAPV, and 24 h CoVSBP. Low-grade inflammation markers correlated with BPV indices in both groups. In multivariate analysis, MNR predicted 24 h ABPM MAP SD (beta = 0.290, 95CI: 0.029–0.551), 24 h RPI (beta = −0.348, 95CI: −0.587–−0.108), and 24 h WDBPV (beta = 0.286, 95CI: 0.032–0.540); monocyte count—24 h RPI (beta = 0.281, 95CI: 0.041–0.521), and hsCRP—24 h WDBV (beta = 0.310, 95CI: 0.055–0.564). ROC analysis revealed a good diagnostic profile for lymphocyte count as a positive determinant of non-dipping status in PH children (cut-off point 2.59 [×10³/µL]). Conclusions: BPV is higher in children with PH compared to healthy peers and is associated with low-grade inflammation. MNR may be the most helpful indicator of BPV, whereas high lymphocyte count predicts the best non-dipping status in these patients. Full article

Lasia spinosa Thwaites (LST) has emerged as a potential supplement for enhancing male reproductive performance. This study evaluated the effects of long-term oral supplementation with LST on hematological parameters, semen characteristics, ultrasonographic measurements of the prostate gland and testes, and the cryopreservation potential of canine sperm. Six healthy male dogs received oral LST supplementation at a dosage of 10 mg/kg body weight once daily for 7 days (short-term). After a three-month washout period to ensure full physiological recovery, the same dogs underwent a long-term supplementation protocol (60 days). In the short-term trial, no clinically significant changes were observed in hematological or serum biochemical parameters, including complete blood count, alanine aminotransferase, creatinine, blood urea nitrogen, total protein, and albumin; all parameters were within normal reference ranges. Serum testosterone levels and semen characteristics were also unaffected (p > 0.05). During the long-term treatment, blood profiles and testosterone levels remained stable. Although prostatic and testicular volumes increased slightly, the changes were not statistically significant (p > 0.05). A significant increase in semen volume was observed (p < 0.05), while other semen parameters showed no significant differences. Notably, post-thaw sperm motility significantly improved at both 15 min and 4 h after thawing, and sperm viability was significantly enhanced at 4 h post-thaw (p < 0.05), suggesting a potential protective effect of LST during cryopreservation. These findings indicate that LST supplementation is physiologically safe and may improve canine sperm quality during freezing and thawing, supporting its potential application in reproductive health management. Full article

STAT3 mutations are commonly observed in human pathology yet have no uniform patient presentation. Their effects range from cancer and autoimmunity to primary immunodeficiencies and bone deformity. Designing animal models of those mutations can help researchers identify their direct effects to better inform the clinical setting. In this manuscript, we report a mouse model harboring the same mutation as an autosomal-dominant hyper-IgE syndrome (AD-HIES) patient reported in the literature. Surprisingly, while the deletion of five amino acids in the SH2 domain of STAT3 did result in frequency changes in several immune populations as measured by complete blood count and flow cytometry analysis, it did not yield the expected phenotype of AD-HIES, with no increase in serum IgE or eosinophil count. We additionally provide structural analysis of the STAT3^G656_M660del deletion, visualizing changes in protein architecture and potential effects on the neighboring Y705 phosphorylation site. Our model showcases the sexually dimorphic immune dysregulation caused by a STAT3 mutation and highlights that predicted gain- and loss-of-function mutations can yield unexpected phenotypes. Full article

Background: Biological aging influences cancer outcomes, but its changes during chemotherapy and impact on chemotoxicity in colorectal cancer (CRC) remain underinvestigated. We examined (1) trajectories of biological aging (using Levine Phenotypic Age) during six months of chemotherapy, (2) sociodemographic and clinical risk factors for biological aging, and (3) links between biological aging and chemotoxicity. Methods: Using data from electronic health records (2013–2019) from 1129 adult CRC patients, we computed biological aging (raw Levine Phenotypic Age and its age acceleration [Levine Phenotypic Age–chronological age]) from routine blood tests (e.g., complete blood counts, hepatorenal/inflammatory markers). Chemotoxicity was identified primarily via International Classification of Diseases (ICD-9 and -10) codes. Results: Chemotherapy accelerated biological aging over time. Biological aging at baseline and changes over time predicted chemotoxicity. However, changes in biological aging over time showed stronger associations than baseline biological aging. Advanced cancer stages, higher comorbidity burden, and socioeconomic disadvantage (especially area-level deprivation) were associated with accelerated biological aging at baseline and over time. Biological aging occurred across both young and older adults. Conclusions: Levine Phenotypic Age, computed from routine blood tests in EHRs, offers a feasible clinical tool for aging-related chemotoxicity risk stratification. Validation in diverse cohorts and the development of predictive models are needed. Full article