Search Results (1,399)

Radiation is widely used in cancer therapy but also damages healthy tissues through oxidative stress or inflammation. In addition to cancer patients, many professionals are occupationally exposed to ionizing radiation (IR). Natural compounds, particularly polyphenols, have been increasingly investigated as potential radioprotective agents to minimize side effects in both patients and occupationally exposed individuals. This study evaluated the radioprotective effects of a polyphenol-rich extract blend derived from chokeberry, elderberry, blackcurrant, and evening primrose in female Balb/c mice exposed to acute IR. The animals were pre-treated with the blend (100 mg/kg) for 7 days prior to whole-body IR at 6 Gy. Hematological parameters, immune cell viability, TNF-α level, gene expression, lipid peroxidation, and tissue morphology were assessed by hematology analysis, flow cytometry, ELISA, qRT-PCR, MDA assay, and histology. IR significantly reduced leukocyte (3.22-fold; p < 0.0001) and platelet counts (1.37-fold; p < 0.0001), increased TNF-α levels (53.93%; p < 0.0001), and elevated oxidative stress. Pre-treatment with the blend restored hematological parameters, reduced pro-inflammatory cytokines, and normalized genes regulating oxidative stress and apoptosis. Histology confirmed preserved liver and kidney structures compared with irradiated controls. These findings highlight the polyphenol-rich extract blend as a promising natural radioprotective agent by modulating immune responses, reducing oxidative stress, and preserving tissue integrity. Full article

Platelets play a pivotal role in coagulation, traditionally recognized for their involvement in thrombin generation via the prothrombinase complex and for regulating thrombopoietin (TPO) synthesis through platelet-mediated TPO uptake. However, recent studies suggest that TPO homeostasis involves more dynamic, feedback-driven mechanisms, though these interactions remain incompletely described and experimentally confirmed. The interplay between platelet activating factor (PAF) secretion, fibrinolysis, interleukin-6 (IL-6) signalling, hepatic TPO synthesis, as well as the complexity of platelet subpopulations, emphasises platelets’ multifaceted role in haemostasis and haematopoiesis. Our article investigates novel pathways by which fibrinogen degradation products (FgDPs) influence plasminogen and TPO synthesis, focusing on the interconnection between procoagulant platelets, platelet-derived messengers, and fibrinolytic processes. In this work several intermediary mechanisms are hypothesised, including the FgDP-IL-6-plasminogen pathway, the PAF-IL-6-TPO pathway, and the thrombin-FgDP-IL-6-TPO pathway, which may link FgDP and plasminogen biosynthesis with platelet activation, cytokine release, and thrombopoiesis regulation. The proposed mechanisms involve secretion of PAF by procoagulant platelets, inducing IL-6 synthesis in endothelial cells, fibroblasts, and vascular smooth muscle cells. Subsequently, IL-6 stimulates hepatocyte-driven TPO production, potentially serving as a feedback mechanism to restore platelet counts following coagulation. Furthermore, fibrinolysis-generated FgDPs may further enhance IL-6 release, implying alternative routes for TPO regulation. Our hypotheses challenge the prevailing view that platelet numbers alone dictate TPO homeostasis. Therefore, we propose that inflammatory and fibrinolytic signals actively regulate TPO homeostasis, challenging the platelet-count-centric paradigm. These insights provide a new perspective on haematopoiesis and suggest novel therapeutic targets for thrombocytopenia and coagulation disorders, highlighting the need for further experimental validation. Full article

COVID-19 remains a global health challenge, with severe cases often leading to complications and fatalities. The objective of this study was to assess supervised machine learning algorithms for predicting severe COVID-19 based on demographic, clinical, biochemical, and genetic variables, with the aim of identifying the most informative prognostic markers. For Machine Learning (ML) analysis, we utilized a dataset comprising 226 observations with 68 clinical, biochemical, and genetic features collected from 226 patients with confirmed COVID-19 (54—moderate, 142—severe and 30 with mild disease). The target variable was disease severity (mild, moderate, severe). The feature set included demographic variables (age, sex), genetic markers (single-nucleotide polymorphisms (SNPs) in FGB (rs1800790), NOS3 (rs2070744), and TMPRSS2 (rs12329760)), biochemical indicators (IL-6, endothelin-1, D-dimer, fibrinogen, among others), and clinical parameters (blood pressure, body mass index, comorbidities). The target variable was disease severity. To identify the most effective predictive models for COVID-19 severity, we systematically evaluated multiple supervised learning algorithms, including logistic regression, k-nearest neighbors, decision trees, random forest, gradient boosting, bagging, naïve Bayes, and support vector machines. Model performance was assessed using accuracy and the area under the receiver operating characteristic curve (AUC-ROC). Among the predictors, IL-6, presence of depression/pneumonia, LDL cholesterol, AST, platelet count, lymphocyte count, and ALT showed the strongest correlations with severity. The highest predictive accuracy, with negligible error rates, was achieved by ensemble-based models such as ExtraTreesClassifier, HistGradientBoostingClassifier, BaggingClassifier, and GradientBoostingClassifier. Notably, decision tree models demonstrated high classification precision at terminal nodes, many of which yielded a 100% probability for a specific severity class. Full article

Platelet-rich plasma (PRP) has gained attention in regenerative medicine due to its bio-active proteins with tissue-healing potential. However, heterogeneity in PRP composition remains a major challenge for reproducibility and standardization. Given that body mass index (BMI) affects systemic blood parameters, we investigated whether BMI affects the cellular and molecular composition of PRP. Seventy-three participants were stratified into normal weight, overweight, and obese groups. PRP was prepared using a double-syringe system, and platelet activation was induced by freeze–thaw cycles. Whole blood and PRP cell counts were analyzed, and IL6, IGF1, HGF, and PDGF-BB levels in PRP were quantified by ELISA. Platelet enrichment and levels of IGF1, HGF, and PDGF-BB in PRP did not significantly differ between BMI groups. In contrast, IL6 concentrations were higher in normal-weight compared to overweight and obese individuals. Moreover, BMI-related associations emerged between platelet counts and PDGF-BB, and between PRP proteins and sex or caffeine intake, suggesting a more complex BMI-specific modulation of PRP composition. In conclusion, our findings support considering BMI as a relevant factor in PRP therapy. Incorporating BMI into PRP standardization strategies could improve reproducibility and support personalized regenerative approaches. Full article

In children under 4, septic arthritis of the hip (SAH) caused by Kingella kingae (SAH-KK) can be misdiagnosed, as it does not meet classic septic joint criteria (fever > 38.5°, pain, limited range of motion, and inability to bear weight). The objective of this study was to report clinical and paraclinical characteristics in a large cohort of children with confirmed SAH-KK and to evaluate the reliability of the Kocher (KC) and Caird criteria (CC) in predicting SAH-KK. Medical records of 140 children with confirmed SAH-KK were collected. Data on sex, age, temperature on admission, weight-bearing status, white blood cell (WBC) count, platelet count, C-reactive protein (CRP) value, and erythrocyte sedimentation rate (ESR) were extracted. The study focused on the sensitivity of KC (body temperature, refusal to bear weight, leukocytosis, and ESR) and CC (KC criteria plus CRP level). All patients had bacteriologically confirmed SAH-KK; most had mild symptoms and near-normal inflammatory markers. CRP (76.2%) had the highest sensitivity, followed by weight-bearing status (73.8%) and WBC count (69.6%). Body temperature and ESR exceeded cutoff values in less than 50% of cases. Among 77 patients fulfilling all KC, 49 (63.5%) had less than a 40% probability of SAH. Of 50 children with complete CC, 20 (40%) had a 62.4% or lower probability of SAH. KC and CC are not sufficiently accurate to confidently exclude SAH-KK in preschool-aged children due to heterogeneous clinical presentations. Further studies are needed to redefine diagnostic criteria based on patient age and causative pathogens. Full article

Background/Objectives: Gaucher disease type 1 is an autosomal recessive lysosomal storage disorder caused by pathogenic variants in the GBA1 gene. Although enzyme replacement therapy has improved patient outcomes, there is limited long-term real-world data on taliglucerase alfa. This study aimed to evaluate the long-term efficacy and safety of taliglucerase alfa in both treatment-naïve and previously treated patients with Gaucher disease type 1 over a 10-year period. Methods: This prospective, single-centre cohort study involved 29 patients (13 treatment-naïve and 16 previously treated with imiglucerase) who received taliglucerase alfa from 2015 to 2024. Clinical, hematological, visceral, skeletal, and biochemical parameters were assessed at baseline and at 12, 60, and 120 months. Biomarkers included chitotriosidase and glucosylsphingosine. Safety was evaluated through adverse event reporting and anti-drug antibody testing. Results: Hemoglobin and platelet counts improved or remained stable in all patients. By 60 months, liver volume had normalised in treatment-naïve patients (mean reduction: 23.1%), while spleen volume had decreased by up to 47.3%. Lyso-Gb1 levels decreased by 86.1% in patients who had not previously received treatment and by 59.5% overall, with a strong correlation to adherence. Bone mineral density improved in most cases. 137 adverse events were reported, 24% of which were mild infusion-related reactions. Anti-drug antibody developed in two patients, including one with a reduced therapeutic response. Conclusions: Taliglucerase alfa offers sustained long-term clinical, hematological and biochemical benefits in both treatment-naïve and previously treated Gaucher disease type 1 patients, with a favorable safety profile. Glucosylsphingosine proved to be a highly sensitive biomarker for monitoring therapeutic efficacy and detecting treatment response. Full article

Background/Objectives: Complete blood count tests are inexpensive and widely available and may help identify low-grade inflammation in otolaryngologic (Ear, Nose and Throat, ENT) diseases, such as facial paralysis and hearing loss. This study aimed to describe the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte ratio (ELR), and lymphocyte-to-monocyte ratio (LMR) in ENT diseases and to provide preliminary evidence supporting further research. Methods: Data from 62 patients with ENT diseases were analyzed in a cross-sectional design. Results: The prevalence of ENT diseases was higher in women (63%) and adults (85.5%), highlighting vertigo, hearing loss, and septal deviation. Most marker values were within normal ranges; however, NLR values were elevated in patients with either septal deviation or vertigo, and ELR values were increased in cases of allergic or infectious rhinitis and sinusitis. In contrast, LMR values were at the lower normal limits in patients with septal deviation. Conclusions: These findings highlight the need for further studies to clarify the role of these biomarkers in chronic conditions and morphological alterations associated with ENT diseases, using more complex study designs. Full article

Background: Osteoarthritis (OA) is a major global health issue, increasing with aging and obesity. Current therapies mainly address symptoms without modifying disease progression. Platelet-rich growth factor (PRGF) therapy has potential regenerative effects through high cytokines and growth factors, but the outcomes of these therapies remain heterogeneous. This study explores the relationship between patient nutritional status, PRGF characteristics, and clinical outcomes in knee OA treatment. Methods: Baseline anthropometric, metabolic, and nutritional assessments of 41 patients with knee OA who underwent PRGF treatment were conducted. Blood samples were analyzed for metabolic and inflammatory markers. PRGF composition was assessed by protein content and extracellular vesicle (EV) markers. KOOS and VAS pain scores were collected at 2, 6, and 12 months. Responders improved KOOS by ≥10 points. An elastic-net regularized logistic model allowed the identification of the predictors of treatment response. Results: KOOS and VAS scores improved significantly at all follow-ups. At 2 months, the PRGF of responder patients showed higher PRGF G-CSF levels; at 12 months, increased CD49e and HLA-ABC expression. Higher BMI correlated with increased IL-6, IL-1ra, and resistin in PRGF samples. Hypercholesterolemic patients displayed altered EV profiles, with elevated levels of CD8 but reduced CD49e, HLA-ABC, CD42a, and CD31. Multivariate analysis identified BMI, biceps fold, fat percentage, red blood cell, platelet, and neutrophil counts as predictors of early response. Conclusions: Metabolic and immunological factors influence PRGF composition and clinical efficacy in knee OA. Baseline body composition and hematological parameters as key predictors of response, highlighting the potential of personalized PRGF therapy. Full article

Aim: The rationale for combining various extracorporeal blood purification techniques to improve patient outcomes is currently being discussed extensively. The combined use of CytoSorb^®, with high capacity for cytokine removal, and Oxiris^®, which adsorbs endotoxins and smaller cytokines, may enhance the efficacy of blood purification in sepsis. Study Design: Retrospective analysis of efficacy and safety of simultaneous use of CytoSorb^® and Oxiris^® in 12 consecutive critically ill patients with COVID-19, who developed secondary bacterial sepsis and persistent hemodynamic instability. Results: Most of the patients (n = 8) treated with combination of the Oxiris^® and CytoSorb^® had a significant decrease in vasopressor requirement. Pre- and post-haemoadsorption data were analysed in 9 patients, who completed a 24 h course of treatment. A significant decrease in mean SOFA score (16.3 ± 1.7 to 15.0 ± 2.0 points), median vasopressor requirement (0.56 ± 0.29 to 0.11 ± 0.21 µg/kg/min), median procalcitonin levels (6.5 ± 27.0 to 1.6 ± 6.0 ng/mL), median IL-6 levels (584 ± 6279 to 107 ± 571 pg/mL), and mean leucocyte count (36.0 ± 20.6 to 20.9 ± 10.1 × 10³/mL) was observed. Furthermore, there was significant increase in PaO₂/FiO₂ ratio (108 ± 30 to 185 ± 55). We did not observe any device-associated adverse events or technical problems. A 27.5% drop in platelet count (269 ± 116 to 195 ± 82 × 10⁶/mL) and an 11.8% drop in haemoglobin level (10.7 ± 2.9 to 9.5 ± 2.0 g/dL) was noted. Conclusions: Our data suggests that combined use of Oxiris^® and CytoSorb^® for simultaneous cytokine and endotoxin removal in patients with underlying viral infection may be a promising therapeutic option. Our findings may serve as a guide for future research and provide directions for further development in this field. Full article

Background/Objective: Systemic inflammation is a hallmark of end-stage renal disease (ESRD) and contributes to the high burden of cardiovascular morbidity and mortality in hemodialysis (HD) patients. The systemic immune–inflammation index (SII), derived from peripheral neutrophil, lymphocyte, and platelet counts, has emerged as a promising biomarker of immune–inflammatory status. This study aimed to assess the acute effect of a single HD session on systemic inflammation and to identify metabolic predictors associated with this response. Methods: In this single-center observational before–after study, 44 chronic HD patients were enrolled. Blood samples were collected immediately before and after a single HD session. SII was calculated as platelet count × neutrophil count/lymphocyte count. Subgroup analyses were conducted based on renal disease etiology and diabetic status. Multivariable linear regression models identified baseline predictors of SII variation. Results: Median SII significantly decreased post-HD in the overall cohort (from 553.4 [342.6–847.5] to 449.1 [342.6–866.6], p = 0.001), with a more pronounced reduction in patients with cardiometabolic etiologies (from 643.4 [353.3–1360.0] to 539.1 [324.8–1083.4], p = 0.007) and diabetes (from 671.1 [408.7–1469.1] to 458.3 [285.7–1184.4], p = 0.028), but not in those with nephroangiosclerosis (p = 0.182). Baseline total cholesterol (p = 0.001) and gamma-glutamyl transferase (p = 0.034) were positively associated with smaller reductions in SII, while higher baseline glycaemia predicted a greater decrease in post-dialysis SII (p = 0.021). Conclusions: HD acutely modulates systemic inflammation, as reflected by reduction in SII. The magnitude of this response is significantly influenced by individual metabolic profiles. These findings highlight the relevance of metabolic–immune crosstalk in ESRD and suggest that SII may serve as a dynamic biomarker integrating inflammatory and metabolic signals, deserving further validation in larger, outcome-driven studies. Full article

Background: Perioperative Cardiac Arrest (POCA) is a rare but catastrophic event with persistently low survival rates. Existing prediction models often fail to capture the perioperative context or predict short-term outcomes. This study aimed to develop and internally validate the POTEC (Platelet count, Oxygen saturation, Time of cardiopulmonary resuscitation (CPR), Elective surgery, and initial end-tidal carbon dioxide (ETCO₂) Score, a simple clinical tool for predicting 24-h survival following perioperative CPR. Methods: We conducted a retrospective cohort study of adult patients (≥18 years) who experienced POCA during or within two hours after non-cardiac surgery under anesthesia at a tertiary university hospital between 2010 and 2023. Multivariable logistic regression was used to identify independent predictors of 24-h survival. The final model’s coefficients were used to construct the POTEC Score, which was internally validated using bootstrapping (1000 replications). Results: Of 321 eligible patients, 65 (20.25%) survived at 24-h. Five variables were independently associated with 24-h survival and included in the POTEC score: preoperative platelet count 100 × 10⁹/L, preoperative oxygen saturation of ≥90% on room air upon arrival in the operating room, CPR duration ≤30 min, elective surgery, and initial end-tidal CO₂ between 35 and 45 mmHg. The score demonstrated good discrimination (AuROC = 0.788, 95% CI: 0.73–0.85) and calibration (Hosmer–Lemeshow p = 0.535). A score of 4 points or higher was associated with significantly higher odds of 24-h survival (adjusted OR = 2.78, 95% CI: 2.05–3.79). Model optimism was minimal (0.009) after bootstrapping. Conclusions: The POTEC Score is a clinically practical tool for early risk stratification in patients undergoing perioperative CPR. Its integration into perioperative workflows may aid in timely decision-making and resource prioritization during critical postoperative care. Full article

Background: End-stage renal disease (ESRD) patients on haemodialysis present a high burden of cardiovascular comorbidities and require anticoagulation, which increases bleeding risk. Methods: We performed a retrospective observational study (2021–2024) in the Haemodialysis Centre of The Clinical Emergency Hospital of Constanta County, Romania, including 50 adults with stage G5 CKD on haemodialysis for ≥3 months and receiving anticoagulant therapy. We collected from electronic medical records detailed demographic data (age, sex, place of residence), comorbidities (hypertension, atrial fibrillation, ischaemic heart disease, diabetes, deep-vein thrombosis, stroke, myocardial infarction, pulmonary embolism, cirrhosis), lifestyle factors (smoking and alcohol consumption), vascular access type (arteriovenous fistula or central venous catheter) and laboratory parameters (haemoglobin, haematocrit, creatinine, albumin, total protein, electrolytes, LDL- and HDL-cholesterol, total cholesterol, INR, APTT, D-dimer, BNP, CK-MB, troponin). All laboratory units were standardised and checked for plausibility. Results: Median age was 71 years; 48% were female. The most common comorbidities were: hypertension (100%), atrial fibrillation (100%) and ischaemic heart disease (62–81%). Patients exhibited severe anaemia (mean Hb ~9.7 g/dL), nephrotic-range proteinuria, hypoalbuminaemia, and impaired coagulation profiles (INR ~1.8–1.9; prolonged APTT in men). Female patients had higher platelet counts and D-dimer levels, suggesting a stronger prothrombotic profile, while males showed longer APTT. Cardiovascular strain was reflected by elevated BNP in men and also troponin/CK-MB. Correlations included smoking with leukocytosis, alcohol with increased urine density, diabetes with higher urea and lower protein, and subtherapeutic INR in cerebrovascular disease. Conclusions: Patients with ESRD on haemodialysis and anticoagulant therapy display a complex interplay of cardiovascular comorbidities, anemia, overlapping thrombotic and bleeding risks, with sex-specific differences. Therefore, systematic monitoring of proteinuria, haemoglobin, D-dimer, and coagulation markers is crucial to balance thrombotic and bleeding risks. Objective: To characterise the clinical and paraclinical profile and comorbidity–laboratory correlations of ESRD patients undergoing haemodialysis and anticoagulant therapy. Full article

Background/Objectives: We aimed to investigate the relationship between early pregnancy inflammatory indices and adverse perinatal outcomes in pregnancies complicated by pregestational diabetes mellitus (PREGDM) and to evaluate their predictive value, particularly for preterm birth and composite adverse perinatal outcome (CAPO). Methods: This retrospective study included 140 women with PREGDM and 140 age-matched controls. Early pregnancy (8–14 weeks) inflammatory indices [the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), systemic inflammation response index (SIRI)], and C-reactive protein (CRP) were calculated from complete blood counts. Associations with preterm birth and CAPO were analyzed using correlation, ROC analysis, and multivariate logistic regression adjusted for maternal age, BMI, HbA1c, and parity. Results: All inflammatory indices were significantly higher in the PREGDM group compared to controls (p < 0.05). Preterm birth, macrosomia, cesarean delivery, NICU admission, and CAPO were more frequent in PREGDM pregnancies (all p < 0.001). On univariate analysis, NLR, PLR, MLR, SII, and SIRI were significantly higher in women with preterm birth (p < 0.05), but not in those with CAPO. ROC curves showed modest discriminative ability of NLR, PLR, and SII for preterm birth (AUC 0.64–0.66), while AUCs for CAPO prediction were close to 0.5. In multivariate analysis, inflammatory indices were not independent predictors of either outcome. Only HbA1c (OR: 1.71, 95% CI 1.20–2.43, p = 0.003) and parity (OR: 1.62, 95% CI 1.08–2.45, p = 0.021) independently predicted preterm birth, and similarly HbA1c (OR: 1.68, 95% CI 1.14–2.46, p = 0.008) and parity (OR: 1.49, 95% CI 1.02–2.15, p = 0.037) predicted CAPO. Conclusions: Early pregnancy inflammatory indices were associated with preterm birth in univariate analyses but lost significance after adjustment for maternal and metabolic risk factors. HbA1c and parity remained the only independent predictors of adverse outcomes in PREGDM pregnancies. Inflammatory indices may provide supplementary information but should not be used as stand-alone predictors; they may instead be incorporated into multiparametric models with established clinical and metabolic markers to improve risk stratification. Full article

This pilot study evaluated the effects of cannabidiol (CBD) oil supplementation on growth performance, stress biomarkers, and haematological profiles in dairy calves undergoing the weaning transition. Nineteen Holstein calves were divided into two paternal-sibling groups: a CBD-supplemented experimental group (n = 10) and a CON-control group (n = 9). The CBD group received 5 mL/head/day of CBD oil for the first two days (pre-weaning), followed by 10 mL/head/day for three consecutive days post-weaning. Body weight increased significantly over time in both groups (p = 0.000); nevertheless, no significant differences were observed between groups (p = 0.173) or for the group × time interaction (p = 0.929), indicating that CBD did not affect overall growth trajectory. However, a significant group × time interaction (p = 0.006) for average daily gains in the CBD group was observed. Serum cortisol concentrations were significantly lower in CBD-supplemented calves at Day 0 and +2 days, compared to the CON group, indicating a transient anti-stress effect (p = 0.043 for group effect). At +5 days, cortisol levels in the CBD group increased, surpassing control values, though this difference was not significant. A trend-level group × time interaction (p = 0.067) suggested a distinct temporal cortisol response in CBD-treated calves. Immune cell counts (LYM, MON, NEU) showed no significant differences, though monocyte levels trended lower in CBD calves at early time points. Platelet indices revealed a significant reduction in mean platelet volume (p = 0.047) and stable PDWc and plateletcrit values in the CBD group, suggesting modulation of inflammatory status. Alanine aminotransferase levels increased over time with a significant group effect (p = 0.014), indicating a mild hepatic response, while glucose and alkaline phosphatase remained within physiological ranges. These findings suggest that short-term CBD supplementation may transiently modulate stress and inflammatory responses during weaning, with potential benefits for physiological resilience. However, rebound endocrine effects and hepatic sensitivity highlight the need for further research to refine dosing strategies and assess long-term safety in dairy production systems. Full article

Background: The platelet-to-hemoglobin ratio (PHR) has emerged as a potential prognostic marker in various cardiovascular contexts, but its role in acute coronary syndrome (ACS), particularly among patients with diabetes mellitus (DM), remains unclear. Methods: In this retrospective cohort study, 843 ACS patients admitted to the 2nd Cardiology Department at Hippokration Hospital of Thessaloniki, Greece, between 2017 and 2023 were evaluated. PHR was calculated from admission complete blood counts. The primary endpoint was all-cause mortality during a median follow-up of 25 months. Multivariate logistic and Cox regression analyses, receiver operating characteristic (ROC) curves, Kaplan–Meier survival analyses, and restricted cubic spline (RCS) models were employed, with subgroup analyses by DM status. Results: Higher PHR was independently associated with increased mortality in the overall cohort (adjusted hazard ratio [aHR] 1.35, p < 0.001). This association showed stronger predictive value in DM patients, reflected in both a higher aHR (1.52 vs. 1.36 in non-DM patients, p < 0.001 and p = 0.018, respectively) and superior discriminative performance on ROC analysis (AUC 0.707 vs. 0.600 overall, p = 0.0006). Kaplan–Meier analysis confirmed poorer survival in high-PHR groups, especially in DM patients. RCS analysis revealed a J-shaped relationship, with risk increasing markedly beyond PHR values of 2.2. Conclusions: PHR is an independent predictor of long-term mortality in ACS, with greater prognostic significance in DM patients. Its simplicity, low cost, and availability from routine blood tests make it a promising tool for risk stratification in ACS. Full article