Search Results (1,432)

(1) Background: COVID-19 sepsis, marked by hyperinflammation and cardiac injury, poses significant challenges in high-comorbidity populations. This prospective cohort study evaluates the prognostic value of IL-6, troponin, NT-proBNP, and radiological findings for mortality and unfavorable outcomes in a post-2022 Eastern European cohort. (2) Methods: At “Victor Babes” Hospital, Timisoara, Romania (September 2022–December 2024), 207 adults with COVID-19 sepsis (Sepsis-3 criteria) were enrolled. Baseline IL-6, troponin, NT-proBNP, CRP, PCT, D-dimers, and chest CT lung involvement were measured. Unfavorable outcomes (in-hospital death, ICU transfer, mechanical ventilation, or vasopressor use) were analyzed using logistic and linear regression. (3) Results: Among 207 patients (mean age: 68.7 years, 54.1% male), 52 (25.1%) experienced unfavorable outcomes. Multivariable analysis identified IL-6 (OR 1.016 per pg/mL, p = 0.013), troponin (OR 1.013 per ng/L, p = 0.017), NT-proBNP (OR 1.009 per pg/mL, p = 0.049), >50% lung involvement (OR 1.835, p = 0.011), unvaccinated status (OR 2.312, p = 0.002), and higher BMI (OR 1.112 per kg/m², p = 0.005) as independent predictors of unfavorable outcomes. Tocilizumab use (n = 12) was associated with reduced mortality (p = 0.041). IL-6 (cut-off 39.0 pg/mL, AUC = 0.91) and troponin (cut-off = 111.3 ng/L, AUC = 0.88) showed strong predictive accuracy. (4) Conclusions: Elevated IL-6, troponin, NT-proBNP, severe lung involvement, unvaccinated status, and higher BMI predict adverse outcomes in COVID-19 sepsis. Tocilizumab may offer survival benefits, warranting larger trials. These findings support targeted risk stratification in high-comorbidity populations. Full article

This study aimed to explore prognostic factors for mortality in dogs and cats following traumatic diaphragmatic herniorrhaphy using both multivariable logistic regression, a traditional statistical method, and the random forest algorithm, a machine learning approach. Associations between demographic and clinical variables and mortality were examined. Overall survival was 78.8% (149/189), 77% (97/126) in cats and 82.5% (52/63) in dogs. Key findings revealed that chronic diaphragmatic hernia (DH) significantly increased the odds of death compared to acute cases (adjusted odds ratio (OR) = 4.01, 95% confidence interval (CI): 1.69–9.53). Elevated blood urea nitrogen (BUN) increased mortality (adjusted OR = 3.24, 95% CI: 1.22–8.57). Cox proportional hazards analysis revealed that chronic DH (adjusted hazard ratio (HR) = 3.31, 95% CI: 1.51–7.30) and elevated BUN (HR = 2.88, 95% CI: 1.23–6.77) were associated with increased one-year mortality risk. The random forest analysis reinforced these findings, identifying hernia duration (Gini importance: 1.90) and BUN (Gini importance: 0.94) as the most crucial predictors. Among chronic DH patients, 55% of those with elevated BUN experienced fatal outcomes based on classification and regression tree (CART) analysis. The consistency of random forest results with logistic regression strengthens the reliability of these prognostic insights for DH patients. Full article

Background/Objectives: Drug-resistant tuberculosis (DR-TB) presents significant challenges to public health, particularly in rural South Africa, where limited infrastructure, high HIV co-infection rates, and weak clinical governance contribute to poor treatment outcomes. This study evaluates treatment trajectories and the impact of clinical governance and public health interventions on DR-TB outcomes in the rural Eastern Cape. Methods: A retrospective cohort study was conducted among 323 laboratory-confirmed DR-TB patients treated between 2018 and 2021. Kaplan–Meier curves and Cox proportional hazards analysis identified predictors of unfavorable outcomes. Logistic regression analysis simulated the impact of enhanced clinical governance scenarios on treatment success. Results: Treatment outcomes included cure (36.2%), completion (26.0%), loss to follow up (LTFU) (9.0%), death (9.3%), failure (2.2%), and transfer (9.3%). The median treatment duration was 10 months (IQR: 9–11). Survival analysis indicates the highest risk of death and LTFU occurred in the first 6–8 months of treatment. Multivariate Cox regression revealed that primary (HR = 0.39; 95% CI: 0.23–0.68; p = 0.0017) and secondary education (HR = 0.50; 95% CI: 0.31–0.85; p = 0.0103) were significantly protective. Paradoxically, patients with pre-XDR (HR = 0.13; p = 0.034) and XDR TB (HR = 0.16; p = 0.043) showed lower hazard of poor outcomes, likely due to early mortality or referral. HIV-negative status was associated with higher risk of poor outcomes (HR = 1.74; p = 0.010). Simulations suggested that improved clinical governance via better follow-up, TB/HIV integration, and adherence support could improve treatment success by up to 20 percentage points in high-impact scenarios. Conclusions: Strengthening clinical governance through targeted interventions could substantially reduce LTFU and mortality, especially in vulnerable subgroups. A coordinated, patient-centered approach is critical for improving DR-TB outcomes in rural, high-burden settings. Full article

Background: Accurate and timely molecular testing in patients with non-small cell lung cancer (NSCLC) is mandatory for targeted therapies and improved outcomes. Real-world obstacles, including geographic distance from specialized lung cancer services, along with comorbidities, may delay molecular diagnosis and subsequent treatment, therefore hampering survival. Methods: We conducted a retrospective, multi-departmental observational study of 927 patients with newly diagnosed NSCLC that were referred to a tertiary hospital in western Greece between January 2021 and December 2024. Patients were classified based on distance of residence (<30 km vs. ≥30 km). Clinical characteristics, time elapsed from pathological to final molecular diagnosis, and survival outcomes were analyzed and compared. Multivariable Cox regression was used to identify independent predictors of overall survival. Results: Patients residing ≥30 km away (61.2%) experienced delays in molecular testing (median 31 vs. 26 days, p = 0.002) and were less likely to undergo such testing (p = 0.012) compared to those residing <30km. Patients residing >30 km also had a higher prevalence of COPD (42.5% vs. 31.2%, p = 0.002). Median survival from initial pathological diagnosis to death was significantly shorter in non-urban patients (129 vs. 215 days, p = 0.010). A molecular testing delay >35 days was independently associated with worse survival (HR = 0.684, 95% CI: 0.508–0.923, p = 0.013). No differences in TNM stage distribution were observed between geographical groups. Conclusions: Geographic disparities significantly impact access to advanced lung cancer services and molecular diagnostics and may provisionally affect prognosis in NSCLC. Improving testing pathways, incorporating reflex testing in pathological molecular analysis, and optimizing referral systems in rural areas may help to reduce inequalities and improve patient outcomes. Full article

Visceral disseminated varicella-zoster virus infection (VD-VZV) involves the hematogenous spread of VZV from the skin to the internal organs. Though rare, it is potentially life-threatening, predominantly affecting immunocompromised individuals. Diagnosis is often delayed due to nonspecific symptoms mimicking other viral illnesses. While the vesicular rash is a hallmark sign, it is absent in approximately 5% of cases. Visceral involvement may precede cutaneous lesions, complicate early recognition, and increase the risk of severe complications. This scoping review screened 594 articles of which 153 met the inclusion criteria, yielding 156 individual cases. Patients were predominantly male (53.8%), with a mean age of 42.3 years. The overall mortality rate was 25.0%. Multiple organs were involved in 46.1% of cases. The most frequently affected were the lungs (56%), liver (44%), heart (16%), kidneys (11%), pancreas (11%), stomach (10%), and esophagus (6%). Antivirals were administered in 89.1% of cases, while corticosteroids were used in 22.4%, with no significant impact on outcomes. Early diagnosis, achieved in 65.4% of patients, was significantly associated with survival (p = 0.043). Mortality was significantly associated with underlying comorbidities (p = 0.004), especially autoimmune diseases requiring immunosuppression (p = 0.048). Septic shock or multi-organ dysfunction (MODS), hepatitis, acute kidney injury, and acute liver failure were linked to higher mortality in univariate analysis. Multivariate analysis identified comorbidities (p < 0.001), septic shock/MODS (p = 0.008), and acute liver failure (p = 0.039) as independent predictors of mortality. Patients with septic shock/MODS had over twice the risk of death (OR = 2.24; p = 0.008). This review underscores the diagnostic challenges and high mortality of VD-VZV. Early recognition and timely administration of antiviral treatment appear critical for survival. Greater clinical awareness and further research are needed to guide management. Full article

Introduction: Heart failure (HF) remains a leading cause of morbidity and hospitalization among elderly patients. Therefore, identifying reliable prognostic indicators is crucial for improving clinical outcomes in this population. The aim of this study was to evaluate the association between the Model for End-stage Liver Disease excluding INR (MELD-XI) and clinical outcomes in elderly patients hospitalized for decompensated HF. Material and methods: This was a single-center observational study involving 242 elderly patients with end-stage HF who were hospitalized for decompensation at our institution between 2019 and 2023. Upon hospital admission and discharge, MELD-XI scores were calculated using serum bilirubin and creatinine levels. The primary endpoint of the study was all-cause mortality during the follow-up period. Results: The median age of the patients was 68 years (66–74.6), and 78.9% were men. The median (Q1–Q3) follow-up time was 1.47 (0.78–2.31) years. During the follow-up period, 47.1% of the patients died. Independent predictors of mortality were diabetes mellitus [HR 1.656 (1.113–2.463), p = 0.013] and MELD-XI at discharge [OR 1.267 (1.210–1.327), p < 0.001]. The area under the receiver operating characteristic curves (AUC) for MELD-XI at discharge was 0.827 (95% CI: 0.776–0.878). The cut-off value for MELD-XI at discharge (>11.7 points) had a sensitivity of 97% and a specificity of 59%. Conclusions: Independent predictors of death in the analyzed population of elderly patients with decompensated HF were diabetes mellitus and MELD-XI at discharge. Full article

Background: Reduced-dose prasugrel is widely used in East Asia for acute coronary syndrome (ACS), but real-world data in diverse Asian populations are limited. This study evaluated its effectiveness and safety in Taiwanese patients. Methods: The PROMISE-TW Registry was a multicenter, retrospective study including 1167 patients with ACS or chronic coronary syndrome (CCS) treated with reduced-dose prasugrel (20 mg loading, 3.75 mg maintenance) across 13 hospitals in Taiwan from 2018 to 2022. The primary endpoint was 1-year major adverse cardiovascular events (MACEs: cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke). Secondary outcomes included composite ischemic events and major bleeding (BARC 3–5). Results: Among enrolled patients (mean age 63.9 years; 81.2% male; 83% ACS), percutaneous coronary intervention was performed in 90.8%. At one year, MACEs occurred in 1.9%, composite ischemic events in 8.2%, and major bleeding in 0.8%. Subgroup analysis identified prior stroke, diabetes, and chronic total occlusion intervention as predictors of bleeding. Male sex, chronic kidney disease, and left circumflex artery intervention predicted higher ischemic risk. Conclusions:Reduced-dose prasugrel provided effective ischemic protection and low bleeding rates in Taiwanese patients, especially those with ACS. These findings support the clinical utility of dose-adjusted prasugrel in East Asian populations and highlight the importance of individualized risk assessment. Full article

Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) often coexists with multivessel coronary artery disease (MVD), complicating treatment decisions. Current guidelines suggest complete revascularization (CR), yet robust evidence in hemodynamically stable patients remains insufficient. However, the comparative benefit of CR over incomplete revascularization (IR) in reducing ischemic events and improving cardiac function in this population is not well established. The aim of this study was to evaluate the impact of CR on all-cause mortality, cardiac death, and ischemic readmissions at 6 and 12 months, as the composite primary outcome, and to assess left ventricular ejection fraction (LVEF) improvement at discharge and hospital length of stay, as secondary outcomes. A total of 282 hemodynamically stable NSTE-ACS patients with MVD were included, of whom 218 (77.3%) underwent CR and 64 (22.7%) IR. The primary composite outcome occurred in 40.6% of IR patients versus 11.0% in the CR group at 6 months (p < 0.001), and 68.8% vs. 22.0% at 12 months (p < 0.001). CR was associated with significantly lower rates of all-cause and cardiac death, myocardial infarction, and unstable angina. Stroke incidence was similar. Event-free survival favored CR. Multivariable analysis identified CR and baseline LVEF as independent predictors of 12-month outcomes (HR for CR: 7.797; 95% CI: 3.961–15.348; p < 0.001; HR for LVEF: 0.959; CI: 0.926–0.994; p = 0.021). These findings strongly support CR as the preferred therapeutic strategy. Future prospective randomized studies are warranted to confirm the results. Full article

Background and Objectives: Early repolarization (ER), previously considered benign for many years, is now recognized as a substantial risk factor for malignant arrhythmia, coronary artery disease, and mortality. The ER pattern, previously regarded as a benign electrocardiographic characteristic, has lately been demonstrated to have a strong association with malignant arrhythmias, coronary artery disease, and elevated death rates. This study seeks to illustrate the prognostic significance of QT interval (QTc) prolongation on electrocardiograms for acute coronary syndrome and death in emergency cases. Prolongation of QTc duration on electrocardiography in emergency room cases may serve as a possible predictor for acute coronary syndrome and mortality. Materials and Methods: A retrospective study was conducted on 924 patients diagnosed with ER in the emergency department from 2020 to 2023. The QTc durations, serum glucose levels, troponin I levels, and additional auxiliary data of the patients were assessed. The alteration in the aVR derivation, often overlooked and deemed insignificant, was compared with clinical severity in ER cases. Results: The average age of the 924 patients in the study was 48.43 (9.65) years, with 30.7% being female. In the non-cardiac group, the mean age was 51.67 (7.98) years, with 738 females (31.9%). The QTc interval in the patient group was 409.54 (33.46) ms, while in the control group it was 411.57 (27.91) ms (p < 0.001). The one-year death rate was 49 (5.3%) for the ER group and nine (0.9%) for the follow-up group. The most common comorbid condition in both groups was tobacco and/or tobacco product intake. Univariate and multivariate regression analyses conducted for both ER types and mortality indicated that QTc prolongation may serve as a predictive factor (p < 0.001). The sensitivity and specificity of prolonged QTc in predicting acute coronary syndrome and mortality were determined to be 76% at the lowest and 98% at the highest levels in ER cases (p < 0.001). The Kaplan–Meier survival analysis for ER types revealed 321 days for the horizontal type and 363 days for the ascending type. Conclusions: Prolonged QTc duration in early repolarization cases may serve as an independent predictor of acute coronary syndrome and mortality. Full article

Background: Inherent to the challenge of acute pulmonary embolism (APE), the breadth of presentation ranges from asymptomatic pulmonary emboli to sudden death. Risk stratification of patients with APE is mandatory for determining the appropriate therapeutic management approach. However, the optimal clinically most relevant combination of predictors of death remains to be determined. Radiomics is an emerging discipline in medicine that extracts and analyzes quantitative data from medical images using mathematical algorithms. In APE, these data can reveal thrombus characteristics that are not visible to the naked eye, which may help to more accurately identify patients at higher risk of early clinical deterioration or mortality. We conducted a scoping review to explore the current evidence on the prognostic performance of radiomic models in patients with APE. Methods: PubMed, Web of Science, EMBASE, and Scopus were searched for studies published between January 2010 and April 2025. Eligible studies evaluated the use of radiomics to predict adverse outcomes in patients with APE. The PROSPERO registration number is CRD420251083318. Results: Nine studies were included in this review. There was significant heterogeneity in the methodology for feature selection and model development. Radiomic models demonstrated variable performance across studies. Models that combined radiomic features with clinical data tended to show better predictive accuracy. Conclusions: This scoping review underscores the potential of radiomic models, particularly when combined with clinical data, to improve risk stratification in patients with APE. Full article

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality worldwide, with survival outcomes influenced by a range of demographic and pathological factors. While cirrhosis is a well-established risk factor, recent evidence shows that HCC can also develop in patients with only mild to moderate liver fibrosis. However, there is limited understanding of how fibrosis severity interacts with other clinical variables, such as patient age, to affect mortality. This study aims to explore how fibrosis scores relate to both overall and cancer-specific mortality in US HCC patients, with an emphasis on how this relationship may shift across different age groups. Methods: We utilized data from the Surveillance, Epidemiology, and End Results (SEER) database to identify 15,796 adult patients diagnosed with HCC between 2010 and 2021. Baseline demographics, disease characteristics, and treatment variables were examined. Mortality outcomes were evaluated using Cox proportional hazard regression. Variables significant at p < 0.1 in univariate analysis were included in multivariate models to identify independent predictors of mortality (with hazard ratios [HRs] > 1 signifying increased risk). A secondary analysis assessed how age modifies the association between fibrosis score and mortality. Results: The study population was predominantly male (77.2%), with most patients aged 60–79 (59.6%) and presenting with localized disease (61%). A majority had advanced liver fibrosis or cirrhosis (81.7%) and lived in large urban areas (62.9%). Crude comparisons indicated that male sex, older age, single status, advanced tumor stage, lower income, and cirrhosis were linked to worse outcomes. In adjusted models, independent predictors of increased mortality included male sex, older age, unmarried status, and more advanced disease stage. Receipt of surgery or chemotherapy was associated with a lower risk of death. Notably, the influence of fibrosis on mortality was found to be greater in older patients than in their younger counterparts. Conclusions: This analysis identifies key prognostic indicators in HCC and suggests that the relationship between fibrosis and survival is not uniform across age groups. These findings support the need for age-specific clinical management strategies and highlight the potential benefit of early detection and appropriate interventions, even in non-cirrhotic patients. Full article

Background/Objectives: Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries. Early-onset PE (EOP) and late-onset PE (LOP) are distinct clinical entities with differing pathophysiological mechanisms and prognoses. However, few studies have explored differential risk factors for EOP and LOP in Latin American populations. This study aimed to identify and assess clinical risk factors for predicting EOP and LOP in a cohort of pregnant women from Bogotá, Colombia, using traditional statistics and machine learning (ML). Methods: A cross-sectional observational study was conducted on 190 pregnant women diagnosed with PE (EOP = 80, LOP = 110) at a tertiary hospital in Bogotá between 2017 and 2018. Risk factors and perinatal outcomes were collected via structured interviews and clinical records. Traditional statistical analyses were performed to compare the study groups and identify associations between risk factors and outcomes. Eleven ML techniques were used to train and externally validate predictive models for PE subtype and secondary outcomes, incorporating permutation-based feature importance to enhance interpretability. Results: EOP was significantly associated with higher maternal education and history of hypertension, while LOP was linked to a higher prevalence of allergic history. The best-performing ML model for predicting PE subtype was linear discriminant analysis (recall = 0.71), with top predictors including education level, family history of perinatal death, number of sexual partners, primipaternity, and family history of hypertension. Conclusions: EOP and LOP exhibit distinct clinical profiles in this cohort. The combination of traditional statistics with ML may improve early risk stratification and support context-specific prenatal care strategies in similar settings. Full article

Background/Objectives: The TOPAZ-1 phase III trial reported a survival benefit of using durvalumab, an anti-programmed death ligand 1 (anti-PD-L1) antibody, in combination with gemcitabine and cisplatin (GCD) treatment in patients with advanced biliary tract cancer. This retrospective study investigated the efficacy and safety of GCD treatment for advanced biliary tract cancer in real-world conditions. Methods: The study subjects were 52 patients with biliary tract cancer who received GCD therapy between January 2023 and May 2024. The observation parameters included the modified Glasgow Prognostic Score (mGPS), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), tumor markers (CEA, CA19-9), overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events. Results: The cohort included 36 men and 16 women, with a median age of 73.0 years. There were 36 cases of cholangiocarcinoma (distal: 10, perihilar: 19, intrahepatic: 7), 13 cases of gallbladder cancer, and 3 cases of ampullary carcinoma. The stages were locally advanced in 30 cases and metastatic in 22 cases. Biliary drainage was performed in 30 cases. There were 38 cases receiving first-line therapy and 14 cases receiving second-line or later treatments. The median values at the start of GCD therapy were ALB 3.7 g/dL, CRP 0.39 mg/dL, NLR 2.4, PLR 162.5, CEA 4.8 ng/mL, and CA19-9 255.9 U/mL. The mGPS distribution was 0:23 cases, 1:18 cases, and 2:11 cases. The treatment outcomes were ORR 25.0% (CR 2 cases, PR 11 cases), DCR 78.8% (SD 28 cases, PD 10 cases, NE 1 case), median PFS 8.6 months, and median OS 13.9 months. The PLR was suggested to be useful for predicting PFS. A decrease in CEA at six weeks after the start of treatment was a significant predictor of PFS and OS. Gallbladder cancer had a significantly poorer prognosis compared to other cancers. The immune-related adverse events included hypothyroidism in two cases, cholangitis in one case, and colitis in one case. Conclusions: The ORR, DCR, and PFS were comparable to those in the TOPAZ-1 trial. Although limited by its retrospective design and small sample size, this study suggests that GCD therapy is an effective treatment regimen for unresectable biliary tract cancer in real-world clinical practice. Full article

Background: Pancreatic adenocarcinoma (PDAC) with liver oligometastases (LOM) presents a therapeutic challenge, with optimal management strategies remaining uncertain. This study evaluates the long-term outcomes, patterns of disease progression, and potential factors influencing prognosis in this patient subset. Methods: Patients diagnosed with PDAC and LOM were retrospectively analyzed. Disease progression patterns, causes of death, and predictors of long-term outcomes were assessed. Results: Among 1442 patients diagnosed with metastatic PDAC between November 2009 and July 2024, 129 (9%) presented with LOM, defined as ≤3 liver lesions each measuring <2 cm. Patients with LOM had significantly improved overall survival (OS) compared to those with high-burden disease (p = 0.026). The cause of death (local regional disease vs. systemic disease) could be determined in 74 patients (57%), among whom age at diagnosis, history of smoking, and white blood cell (WBC) count differed significantly between groups. However, no significant difference in OS was observed between the two groups (p = 0.64). Sixteen patients (22%) died from local complications of the primary tumor, including 6 patients (7%) who showed no evidence of new or progressive metastases. In competing risk and multivariable analysis, a history of smoking remained the only factor significantly associated with death due to local complications. Conclusions: Approximately one in five patients with PDAC-LOM died from local tumor-related complications—some without metastatic progression—highlighting a potential role for surgical intervention. Further multicenter studies are warranted to refine diagnostic criteria and better identify patients who may benefit from surgery. Full article

Background: Epidermal growth factor receptor (EGFR) mutations are presented in approximately 50% of East Asian populations with advanced non-small cell lung cancer (NSCLC). While EGFR-tyrosine kinase inhibitors (TKIs) are the standard treatment, patient outcomes are also influenced by host-related factors. This study aimed to investigate clinical and radiological factors associated with early mortality and develop a prognostic prediction model in advanced EGFR-mutated NSCLC. Methods: A retrospective cohort was conducted in patients with EGFR-mutated NSCLC treated with first line EGFR-TKIs from January 2012 to October 2022 at Chiang Mai University Hospital. Clinical data and radiologic findings at the initiation of treatment were analyzed. A multivariable flexible parametric survival model was used to determine the predictors of death at 18 months. The predicted survival probabilities at 6, 12, and 18 months were estimated, and the model performance was evaluated. Results: Among 189 patients, 84 (44.4%) died within 18 months. Significant predictors of mortality included body mass index <18.5 or ≥23, bone metastasis, neutrophil-to-lymphocyte ratio ≥ 5, albumin-to-globulin ratio < 1, and mean pulmonary artery diameter ≥ 29 mm. The model demonstrated good performance (Harrell’s C-statistic = 0.72; 95% CI: 0.66–0.78). Based on bootstrap internal validation, the optimism-corrected Harrell’s C-statistic was 0.71 (95% CI: 0.71–0.71), derived from an apparent C-statistic of 0.75 (95% CI: 0.74–0.75) and an estimated optimism of 0.04 (95% CI: 0.03–0.04). Estimated 18-month survival ranged from 87.1% in those without risk factors to 2.1% in those with all predictors. A web-based tool was developed for clinical use. Conclusions: The prognostic model developed from fundamental clinical and radiologic parameters demonstrated promising utility in predicting 18-month mortality in patients with advanced EGFR-mutated NSCLC receiving first-line EGFR-TKI therapy. Full article