Search Results (383)

Background: Malnutrition is highly prevalent among critically ill patients and has been associated with worse clinical outcomes, particularly in sepsis. Several nutritional risk scores have been proposed to identify patients at increased risk of mortality in the intensive care unit (ICU). This study aimed to evaluate the prognostic value of three commonly used nutritional indices—modified Nutrition Risk in the Critically Ill (mNUTRIC), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT)—for predicting mortality in septic ICU patients. Methods: In this prospective observational cohort study conducted at two ICUs, 155 critically ill patients at nutritional risk were evaluated, including 105 patients with sepsis and 50 without sepsis. The primary endpoint was ICU mortality. Nutritional risk scores (mNUTRIC, PNI, and CONUT) were calculated at ICU admission. Survival analysis was performed using Kaplan–Meier (KM) curves and log-rank tests to compare survival probabilities across nutritional risk categories. Cox proportional hazards regression analysis was used to assess the association between nutritional scores and ICU mortality. Of note, only 24 mortality events were recorded in the septic cohort, which limits the statistical power of the findings. Results: KM analysis revealed significantly reduced survival among patients with severe malnutrition, as measured by the PNI score (log-rank p = 0.044). Patients with high mNUTRIC scores showed a tendency toward lower survival probability compared with those with low nutritional risk, approaching statistical significance (log-rank p = 0.059). No significant survival differences were observed between CONUT categories (log-rank p = 0.380). In univariate Cox regression analysis, the mNUTRIC score was significantly associated with ICU mortality (HR 1.67, 95% CI 1.17–2.38, p = 0.005). Conclusions: In this selected cohort, mNUTRIC demonstrated the strongest univariate prognostic signal for ICU mortality; however, this association was attenuated and did not reach statistical significance after limited multivariable adjustment. These findings are exploratory and apply specifically to a cohort of septic ICU patients with confirmed nutritional risk and therefore should not be generalized to the broader population of critically ill septic patients. Full article

Background: Accurate prognostic stratification remains essential for optimizing outcomes in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT). The hemoglobin–albumin–lymphocyte–platelet (HALP) score is a composite biomarker reflecting systemic inflammation, nutritional status, and immune competence, and has demonstrated prognostic value in several malignancies. This study aimed to evaluate the predictive utility of the HALP score for survivals and recurrence in HCC patients undergoing LT. Methods: A total of 476 consecutive patients who underwent LT for HCC between 2006 and 2024 were retrospectively analyzed. Pretransplant HALP scores were calculated for all patients. Receiver operating characteristic (ROC) analysis identified an optimal cut-off value of 29 for recurrence prediction. Patients were stratified into HALP ≥ 29 and HALP < 29 groups. DFS and recurrence rates were compared. Prognostic performance was assessed using the concordance index (C-index) and area under the ROC curve (AUC). Outcomes were further compared with the Milan and Expanded Malatya criteria. Results: Of the 476 patients, 335 (70.4%) had HALP ≥ 29 and 141 (29.6%) had HALP < 29. The HALP ≥ 29 group demonstrated significantly higher 5- and 10-year DFS rates compared with the HALP < 29 group (67.1% vs. 58.5% and 49.5% vs. 33.5%, respectively; p < 0.001). Recurrence rates were significantly lower in the HALP ≥ 29 group (14.0% vs. 31.9%; p < 0.001). However, patients within the Milan and Expanded Malatya criteria showed superior long-term DFS and lower recurrence rates in the HALP ≥ 29 compared to the HALP < 29 group (p ≤ 0.037). HALP ≥ 29 was associated with lower tumor burden parameters and improved hepatic functional reserve. Despite its significance, HALP demonstrated inferior discriminative performance (C-index: 0.565) compared with the Milan (0.621) and Expanded Malatya (0.648) criteria. Patients beyond the Milan criteria (n = 233) with HALP ≥ 29 achieved a 5-year overall survival of 54.2%, compared with 37.8% with HALP < 29. Conclusions: Low HALP score is associated with poor DFS and a high post-transplant recurrence rate. Although it represents a non-invasive and cost-effective biomarker, its prognostic accuracy remains inferior to established transplant selection criteria, limiting its use as a standalone selection tool. However, individuals beyond Milan with HALP ≥ 29 achieved survival outcomes exceeding internationally accepted post-transplant benchmarks. Incorporating HALP into pre-transplant evaluation may help identify a biologically favorable subgroup among patients traditionally considered high risk based solely on tumor burden. Full article

Background: Unplanned hospitalizations in patients with cancer are associated with adverse outcomes, including intensive care unit (ICU) transfer and in-hospital mortality. This study aimed to evaluate the predictive role of the prognostic nutritional index (PNI) and albumin-to-globulin ratio (AGR) for these outcomes in patients with unplanned hospitalization in a medical oncology ward. Methods: This retrospective, single-center study included patients aged ≥18 years with malignancy who had unplanned hospitalization between 1 January and 30 April 2025. PNI and AGR were calculated at admission. The primary outcome was ICU transfer or in-hospital mortality. Univariable and multivariable logistic regression analyses were performed, with AGR and PNI evaluated in separate models to avoid collinearity. Predictive performance was assessed using ROC analysis. Results: A total of 418 patients were included, with adverse clinical outcomes in 26.8%. Metastatic disease was present in 73.7%, and gastrointestinal (41.6%) and lung cancers (21.5%) were most common. In univariable analysis, metastatic disease (p < 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (p < 0.001), cancer type (p = 0.030), reason for hospitalization (p = 0.001), AGR (p < 0.001), and PNI (p < 0.001) were significantly associated with adverse clinical outcomes. In multivariable analyses performed in separate models, ECOG ≥ 2 emerged as the strongest independent predictor of adverse clinical outcomes (AGR model: OR: 9.93; PNI model: OR: 11.14; both p < 0.001). Metastatic disease remained an independent risk factor, while higher AGR and PNI values were independently associated with a reduced risk (all p < 0.05). Among hospitalization reasons, only electrolyte imbalance/transfusion was associated with a lower risk, whereas most cancer type subgroups were not independently significant. Both indices showed moderate predictive performance, with PNI performing slightly better than AGR (AUC: 0.729 vs. 0.707). Conclusions: ECOG performance status, together with PNI and AGR, were identified as practical and accessible predictors of adverse clinical outcomes in patients with unplanned hospitalization in a medical oncology ward. Full article

Background: Normal-weight obesity (NWO) is a nutritional status in which individuals have a normal body mass index (BMI) with a high percentage of body fat (%BF). However, the impact of elevated %BF on cardiometabolic risk remains unclear. This study aimed to evaluate whether NWO is associated with worse cardiometabolic risk markers and scores. Methods: We conducted a cross-sectional study using a convenience sample of employees from a public hospital. Participants aged ≥18 years with a BMI between 18.5–24.9 kg/m² were included in the study. %BF was categorized according to sex and age (InBody720). Normal weight and normal %BF (NWNB) and NWO were defined using cutoff points. Body composition, serum biochemical and inflammatory markers, hemodynamics, and autonomic function were considered cardiometabolic risk markers. The visceral fat area (VFA), atherogenic coefficient (AC), atherogenic index of plasma (AIP), body shape index (ABSI), and Framingham Risk (FR) score were considered cardiometabolic risk scores. Statistical significance was set at p < 0.05. Results: Of the 228 eligible participants, 52 met the inclusion criteria (NWNB, N = 29 and NWO, N = 23). Participants with NWO presented worse values of lipid profiles, anthropometric measurements, hemodynamic parameters, and autonomic function indices. After adjustment for age and sex, NWO remained associated with selected cardiometabolic markers, particularly LDL-c, triglycerides, and autonomic indices, whereas body composition findings should be interpreted as confirmatory of the phenotype. Conclusions: In this cross-sectional secondary analysis, NWO was associated with worse cardiometabolic markers and selected risk scores compared with NWNB. These findings support an unfavorable cardiometabolic profile in individuals with NWO, but do not allow inferences about future cardiometabolic events or causal relationships. Longitudinal studies are needed to clarify its prognostic significance. Full article

Background: Post-stroke dysphagia is a frequent complication associated with aspiration, malnutrition, and prolonged dependence on enteral feeding. Systemic inflammation and impaired nutritional status may adversely affect neuromuscular recovery; however, their relative and combined associations with swallowing recovery and transition from enteral to oral feeding remain insufficiently characterized. Objective: This study aimed to examine the independent associations of inflammatory and nutritional indices with swallowing function recovery and to evaluate their relationship with enteral-to-oral feeding transition in patients with post-stroke dysphagia. Methods: In this retrospective observational study, patients with dysphagia following ischemic stroke were evaluated before (T0) and after (T1) routine dysphagia rehabilitation. Inflammatory indices including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune–inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune–inflammation value (PIV), as well as the prognostic nutritional index (PNI), were calculated at both time points. Changes in indices (Δ = T1 − T0) were analyzed in relation to changes in swallowing function assessed by the Functional Oral Intake Scale (FOIS) and the Penetration–Aspiration Scale (PAS). Results: Changes in PNI were independently associated with greater improvement in functional oral intake (ΔFOIS) and reductions in aspiration severity for both liquid and soft consistencies (ΔPAS; all p < 0.01). In contrast, changes in inflammatory indices (ΔSIRI, ΔSII, ΔPLR, and ΔPIV) were consistently associated with less favorable swallowing outcomes. In multivariable logistic regression analysis, baseline stroke severity (NIHSS) was the only independent determinant of transition from enteral to oral feeding (OR = 0.72, p = 0.002). The model demonstrated good discrimination (AUC = 0.81). Conclusions: Changes in nutritional status, as reflected by ΔPNI over time, were the biomarker most consistently associated with functional swallowing recovery and reduced aspiration severity in patients with post-stroke dysphagia. While inflammatory burden was associated with less favorable swallowing physiology, transition from enteral to oral feeding appeared to be primarily driven by neurological severity rather than inflammatory or nutritional indices alone. These findings may support the clinical value of monitoring nutritional reserve alongside inflammatory burden during dysphagia rehabilitation. Full article

Background: Prognostic markers reflecting nutritional vulnerability in idiopathic pulmonary fibrosis (IPF) remain poorly defined. Methods: In this prospective cohort study, 63 stable outpatients with IPF were followed for 3 years. Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia criteria. Serum transthyretin levels were measured concurrently. Cox proportional hazards regression, binary logistic regression, and Kaplan–Meier survival analyses were performed. Results: During follow-up, 18 patients (29%) died and 21 (33%) experienced respiratory-related hospitalization. Serum transthyretin was an independent predictor of both 3-year mortality and respiratory-related hospitalization, even after adjusting for the Gender–Age–Physiology index. Conversely, sarcopenia and low appendicular skeletal muscle mass index (ASMI) were not independently associated with either outcome. Kaplan–Meier analysis demonstrated significant differences in both mortality and hospitalization according to serum transthyretin levels. Low ASMI evaluated using sex-specific cutoffs was associated with higher mortality in the unadjusted analysis, but not with hospitalization; sarcopenia was not significantly associated with either endpoint. Conclusions: Serum transthyretin may serve as a practical biomarker of nutritional vulnerability, providing complementary prognostic information beyond muscle mass-based assessment in IPF. Full article

Background/Objectives: Young women with breast cancer (aged ≤ 40 years) have distinct prognostic characteristics, yet little is known about how modifiable body composition factors influence outcomes in this age group. This study examined whether CT-derived body composition measures could identify thresholds that predict overall survival (OS). Methods: This was a single-center, 10-year, matched case–control study nested within a cohort, utilizing retrospectively collected data. Using an institutional database (2009–2018) and the initial cohort of 112 patients, we performed a subset analysis of patients with stage I–III breast cancer at diagnosis who had available pretreatment CT scans to estimate associations with body composition metrics and OS. The final analytic dataset included 89 individuals (49 survivors and 40 deceased). CT scans at the L3 level were analyzed using Slice-O-Matic software to quantify visceral (VAT), subcutaneous (SAT), intermuscular (IMAT), total adipose tissue (TAT), skeletal muscle density (SMD), skeletal muscle gauge (SMG), and skeletal muscle index (SMI). Cox proportional hazard models determined optimal cutpoints for OS. Multivariable models included adjustments for disease stage and hormone receptor status. Results: The median age was 35 (IQR, 32–38); 47% were White and 37% were Black. The majority (78%) were not Hispanic or Latina. Most (67%) were overweight/obese. Specific thresholds for IMAT index (>2.57), VAT (>31.38), and SMG (<2419.89) were associated with worse survival (all p < 0.05), while no cutpoints were identified for other variables. Conclusions: These findings show that muscle fat infiltration and reduced muscle quality have important prognostic value in young women with breast cancer. Exploratory cutpoints derived from routine staging CT scans may help inform risk stratification and generate hypotheses for targeted nutritional or exercise interventions, but require validation in larger, independent cohorts before clinical application. Full article

Background/Objectives: The aim of this study was to identify which pre-radiotherapy (RT) immunonutritional indices best predict mortality and overall survival in geriatric patients with lung cancer (LC). Methods: This retrospective single-center study included LC patients aged ≥ 65 years who underwent RT between August 2020 and December 2024. Clinical records and laboratory data obtained within 14 days before RT were used to calculate immunonutritional indices. Survival and subgroup analyses evaluated prognostic significance. Results: Among the 174 patients included in the study, the median age was 69 years, and the median follow-up after RT was 8 months. Inflammatory indices were higher among non-survivors, whereas nutritional indices were lower (all p < 0.05). The ROC curve analyses identified the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and CALLY (CRP–Albumin–Lymphocyte Index) as the strongest predictors of mortality (AUCs > 0.700). In adjusted Cox models, CALLY (HR = 0.652), PNI (HR = 0.939), and GNRI (HR = 0.950) were independently associated with reduced mortality risk. Conclusions: In older adults with LC undergoing RT, pre-treatment immunonutritional indices were independently associated with overall survival. Lower inflammatory burden and higher nutritional scores were linked to improved outcomes. These indices were associated with mortality before RT across LC types, independent of disease stage. Among them, CALLY, PNI, and GNRI showed the strongest associations with mortality, suggesting that these markers may be promising candidates for pre-RT risk assessment. However, further validation in prospective cohorts is required before routine clinical implementation. Full article

Background: Infective endocarditis (IE) remains associated with high morbidity and mortality despite advances in diagnostic and therapeutic strategies. Markers reflecting both inflammatory burden and nutritional status may improve early risk stratification. The hemoglobin-albumin-lymphocyte-platelet (HALP) score is a composite index integrating hematologic and nutritional parameters; however, its prognostic value in IE has not been well established. Methods: This two-center retrospective cohort study included 218 adult patients hospitalized with IE between January 2016 and January 2025. HALP score was calculated from admission laboratory values. The primary outcome was in-hospital mortality, and 1-year mortality was evaluated as a secondary outcome. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value. Patients were categorized into low- and high-HALP groups, and survival was assessed using Kaplan–Meier analysis. Cox regression analyses were performed to identify independent predictors of in-hospital mortality. Results: A total of 218 patients were analyzed. In-hospital mortality occurred in 38.5% of patients. HALP score was significantly lower in non-survivors and was independently associated with in-hospital mortality. ROC analysis demonstrated good discriminatory performance (AUC 0.784), with an optimal cut-off value of 15.1 (sensitivity 73.9%, specificity 73.8%). Low HALP scores were associated with more advanced functional status, more frequent intracardiac complications, and higher rates of acute heart failure, renal failure, and septic shock. One-year mortality was also higher in the low-HALP group (42.9% vs. 18.2%, p = 0.005). Conclusions: HALP score is independently associated with in-hospital mortality in patients with IE and identifies a subgroup with more severe disease and worse outcomes. As an easily calculated parameter, it may serve as a complementary tool for risk stratification and clinical decision-making. Full article

Background: Systemic inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) have demonstrated prognostic relevance in metastatic colorectal cancer (mCRC). However, most available evidence relies on single baseline measurements, while the longitudinal dynamics of these biomarkers in relation to immunonutritional status remain insufficiently explored. Methods: This retrospective longitudinal study included 86 patients with previously untreated mCRC receiving first-line chemo-biological therapy. NLR, PLR, and SII were assessed at three predefined time points: before treatment initiation, after completion of induction therapy, and at radiologically confirmed disease progression. Nutritional and sarcopenia risk were evaluated using the NRS-2002 and SARC-F tools. Longitudinal differences were analyzed using the Friedman test with post hoc comparisons. Results: In nutritionally preserved patients, significant longitudinal changes were observed for NLR (χ²(2) = 16.72, p < 0.001), PLR (χ²(2) = 6.36, p = 0.003), and SII (χ²(2) = 24.57, p < 0.001), characterized by a marked decline following induction therapy and re-elevation at disease progression. In high nutritional risk patients, significant dynamics were observed only for SII (χ²(2) = 5.60, p = 0.007). Similarly, in the low SARC-F subgroup, all three indices demonstrated significant modulation over time, whereas no statistical analysis was feasible in the high SARC-F subgroup due to limited sample size. Among the evaluated parameters, SII showed the most consistent and pronounced longitudinal variation. Conclusions: The clinical value of inflammatory hematologic indices in mCRC appears to derive primarily from their longitudinal dynamics rather than single absolute measurements. SII, in particular, may serve as a marker of therapy-induced modulation of systemic inflammation, especially in patients with preserved immunonutritional reserve. Integration of dynamic inflammatory indices into routine clinical monitoring could enhance early identification of biological progression and improve risk stratification in mCRC. Full article

Background: Age- and cancer-related sarcopenia and malnutrition are common in older patients with colorectal cancer (CRC) and may negatively influence treatment tolerance and prognosis. However, the comparative prognostic value of post-chemotherapy changes in CT-based body composition parameters at the third lumbar vertebra (L3) and the twelfth thoracic vertebra (T12) levels, and their associations with nutritional indices, remain unclear. This study aimed to examine and compare the prognostic relevance of post-chemotherapy body composition changes at L3 and T12 and to assess their relationship with nutritional indices in older patients with metastatic CRC (mCRC). Methods: This retrospective study included 87 older patients with mCRC. Baseline and ~3-month follow-up CT scans were analyzed at L3 and T12 using 3D Slicer to quantify skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), visceral-to-subcutaneous fat ratio (VSR), and intramuscular adipose tissue index (IMATI). Changes (Δ) in CT-derived body composition after chemotherapy were calculated as percentage change using ((follow-up − baseline)/baseline) × 100. Prognostic Nutritional Index (PNI) and Geriatric Nutritional Index (GNRI), which are established nutritional assessment tools, were calculated from baseline laboratory/anthropometric data. Agreement between T12 and L3 was assessed, and associations with grade ≥ 3 toxicity, progression-free survival (PFS), and overall survival (OS) were evaluated using multivariable models and ROC analyses. Results: Mean age was 69.0 ± 4.5 years (59 male/28 female), and 26.4% developed grade ≥ 3 adverse events. Over 3 months, mean SMI declined significantly at both L3 (46.7 ± 8.8 → 42.8 ± 9.8 cm²/m²) and T12 (34.6 ± 8.2 → 31.6 ± 8.1 cm²/m²) (p < 0.001 for both), accompanied by decreases in VATI and VSR; T12-IMATI increased significantly. Baseline PNI showed a weak positive correlation with L3-SMI (r = 0.302, p = 0.033), whereas GNRI showed moderate correlations with SMI at L3 (r = 0.502, p < 0.001) and T12 (r = 0.317, p = 0.025) and was associated with longitudinal changes in muscle metrics. T12-SMI consistently yielded lower values than L3-SMI, and agreement varied by compartment (best for SATI; weakest for VSR). Lower GNRI and greater L3-SMI loss were independently associated with grade ≥ 3 toxicity; ΔL3-SMI showed the highest discrimination (AUC = 0.79, 95% CI = 0.69–0.87, p < 0.001; cut-off >5.1% loss). All patients progressed (median PFS 7.6 months); mortality was 82.8% (median follow-up: 25 months). In multivariable analysis, PFS, CRP, GNRI, and ΔL3-SMI remained independently associated with OS. ΔL3-SMI provided the strongest mortality discrimination (AUC = 0.85, 95% CI = 0.74–0.94, p < 0.001; cut-off >10.4% loss), while ΔIMATI was also informative (AUC = 0.71, 95% CI = 0.59–0.82, p = 0.023). Conclusions: In older patients with mCRC, early post-chemotherapy skeletal muscle loss—particularly at the L3 level—showed the strongest prognostic association with severe toxicity and mortality. GNRI provided complementary prognostic information as a marker of baseline immunonutritional reserve. Although T12-derived measurements were correlated with L3-derived values, systematic bias suggests that they should not be interpreted interchangeably for longitudinal risk stratification. Full article

Background/Objectives: Risk stratification in idiopathic pulmonary fibrosis (IPF) remains primarily based on physiological indices, yet increasing evidence suggests that systemic metabolic and nutritional vulnerability may influence outcomes in chronic interstitial lung disease. Methods: In this longitudinal, single-center cohort, 211 patients with IPF were followed from diagnosis until death or last follow-up. Baseline lipid profiles and body mass index (BMI) were assessed. A metabolic–nutritional phenotype was constructed using high-density lipoprotein cholesterol (HDL) and BMI. Survival was analyzed using Kaplan–Meier and multivariable Cox models adjusted for GAP stage. Incremental prognostic value beyond the GAP index was evaluated using Harrell’s C-index and time-dependent ROC analysis. Results: During a median follow-up of 29 months, 134 patients (63.5%) died. Lower HDL levels were associated with increased mortality in unadjusted analysis (HR = 1.45, 95% CI 1.03–2.04) but were not independently predictive after adjustment. In contrast, the combined HDL–BMI phenotype independently stratified mortality risk. Compared with HDL ≤ 1.0 mmol/L and BMI ≤ 24 kg/m², patients with HDL > 1.0 mmol/L and BMI > 24 kg/m² had significantly lower mortality (adjusted HR = 0.48, 95% CI 0.29–0.80), with stronger associations among those aged ≥ 65 years (adjusted HR = 0.37, 95% CI 0.18–0.74). The addition of HDL–BMI improved discrimination beyond GAP (C-index: 0.585 vs. 0.618; 36-month AUC: 0.633 vs. 0.675; NRI: 0.243). Conclusions: The coexistence of HDL ≤ 1.0 mmol/L and BMI ≤ 24 kg/m² identified a subgroup with poorer survival in IPF. This combined metabolic–nutritional phenotype improved mortality risk stratification beyond the GAP stage. Full article

Background/Objectives: Histologic remission has emerged as a key treatment target in inflammatory bowel disease (IBD), but routine assessment requires repeated endoscopy and biopsies. Blood-based indices reflecting inflammation, nutritional status and atherogenic risk are inexpensive and widely available, yet their integrated contribution to histologic activity remains unclear. This study addresses this gap by simultaneously analyzing a broad panel of 44 variables—including nutritional status indicators, CBC-derived inflammation indices, and atherogenic lipid indices—in IBD patients. Methods: In this retrospective study, 100 patients with IBD (50 Crohn’s disease [CD], 50 ulcerative colitis [UC]) without additional comorbidities and with concomitant histologic assessment were analyzed. Histologic activity was coded as active vs. remission. At the time of biopsy, the complete blood count, biochemistry and lipid profile were used to calculate immuno-nutritional indices (CONUT score, prognostic nutritional index), inflammatory indices (neutrophil-to-platelet ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio [LMR], systemic immune-inflammation index, systemic immune-inflammation index, systemic inflammation response index [SIRI], aggregate index of systemic inflammation, C-reactive protein to albumin ratio) and atherogenic indices (atherogenic index of plasma [AIP], triglyceride-to-HDL cholesterol ratio). Variable selection was performed separately for CD and UC using least absolute shrinkage and selection operator (LASSO) regression and sparse partial least squares discriminant analysis (sPLS-DA). Independently associated predictors were then entered into multivariable logistic regression models, and their discriminative performance was evaluated using ROC analysis with bootstrap-derived 95% confidence intervals. Results: LASSO analysis identified a broadly similar systemic profile associated with histologic activity in CD and UC, dominated by the CONUT score, SIRI, AIP, LMR and red blood cell parameters, whereas demographic features and most routine biochemical markers were shrunk towards zero. Cross-validated AUCs for the LASSO models were 0.93 in CD and 0.87 in UC. sPLS-DA confirmed this pattern: CONUT, SIRI and AIP consistently showed the highest variable importance in projection scores and loadings on the first latent component. In multivariable regression, the CONUT score, SIRI and AIP remained independent predictors of histologic activity in CD, while hematocrit, CONUT score, SIRI and AIP were independently associated with histologic activity in UC. In ROC analysis, AUCs for CONUT, SIRI and AIP were 0.81, 0.89 and 0.87 in UC, and 0.72, 0.82 and 0.83 in CD, respectively. Conclusions: Histologic activity in IBD is characterized by a coupled systemic profile in which immuno-nutritional compromise (captured by CONUT) forms the core signal, supplemented by systemic inflammation (SIRI) and atherogenic dyslipidemia (AIP). These readily available blood-based indices may help to approximate histologic disease activity in clinical practice. However, considering that comorbid diseases may affect these indices, the strict exclusion criteria applied in this study may limit the generalizability of the findings among patients with IBD. Consequently, further validation in larger prospective cohorts is warranted. Full article

Background: Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality worldwide, and improved risk stratification beyond conventional biomarkers is needed. Novel laboratory-derived indices reflecting systemic inflammation and immunonutritional status including the inflammatory prognostic index (IPI), prognostic nutritional index (PNI), and aggregate index of systemic inflammation (AISI) may provide integrated prognostic information in ACS. Methods: In this cohort study, 2400 participants were included: 800 controls, 800 patients with non-ST-elevation myocardial infarction (NSTEMI), and 800 with ST-elevation myocardial infarction (STEMI). Results: Compared with controls, NSTEMI and STEMI patients were younger and exhibited higher body mass index, blood pressure, heart rate, and progressively worse glycemic indices (fasting glucose and HbA1c; all p < 0.001). Lipid parameters were significantly higher in ACS groups versus controls (p < 0.001). Cardiac biomarkers were markedly elevated in ACS, with significantly higher troponin I and CK-MB levels in STEMI than NSTEMI and controls (both p < 0.001). Inflammatory and renal parameters (CRP, fibrinogen, urea, creatinine) were increased in ACS, most prominently in STEMI. Composite indices demonstrated strong inter-correlations, including a strong positive correlation between AISI and IPI (r ≈ 0.91, p < 0.001), while PNI correlated inversely with CONUT score (r ≈ −0.70, p < 0.001). The Gensini score differed significantly among groups and was highest in NSTEMI (p < 0.001). Survival was significantly lower in STEMI than NSTEMI (log-rank p = 0.005), with RMST of 315.5 days in NSTEMI versus 299.4 days in STEMI. In multivariable Cox regression, STEMI presentation independently predicted higher mortality risk (HR 1.26, 95% CI 1.04–1.53; p = 0.018), and higher Gensini score was also independently associated with mortality (HR 1.01 per point; 95% CI 1.00–1.02; p = 0.036). Higher PNI was independently protective (HR 0.997; 95% CI 0.993–1.000; p = 0.045), whereas age and CONUT score were not significant in the adjusted model. Conclusions: Novel laboratory-derived systemic inflammatory and nutrition-related indices particularly IPI and AISI as markers of inflammatory burden and PNI as a marker of immunonutritional balance provide clinically relevant prognostic information in ACS. STEMI presentation is associated with shorter survival, and all-cause mortality is independently related to STEMI status, greater angiographic severity (higher Gensini score), and lower PNI. These readily available indices may offer incremental value for risk stratification in NSTEMI and STEMI when integrated with conventional clinical and angiographic assessment. Full article

Background: Up to one-third of brucellosis patients develop focal organ involvement, contributing to increased morbidity and therapeutic failure, yet no clinically validated instrument exists to stratify risk at presentation. Methods: In this three-center retrospective cohort from Türkiye (2015–2025), 355 adults with confirmed brucellosis were enrolled. Thirty-two candidate variables spanning demographics, comorbidities, symptoms, routine laboratory values, and composite inflammation indices underwent LASSO-penalized regression with 10-fold cross-validation for predictor selection, after which a nomogram was constructed and internally validated via 1000-iteration bootstrap resampling. Results: Ninety-two patients (25.9%) developed focal complications. Five predictors were retained by LASSO—prognostic nutritional index (PNI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), chronic disease stage, and hypertension—and combined with age and sex (retained a priori) into a seven-predictor nomogram. PNI was the strongest contributor (OR = 0.901, 95% CI: 0.857–0.948). Apparent C-statistic reached 0.782 (optimism-corrected 0.762), with a calibration slope of 0.894 and Brier score of 0.154. Decision curve analysis indicated net clinical benefit over the 5–55% threshold probability range. Conclusions: This PNI-anchored LASSO nomogram offers a practical bedside risk stratification instrument for brucellosis-related focal involvement. Prospective external validation across geographically diverse endemic regions is warranted before clinical adoption. Full article