Objective Patients with solid tumors are at increased risk of venous thromboembolism (VTE), and COVID-19 infection may further enhance thrombotic risk. Although prophylactic-dose thromboprophylaxis is recommended for hospitalized patients with COVID-19 when bleeding risk is acceptable, its clinical impact among patients with solid tumors remains uncertain. Methods We conducted a multicenter retrospective cohort study across three tertiary hospitals in China from December 2022 to January 2023. Adult patients with solid tumors hospitalized for laboratory-confirmed COVID-19 were included. Patients receiving prophylactic-dose thromboprophylaxis within 24 hours of admission were classified as the early cohort, whereas those initiating prophylaxis after 24 hours or receiving no prophylaxis were classified as the non-early cohort. The primary outcome was 30-day mortality. Secondary outcomes included thrombotic events, bleeding events, and 60-day mortality. Multivariable Cox regression, inverse probability of treatment weighting (IPTW) analyses, multiple imputation, and sensitivity analyses were performed. Results Among 431 patients, 86 were classified into the early cohort and 345 into the non-early cohort. Early prophylactic-dose thromboprophylaxis was not significantly associated with 30-day mortality (adjusted HR=1.468, 95% CI 0.840–2.567, P=0.173) or 60-day mortality (adjusted HR=1.386, 95% CI 0.798–2.408, P=0.241). IPTW-adjusted analyses and sensitivity analyses yielded consistent results. No significant associations were observed between early thromboprophylaxis and thrombotic or bleeding events. Conclusions In this multicenter cohort of patients with solid tumors hospitalized for COVID-19, early prophylactic-dose thromboprophylaxis was not clearly associated with improved 30-day or 60-day mortality. Further prospective studies are needed to identify patients who may benefit from optimized thromboprophylaxis strategies.
Background Cardiovascular-kidney-metabolic syndrome, defined by the American Heart Association (AHA), is characterized by heart and kidney dysfunction. This dysfunction results from systemic inflammation and oxidative stress, which are caused by insulin resistance (IR) and severe obesity. This study explores the association between the monocyte/high-density lipoprotein-cholesterol ratio (MHR) and cardiovascular-kidney-metabolic syndrome, and its association with all-cause mortality. Methods The data for this study come from the National Health and Nutrition Examination Survey (NHANES) conducted from 2003 to 2018 and the National Death Index (NDI) database. Statistical analysis methods such as multiple logistic regression and Cox regression were employed. Additionally, restrictive cubic spline models and subgroup analyses were applied. Results This study included 13,323 participants, of whom 2,452 were identified as having Cardiovascular-Kidney-Metabolic (CKM) syndrome. MHR levels differed significantly between participants with and without CKM syndrome. Weighted logistic regression showed that higher MHR was significantly associated with increased prevalence of CKM syndrome (OR: 1.19; 95% CI: 1.07–1.32). When MHR was analyzed by quartiles, the prevalence of CKM syndrome increased progressively across quartiles (Q4 vs. Q1, OR: 1.63; 95% CI: 1.27–2.11). Restricted cubic spline analysis revealed a nonlinear positive association between MHR and CKM syndrome (P-nonlinear < 0.001). Among participants with CKM syndrome, weighted Cox regression showed that MHR was significantly associated with all-cause mortality (HR: 1.04; 95% CI: 1.01–1.06). After covariate adjustment, restricted cubic spline analysis demonstrated a significant overall association between MHR and mortality (global P = 0.02), with no evidence of nonlinearity (P for nonlinearity = 0.48), suggesting a linear dose-response relationship. Subgroup analyses indicated that the association between MHR and all-cause mortality in CKM syndrome was generally consistent across subgroups, with no significant interactions detected. Conclusion Our study demonstrates that MHR is independently associated with a higher prevalence of CKM syndrome. Among patients with CKM syndrome, MHR showed a modest association with all-cause mortality. These findings suggest that MHR may have potential utility as a biomarker for CKM syndrome, although its prognostic value for mortality appears limited and warrants further prospective validation.
Objective To develop a nomogram for predicting coronary artery calcification (CAC) in atherosclerosis patients using Achilles tendon cross-sectional area (CSA), tendon mechanical parameters, and a combined nutrition score. Methods This case-control study included atherosclerosis patients from January 2021 to January 2025. Data collected included Achilles tendon CSA, lipid content, Young’s modulus, and the triglyceride–total cholesterol–body weight index (TCBI). Multivariable logistic regression was used to identify predictors of CAC. A nomogram was constructed using R, and its clinical utility was evaluated. Results A total of 279 patients were analyzed and randomly assigned to training (n=195) and validation (n=84) sets. Multivariable analysis identified CSA [OR=1.23 (1.13–1.33)], Young’s modulus [OR=0.17 (0.05–0.58)], and TCBI [OR=2.26 (1.30–3.91)] as independent predictors of CAC (all P<0.05). The prediction model was: logit(P)= 5.22+0.20*CSA-1.76*Young’s modulus+0.81*TCBI. The AUC values were 0.91 (0.87–0.95) for the training set and 0.84 (0.76–0.92) for the validation set. The Hosmer–Lemeshow test yielded P=0.962 and 0.837, and calibration curves showed good concordance. Decision curve analysis indicated net clinical benefit across risk thresholds of 2%–98% in the training set and 10%–98% in the validation set. Conclusion The nomogram incorporating Achilles tendon CSA, mechanical parameters, and TCBI effectively predicts CAC in atherosclerosis patients. The underlying mechanisms of abnormal lipid deposition and chronic inflammation provide a theoretical basis for targeted therapeutic strategies.
Background Left ventricular thrombus (LVT) remains an important complication following anterior ST-elevation myocardial infarction (STEMI), despite widespread adoption of primary percutaneous coronary intervention (pPCl). Current guidelines supporting prophylactic oral anticoagulation in high-risk patients are based on limited evidence, and the balance between thromboembolic prevention and bleeding risk remains uncertain. PubMed, Embase and etc were searched for studies comparing triple antithrombotic therapy (TAPT; anticoagulation plus DAPT) versus DAPT alone in patients with anterior STEMI undergoing pPCI. Random-effects model was used to pool risk ratios with 95% confidence intervals (CI). Outcomes included mortality, bleeding, LVT, and etc. Main Text 7 studies including 3,692 participants were included. TAPT was associated with a significantly increased risk of bleeding compared with DAPT alone (RR: 2.10; 95% CI: 1.60-2.76; P<0.0001; I 2 =0%). No significant differences were observed in all-cause mortality (RR: 1.05; 95% CI: 0.54-2.04; P=0.89; I 2 =39%), recurrent myocardial infarction (RR: 1.52; 95% CI: 0.94-2.45; P=0.09; I 2 =0%), stroke (RR: 0.86; 95% CI: 0.20-3.73; P=0.84; I 2 =55%), LVT formation (RR: 0.54; 95% Cl: 0.21-1.40; P=0.21; l 2 =61%), NACE (RR: 0.93; 95% CI: 0.49-1.75; P=0.82; I 2 =77%), or embolic events (RR: 0.53; 95% CI: 0.21-1.33; P=0.18; I 2 =0%). Conclusions TAPT significantly increased bleeding risk compared with DAPT. No significant reductions were observed in ischemic outcomes; however, wide confidence intervals indicate limited precision and do not exclude a clinically meaningful benefit or harm. Current evidence therefore does not support routine prophylactic TAPT, and adequately powered contemporary randomised trials are needed.
Objective This study used two-sample Mendelian Randomization to investigate the causal link between multiple biological aging indicators and vascular disease. Methods Summary genetic data was obtained from genome-wide association studies (GWAS) focusing on aging-related exposures and various vascular disease outcomes. The exposures included granulocyte proportions, PAI-1 (plasminogen activator inhibitor-1), telomere lengths, and the Frailty Index. The primary analysis employed the Inverse Variance Weighted (IVW) method to estimate causal relationships, supported by MR-Egger, weighted median, and weighted mode methods. Sensitivity analyses, including Cochran’s Q test, MR-Egger regression, leave-one-out test, and the MR Pleiotropy Residual Sum and Outlier (MR-PRESSO) test, were conducted to evaluate heterogeneity and pleiotropy. Results The analysis revealed distinct pathways after sensitivity adjustments. A higher genetically predicted Frailty Index was associated with an increased risk of abdominal aortic aneurysm (OR=2.5935, 95% CI: 1.3936–4.8268, P =0.0026, false discovery rate (FDR)=0.0475), atherosclerosis excluding cerebral and coronary sclerosis (OR=2.0262, 95% CI:1.5179–2.705, P =1.66×10 -6 , FDR=1×10 -4 ), and arterial thromboembolic events (OR = 4.0306, 95% CI: 1.7133–9.4818, P = 0.0014, FDR = 0.0337). Conversely, longer telomere length demonstrated a strong, specific protective effect against abdominal aortic aneurysm (OR=0.5008, 95% CI:0.4111–0.6100, P =6.42×10 -12 , FDR=9.25×10 -10 ), indicating that shorter telomere length is associated with an increased risk of AAA. Furthermore, a lower granulocyte proportion was causally linked to an increased risk of thoracic aortic aneurysm (OR=0.0181, 95% CI: 0.0014–0.2376, P =0.0023, FDR=0.0465). Conclusion This study identifies three genetic pathways linking biological aging to vascular disease, offering new molecular targets for its prevention and treatment.
While conventional prophylaxis with clotting factor concentrates (CFC) is the standard of care for hemophilia A and B, its challenges include frequent intravenous administration, factor level fluctuations, and potential inhibitor development. Rebalancing agents, including fitusiran (antithrombin-lowering small interfering ribonucleic acid), concizumab and marstacimab (tissue factor pathway inhibitor antagonists), are novel nonfactor therapies that restore hemostatic balance by targeting natural anticoagulants rather than replacing missing clotting factors. Clinical trials demonstrate that these three rebalancing agents provide effective prophylaxis for people with hemophilia (PwH) with or without inhibitors through subcutaneous administration. Rebalancing agents thus provide subcutaneous alternatives to current treatment regimens and offer effective prophylaxis for people with hemophilia B with inhibitors who previously had limited therapeutic options. Their novel mechanism of action may necessitate individualized dose optimization and unique approaches for managing breakthrough bleeds and surgeries. Those conditions require reduced dosing of CFC or bypassing agents to mitigate potential thrombotic risk. In addition, the use of rebalancing agents in pediatric patients (<12 years old) remains under investigation. While promising, successful implementation depends on individualized treatment approaches, appropriate monitoring protocols, and thorough patient education to improve current care for PwH.
Background Short-video platforms have become important sources of health information, but the quality and reliability of venous thromboembolism (VTE)-related short videos remain unclear. This study evaluated VTE-related short videos on TikTok and Bilibili and conducted an exploratory examination of factors associated with video likes. Methods On February 27, 2025, the top 150 videos from each platform were retrieved according to the platforms’ default ranking algorithms. Video quality and reliability were assessed using the Global Quality Score (GQS), modified DISCERN (mDISCERN), and Medical Quality Video Evaluation Tool (MQ-VET). In an exploratory analysis, an eXtreme Gradient Boosting (XGBoost) model was developed to examine factors associated with video likes. Results A total of 184 videos were included, comprising 81 from Bilibili and 103 from TikTok. Bilibili videos were longer, covered more VTE-related topics, and had higher median numbers of saves and shares, as well as higher GQS, mDISCERN, and MQ-VET scores than TikTok videos. TikTok videos received more likes and comments, while videos from professional uploaders on TikTok demonstrated higher quality and reliability. In the exploratory XGBoost analysis, follower count contributed the most to predicting video likes, followed by days since upload and the use of subtitles. Conclusion The overall quality and reliability of VTE-related short videos were suboptimal. Greater professional involvement and clearer reporting of evidence sources, references, and update information may enhance the educational value of online VTE-related short videos.
Background Myocardial infarction (MI) continues to be one of the leading causes of morbidity and death worldwide. The international normalized ratio (INR) to albumin ratio (PTAR), calculated as INR divided by serum albumin, is a composite biomarker reflecting both nutritional status and coagulation abnormalities. While PTAR has shown prognostic relevance across various severe clinical scenarios, its role in forecasting mortality among critically ill MI patients remains insufficiently defined. The objective of this study was to examine the relationship between PTAR and all-cause mortality, and to evaluate its predictive capability through machine learning models. Methods Data from 1616 critically ill MI patients were retrieved from Version 3.1 of the MIMIC-IV database. The primary and secondary outcomes were 30- and 360-day all-cause hospital mortality. The relationship between PTAR and mortality was evaluated using multivariate Cox regression models, and nonlinear associations were further explored through restricted cubic spline (RCS) analysis. Survival analysis was performed using the Kaplan-Meier method. Feature variables were selected through the Boruta algorithm, and eight machine learning models were constructed to evaluate predictive performance. Results Elevated PTAR levels were independently associated with increased risks of mortality at both 30 and 360 days. In Cox models with full adjustment, participants in the highest PTAR tertile showed a substantially higher risk of mortality relative to those in the lowest category (HR = 2.09, 95% CI: 1.53–2.86 for 30-day mortality; HR = 2.15, 95% CI: 1.69–2.73 for 360-day mortality). RCS analysis demonstrated that the mortality risk increased in a nonlinear fashion with rising PTAR values. Subgroup analyses revealed consistent predictive value across all subgroups. The Boruta algorithm ranked PTAR among the top predictors of mortality. Comprehensively considering the AUC value, calibration curve, and decision curve, the predictive model using LightGBM demonstrated the best performance (AUC = 0.7861). Conclusion Our study revealed a strong positive association between the PTAR and the mortality risk in critically ill patients with MI. Higher PTAR is associated with greater mortality risk. Predictive models based on machine learning demonstrated good performance. These findings suggest that PTAR may serve as a potential predictor of adverse outcomes in critically ill MI patients.
Aim To evaluate whether endothelial activation (soluble intercellular adhesion molecule-1, sICAM-1) and thrombotic activation (thrombin-antithrombin complexes, TAT) markers provide prognostic information beyond standard inflammatory markers for in-hospital mortality in COVID-19 patients with cytokine storm. Materials and methods Prospective cohort study of 47 patients with severe SARS-CoV-2 pneumonia admitted November 2020–February 2021 to District Hospital, Debica, Poland. Patients were stratified by cytokine storm profile (CRP >50 mg/L or IL-6 >30 pg/mL) and survival status. Blood biomarkers included CRP, IL-6, sICAM-1, TAT, d-dimer, and antiphospholipid antibodies. Results Mortality rate was 40.4% (19/47 patients). Among patients with cytokine storm, TAT and sICAM-1 levels were significantly higher in non-survivors versus survivors (TAT: 15.4 (12.2–23.6) ng/mL vs. 11.6 (11.0–14.8) ng/mL, p=0.037; sICAM-1: 12.0 (5.6–35.3) ng/mL vs. 4.3 (2.5–23.9) ng/ml, p=0.033), whereas d-dimer and anticardiolipin IgM did not differentiate mortality outcomes. Elevated TAT was detected in 100% of patients, d-dimer in 93.6%, anticardiolipin IgM in 40.4%, and sICAM-1 in 21.3%. In the multivariable exploratory model based on Firth’s logistic regression, TAT ≥12.14 ng/mL and sICAM-1 ≥4.0 ng/mL emerged as potential independent predictors of mortality (OR: 6.27, 95% CI: 1.31–29.99 and OR: 8.68, 95% CI: 1.22–62.15, respectively). Traditional prognostic factors (diabetes on insulin, and blood desaturation) also discriminated poor outcomes. Conclusions sICAM-1 and TAT were associated with in-hospital mortality within the high-risk subgroup of COVID-19 patients with cytokine storm, suggesting prognostic information beyond conventional inflammatory markers and d-dimer. Given the limited sample size, these exploratory findings should be regarded as hypothesis-generating and require validation in larger, multicentre cohorts before informing risk stratification.
Background Patient response to clopidogrel varies due to CYP2C19 genetic polymorphisms. Impaired metabolism has been linked to an increased risk of recurrent ischemic events. The purpose of this study was to examine CYP2C19 phenotypes and the impact on ADP aggregation in whole blood platelet aggregometry (WBPA) in patients with acute ischemic stroke (AIS). Methods Patients with AIS or transient ischemic attack (TIA) from two academic comprehensive stroke centers between January 2022 and May 2025 were retrospectively reviewed. Inclusion criteria required both CYP2C19 genotyping and WBPA. Categorical variables were compared using chi-square test and continuous variables using Mann-Whitney U test. Multivariable logistic regression identified independent predictors of inadequate platelet inhibition defined by ADP aggregation threshold. Results Among 112 patients (metabolizers: N=62, non-metabolizers: N=50), there was no correlation between CYP2C19 metabolizer phenotype and ADP-induced platelet aggregation (p=0.49). The study found substantial racial (p=0.012) and Hispanic ethnic (p=0.001) differences in metabolizer phenotype. Inadequate platelet inhibition was also associated with age (p=0.020) loading phase (p=0.04), underscoring the need to consider demographic variables, patient characteristics, and the timing of platelet function testing when interpreting platelet reactivity results and making clinical decisions. Conclusion This study found no significant association between an individual’s CYP2C19 metabolizer status and ADP-induced platelet aggregation. The results of this study may help advance understanding of pharmacogenomics, but care must be taken when interpreting them due to this study’s limitations. These findings should be confirmed in a future study.
Background End Stage Renal Disease (ESRD) is the final stage of chronic kidney disease (CKD), where patients retain only <15% of their kidney function. Recent studies on neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) have demonstrated strong predictive utility in ESRD progression; however, there is limited research on ESRD prognosis in relation to additional blood cellular indices. In this study, 11 blood cellular indices, both well-established and lesser-known markers, were evaluated in relation to ESRD as potential prognostic tools. Methods Data was sourced from Loyola University Medical Center (LUMC) clinical database, comparing ESRD patients (n=67) with healthy, non-ESRD ambulatory patients (n=102), randomly identified in 2023. Median, interquartile ranges (IQR), p-values, and fold changes were calculated, clinical and demographic information was collected, and a Spearman correlation matrix was generated on R. Results The Mann-Whitney U test revealed significant differences (p<0.05) in most indices between the two groups, except for the (PLR) with differing fold changes from the healthy ambulatory cohort. The Spearman Correlation matrix indicated weak (0.0-0.2), moderate (0.21-0.6), and strong (0.61-1.0) positive and negative correlations between previously studied indices and indices in this study. Conclusions Despite variability within each cohort, these results highlight the potential of additional blood cellular indices to serve as prognostic markers in ESRD mortality, inflammation, and cardiovascular disease. This study provides the basis for evaluating these indices in a longitudinal manner to assess disease progression.
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are elective procedures that restore quality of life to patients experiencing pain and/or immobility of end stage osteoarthritis, post-traumatic arthritis, or rheumatoid arthritis. Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and is a known complication after joint arthroplasty. Orthopaedic surgeons are as concerned with the complications of postoperative bleeding as they are with the high risk of thrombosis after arthroplasty. Risk stratification allows for patient-specific regimens and has proven to offer both safety and efficacy for thromboprophylaxis, leading to excellent patient outcomes. For patients taking chronic anticoagulants and antiplatelet agents, evidence-based guidelines provide added safety with respect to perioperative management of these medications. Together, surgeons, anesthesiologists, hospitalists, nurses, orthopaedic physician assistants, physical and occupational therapists plus a clinical pharmacy specialist can tailor a medication regimen and discharge plan which is patient-specific, integrating medical evidence with standardized practice.
Background and Aim Thrombotic thrombocytopenic purpura (TTP) is a life-threatening and rare thrombotic microangiopathy (TMA) described as severe thrombocytopenia, microangiopathic hemolytic anemia, and ischemic end-organ injury because of microvascular platelet-rich thrombi. Recent findings show inflammatory conditions such as infection and surgery can be triggers for TTP onset. The aim of this study was to evaluate the diagnostic performance and clinical relevance of hematological inflammatory indices (NLR, PLR, and HPR) in patients with thrombotic thrombocytopenic purpura compared with healthy controls. Methods This case-control study was conducted on 114 TTP patients (90 female and 24 male) and 115 healthy controls from January 2010 to December 2022 in Imam Reza Hospital, Mashhad, Iran. Immune cell counts, inflammatory parameters, and hematological markers including NLR, PLR, and HPR were calculated using the complete blood count at the time of diagnosis and after the treatment. Statistical analyses were conducted by MedCalc, IBM SPSS Statistics version 26 and GraphPad Prism version 9.5.0. Result The result showed that at the time of admission, systemic (70.2%), bleeding (40.4%), and renal (41.2%) symptoms were the most frequent, whereas a lower prevalence of neurological (22.8%) signs and symptoms was observed. White blood cell (WBC) and neutrophil counts were higher in TTP patients (WBC: p< 0.001, neutrophil: p<0.001), and conversely, platelet and lymphocyte counts were higher in the control group compared to TTP patients (platelets: p<0.001, lymphocytes: p<0.001). The indices analysis between the two groups revealed that NLR and HPR were significantly increased in TTP patients (p<0.001), but PLR was significantly reduced in TTP patients (with the mean platelet count of 62.09 ± 55.37× 10 9 /L) compared to the control group (with the mean platelet count of 236.82 ± 43.19× 10 9 /L) (p<0.001). Conclusion Elevated NLR and HPR, together with decreased PLR, were associated with TTP in this cohort and may offer adjunctive diagnostic value alongside established clinical criteria. Confirmation in larger, prospective studies will be important to define their place in routine practice.
Objective To systematically evaluate the interference degree of hemolysis, lipemia, icterus, and sample collection volume on routine test items of the ACL TOP750 automatic coagulation analyzer, assess the technical performance of the HIL module, verify the manufacturer’s anti-interference capability, and establish laboratory-specific anti-interference thresholds for optimizing preanalytical quality management. Methods Gradient interference models of hemolysis, icterus, and lipemia, as well as sample systems with different collection volumes, were constructed. Seven routine coagulation indicators (PT, aPTT, FIB, TT, DD, FDP, AT) were detected, with a relative bias (Bias%) of 10% set as the acceptable standard to comprehensively evaluate the instrument’s anti-interference ability. Results The H-index of ACL TOP750 was highly linearly correlated with hemoglobin concentration, the I-index with total bilirubin, and the L-index with triglyceride concentration (R 2 ≥ 0.951). For hemolysis: TT bias was >10% at H ≥ 650 mg/dL, FIB bias was unacceptable at H ≥ 880 mg/dL, and DD bias was >10% at H ≥ 270 mg/dL. For lipemia, DD bias was >10% at L ≥ 1100 mAbs, and ultracentrifugation effectively improved lipemia interference. For icterus, aPTT bias was unacceptable at I ≥ 35 mg/dL, and PT and FIB biases were >10% at I ≥ 38 mg/dL. At a sample filling ratio of 70% (2.1 mL), biases of several analytes exceeded the acceptable limits; accordingly, 70% was defined as the threshold for sample rejection. Conclusion The HIL module of the ACL TOP750 testing system exhibits excellent performance, and its anti-interference capability meets the manufacturer’s specifications. The optimized HIL index and sample volume anti-interference thresholds established in this study are more in line with clinical practice.
Background In Thai patients with non-valvular atrial fibrillation (NVAF), anticoagulation quality with warfarin remains suboptimal. Existing prediction tools for poor international normalized ratio (INR) control, such as the SAMe-TT 2 R 2 score, perform poorly in this population. Identifying population-specific determinants of time in therapeutic range (TTR) may improve risk stratification and inform clinical decision-making. Methods We conducted a single-center, retrospective cohort study of adult patients with NVAF taking warfarin between 2016 and 2019. TTR was calculated using the Rosendaal method, with a target INR range of 2.0–3.0. Logistic regression analysis was performed to identify independent predictors of suboptimal anticoagulation control (TTR <65%). A novel risk score was derived from the regression coefficients and evaluated using receiver operating characteristic (ROC) curve analysis. Results Among 1,322 patients (median age 68 years; 57% female), median TTR was 50.5% (IQR 29.8–69.0), and 70% had TTR <65%. Independent predictors of suboptimal TTR included age ≥65 years, heart failure, hypertension, and drug–drug interactions with warfarin, while prior warfarin use ≥1 year was protective (all P<0.05). These variables were incorporated into the AHfHDP score (range, −2 to 4). The AHfHDP score showed modest discrimination (C-statistic 0.64; 95% CI 0.61–0.67), outperforming SAMe-TT 2 R 2 (C-statistic, 0.53). Conclusions Warfarin anticoagulation control in Thai patients with NVAF remains suboptimal. The AHfHDP score demonstrated modest predictive performance and superior discrimination compared to the SAMe-TT 2 R 2 score. However, its overall predictive ability remained limited, and external validation is required before clinical application.
Introduction Surgery for acute type A aortic dissection (ATAAD) may expose patients to major bleeding and massive transfusion. We assessed the impact of coagulopathy upon admission, before surgery, on perioperative transfusion requirements and clinical outcomes. Methods We conducted a retrospective single-center study including consecutive patients undergoing emergency surgical aortic repair for ATAAD from August 2017 to July 2022 in a tertiary referral center. We assessed the association between coagulopathy at hospital admission, defined by an International Normalized Ratio (INR) >1.2, and perioperative transfusion requirements and clinical outcomes. Results Among 133 included patients operated for ATAAD, 36 (27%) had coagulopathy at admission. Compared with non-coagulopathic patients, they more frequently presented with preoperative shock and had higher lactate levels at admission. Coagulopathic patients received more intraoperative red blood cell (RBC) transfusions (4 [1.7-7] vs 2 [0-4] units, p=0.009), fresh frozen plasma (FFP) (4 [2.8-6] vs 3 [2-4] units, p=0.028), platelets (5.3 [3.7-8.2] vs 4 [3.2-5.5] x10 11 platelets, p=0.033), and fibrinogen concentrates (3 [2-3.3] vs 2 [1.5-3] g, p=0.019). They also required more RBC transfusion within 48 hours after surgery (5 [3-7] vs 3 [1-4] units, p=0.002) (primary endpoint). ROC analysis showed that INR >1.2 had moderate discriminative ability for predicting intraoperative transfusion of ≥3 RBC units (AUROC 0.68), with high specificity (84%) but limited sensitivity (36%). Postoperative complications were frequent and comparable between groups. Finally, in-hospital mortality rate was 25% in the coagulopathy group versus 16.5% in the group without coagulopathy. Conclusion Admission coagulopathy in ATAAD was associated with increased perioperative transfusion requirements. Preoperative INR may contribute to early transfusion risk assessment, although its limited sensitivity precludes its use as a standalone predictive tool.
Background Sepsis-induced coagulopathy (SIC) is an early stage of disseminated intravascular coagulation (DIC) and is associated with adverse clinical outcomes. The hemoglobin-to-red cell distribution width ratio (HRR) is a novel biomarker that has been found to have predictive value in various diseases. However, its prognostic significance in patients with SIC remains unclear. Methods This retrospective cohort study used the MIMIC-IV database and included ICU patients meeting the Sepsis-3 and SIC criteria. Clinical data within 24 hours of ICU admission were collected to calculate HRR, and patients were categorized into quartiles according to it (Q1: <0.56; Q2: 0.56–0.69; Q3: 0.69–0.82; Q4: ≥0.82). Associations between HRR and 28-, 90- and 365-day all-cause mortality were evaluated using restricted cubic splines, Kaplan–Meier curves, Cox proportional hazards models, and receiver operating characteristic curves. Subgroup and interaction analyses were performed to assess robustness and potential effect modification. Results A total of 5,279 patients with SIC were included in the study. After multivariate adjustment, the lowest HRR quartile was significantly associated with elevated 28-day mortality risk (HR = 1.36, 95% CI: 1.18–1.53, P < 0.001), suggesting that lower HRR levels were linked to higher mortality. This association remained consistent across different time points and was robust in subgroup analyses. Conclusions HRR demonstrated a significant non-linear association with all-cause mortality in patients with SIC, with lower levels indicating a higher risk of death. As a readily available hematological marker, HRR may serve as a practical tool for the early risk assessment in this population.
Background The relationship between onset timing of hospital-associated pulmonary embolism (HAPE) and mortality remains unclear. This study assessed the independent prognostic role of onset timing for 6-month all-cause mortality among HAPE patients, with adjustment for the pulmonary embolism severity index (PESI) and treatment regimens. Methods In this retrospective cohort study, 140 HAPE patients were enrolled. According to onset time, patients were stratified into two groups: in-hospital onset (n = 94) and post-discharge onset (n = 46). Survival curves were plotted via the Kaplan-Meier (KM) methods, and intergroup differences were assessed using the log-rank test. Univariate and multivariate Cox regression were performed. Results Overall, 6-month mortality was 27.1% (38/140). Patients with post-discharge onset demonstrated a substantially higher mortality rate than those with in-hospital onset (39.1% vs. 21.3%, P = 0.026; log-rank P = 0.03). In the univariate Cox model, age, post-discharge onset of HAPE, admitting departments, general anesthesia, pulse rate (PR) ≥ 110 beats per minute (bpm), systolic blood pressure (SBP) < 100 mmHg, oxygen saturation (SpO 2 ) < 90%, altered mental status, intermediate- or high-risk PE risk stratification and higher PESI score were identified as potential predictors of 6-month mortality (all P < 0.1). Multivariate Cox regression revealed post-discharge onset as an independent correlate of 6-month mortality (HR = 1.95, 95% CI: 1.01–3.76, P = 0.046). Subgroup analyses confirmed the robustness of findings. Conclusion Post-discharge onset was identified as an independent risk factor for 6-month all-cause mortality in patients with HAPE. Venous thromboembolism (VTE) assessment before discharge should be emphasized.
Background Calf muscle vein thrombosis (CMVT) is frequently grouped with distal deep vein thrombosis in fracture-related studies, leaving its specific burden and clinical relevance uncertain. This systematic review and meta-analysis evaluated the occurrence, associated factors, and clinical outcomes of CMVT in patients undergoing surgery for hip and lower-limb fractures. Methods PubMed, Embase, Web of Science Core Collection, the Cochrane Library, ClinicalTrials.gov , Google Scholar, and reference lists were searched from inception to June 8, 2026. Eligible studies reported extractable CMVT-related data in patients undergoing surgery or perioperative management for hip or lower-limb fractures. Random-effects meta-analyses were performed using logit-transformed proportions. Risk factors with extractable 2 × 2 data were pooled as unadjusted odds ratios (ORs). Results Eight observational studies involving 3,695 patients were included; seven studies with 3,435 patients contributed to quantitative synthesis. All studies were conducted in mainland China. Overall, 691 CMVT events were reported. The pooled occurrence was 18.2% (95% CI, 12.4%–26.0%; prediction interval, 4.4%–51.6%; I 2 = 96.1%). The pooled preoperative prevalence was 29.1%, whereas the postoperative or perioperative incidence/detection rate was 12.3%. Exploratory pooled analyses showed higher CMVT odds in female patients (OR, 1.53; 95% CI, 1.03–2.29) and in those with intertrochanteric rather than femoral neck fractures (OR, 1.36; 95% CI, 1.10–1.68). Narrative synthesis suggested possible associations with thrombus progression, postoperative complications, prolonged hospitalization, early mortality, and poorer functional outcomes. Conclusion CMVT is relatively common in patients undergoing surgery for hip and lower-limb fractures, particularly when screened preoperatively in older patients with hip fractures. However, because all included studies were observational and conducted in mainland China, and substantial heterogeneity was present, global generalizability is limited. These findings should therefore be interpreted cautiously and confirmed in prospective, multicenter studies.
Background and Aims Atherosclerosis (AS) is associated with high residual cardiovascular risk despite standard treatment. Abnormal homocysteine metabolism and MTHFR polymorphisms are involved in AS progression, but few prognostic models integrate genetic and multidimensional biochemical indicators. This study aimed to develop and validate a prognostic model for major adverse cardiovascular events (MACE) in patients with AS. Methods This single-center observational cohort study enrolled 580 patients with AS confirmed by coronary angiography between January 2023 and January 2026. Baseline data included clinical characteristics, imaging indices, serum biochemical markers, and MTHFR/MTRR genotypes. The primary outcome was MACE. Predictors were screened by LASSO regression, and a nomogram was constructed using multivariable Cox regression. Model performance was evaluated by C-index, calibration curves, and decision curve analysis. Results Over a median follow-up of 24.5 months, 135 patients (23.3%) developed MACE. Independent predictors included MTHFR 677TT mutation, elevated Hcy, low serum folate, Gensini score, CIMT, Lp-PLA2, and diabetes. The model achieved a C-index of 0.885, showing excellent discrimination, good calibration, and favorable net clinical benefit. Conclusion This integrated prognostic model demonstrated good internal discrimination and calibration for predicting MACE in patients with AS. The nomogram provides a practical risk-stratification framework for identifying individuals at high residual cardiovascular risk. However, given the lack of external validation and the inherent risk of optimism bias in single-center studies, these findings should be considered preliminary. Rigorous external validation in diverse, multicenter cohorts is strictly required before this tool can be recommended for routine clinical implementation.
