Abstract Introduction Non-invasive fibrosis scores such as the Fibrosis-4 (FIB-4) index are widely used in routine clinical practice to stratify liver fibrosis risk. However, the interpretation of FIB-4 in older adults is challenging because age is incorporated directly into its calculation and polypharmacy is highly prevalent in this population. This study aimed to evaluate the association between total medication burden and FIB-4-defined risk classification in a real-world internal medicine population, with particular emphasis on patients aged 65 years and older. Methods In this retrospective observational study, 300 adult patients consecutively evaluated in an internal medicine outpatient clinic were included. Demographic characteristics, body mass index, laboratory parameters required for FIB-4 calculation, and medication data were obtained from electronic medical records. Polypharmacy was defined as the concurrent use of five or more active pharmacological agents. Age-adjusted lower thresholds of ≥ 1.30 in patients aged < 65 years and ≥ 2.0 in patients aged ≥ 65 years were used to define above-threshold FIB-4 classification. Comparisons were performed between age groups and, within the older population, according to polypharmacy status. Among patients aged ≥ 65 years, age-inclusive and age-excluded multivariable logistic regression models were evaluated. Results Older patients exhibited a significantly higher total medication burden and higher FIB-4 scores than younger patients. Within the ≥ 65-year age group, polypharmacy was not associated with significantly higher FIB-4 scores or a higher prevalence of above-threshold FIB-4 classification. In the age-inclusive model, total medication burden was not independently associated with above-threshold FIB-4 classification (aOR per active agent: 0.93, 95% CI: 0.78–1.11; p = 0.435). This finding remained unchanged in the age-excluded sensitivity model (aOR per active agent: 1.01, 95% CI: 0.87–1.18; p = 0.882). The age coefficient was not interpreted biologically because age is an explicit component of the FIB-4 equation. Conclusion Among older adults, polypharmacy status was not associated with FIB-4 score or above-threshold FIB-4 classification, and total medication burden was not independently associated with above-threshold FIB-4 classification in either the age-inclusive or age-excluded model. These findings relate to a screening-based risk classification and should not be interpreted as evidence regarding confirmed liver fibrosis or the hepatic effects of individual medications. Because age is incorporated directly into the FIB-4 equation, its association with the outcome should not be interpreted as evidence that age is an independent biological determinant of liver fibrosis.
Abstract Background Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions defined by gastrointestinal inflammation. This study aimed to detect the prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in patients with IBD using non-invasive measures, including laboratory investigations and FibroScan. It also evaluated risk factors for MASLD in this population and investigated the relationship between IBD severity and the degree of hepatic steatosis. Materials and methods A case-control study was carried out on 105 participants who presented to Fayoum University Hospital between May 2024 and January 2026. This included 54 patients with IBD and 51 apparently healthy controls. Patients with IBD were further divided into 5 with CD and 49 with UC, none of whom had a history of chronic liver disease. All participants underwent full medical history, clinical assessment, laboratory investigations, abdominal ultrasound, and FibroScan to measure the Controlled Attenuation Parameter (CAP). Results Receiver operating characteristic (ROC) analysis demonstrated superior diagnostic accuracy for CAP (Area under the curve [AUC] 0.979, sensitivity 93.3%, specificity 97.4% at 225 dB/m) compared to the Hepatic Steatosis Index (HSI) (AUC 0.744, sensitivity 60%, specificity 87.2% at 36.7) in the IBD group. In the control group, ROC analysis revealed perfect diagnostic accuracy for CAP (AUC 1.000, 100% sensitivity/specificity at 217 dB/m) versus good but inferior performance for HSI (AUC 0.805, 82.8% sensitivity, 72.7% specificity at 34.55). Conclusion Our study demonstrates a lower prevalence of MASLD and steatosis in patients with IBD compared to controls. The groups differed substantially in anthropometric and metabolic characteristics, which may have contributed to this difference. No statistically significant association was found between IBD severity and steatosis. Metabolic risk factors appear to drive MASLD overlap, while CAP showed greater apparent discriminative performance than HSI; however, the findings require cautious interpretation given the sample size.
Abstract Objective The benefits of sodium–glucose cotransporter 2 (SGLT2) inhibitors in patients with chronic kidney disease (CKD) or heart failure are well established. However, real-world reports suggest potential acute kidney injury (AKI), conflicting with trial evidence. This study aimed to systematically evaluate the renal safety profile of SGLT2 inhibitors, providing evidence-based support for individualized therapy. Methods Signals of renal adverse events associated with SGLT2 inhibitors were assessed using disproportionality analysis of real-world data from the Food and Drug Administration’s Adverse Event Reporting System. Causal inference was performed with genome-wide association study data through two-sample Mendelian randomization to investigate the potential causal relationships between SGLT2 inhibitor use and renal function indicators. Results Acute kidney injury, renal failure, and renal impairment were the most frequently reported adverse events, with significant and consistent signals indicating positive association between renal injury possibility and SGLT2 inhibitors. In contrast, CKD and end-stage renal disease exhibited negative signals, suggesting lower risk on long-term renal disease. MR analyses demonstrated significant causal associations between SGLT2 inhibitors and multiple renal function parameters, including estimated glomerular filtration rate (eGFR), kidney injury molecule-1 (KIM-1), blood urea nitrogen (BUN) and urinary albumin excretion (UAE). Conclusion This pharmacovigilance study reveals the renal effects of SGLT2 inhibitors, highlighting their relationship with renal injury risk, as well as chronic renal disease. Meanwhile, provides genetic evidence for associations between SGLT2 inhibition and renal function biomarkers. The findings provide evidence to explain early renal function changes during therapy and may facilitate timely identification of renal injury related to SGLT2 inhibitors.
Tumor necrosis factor-alpha (TNF-α) inhibitors have significantly transformed the management of chronic inflammatory diseases. Given the rapid expansion of literature in this field, a bibliometric analysis is essential to identify influential research, key contributors, and evolving trends. This study aimed to analyze the top 100 most-cited articles on TNF-α inhibitors to provide insights into global research patterns and thematic developments. A bibliometric analysis was conducted on the 100 most-cited articles related to TNF-α inhibitors, published between 2002 and 2022. Data were extracted and analyzed for citation counts, annual citation rates, authorship patterns, contributing countries, institutions, journals, and research themes. Quantitative indicators such as total citations and citations per year were assessed alongside qualitative evaluation of study focus and disease distribution. The top 100 articles accumulated a total of 74,115 citations, with citation counts ranging from 135 to 4,017. Research output peaked in the early 2000s, particularly between 2002 and 2006. The United States emerged as the leading contributor, followed by European countries including Belgium and Germany. Prominent authors included Rutgeerts PJ and Sandborn WJ. The majority of studies focused on inflammatory bowel disease, rheumatoid arthritis, and spondyloarthritis, with an emphasis on biologic therapy comparisons. Citation trends showed an early surge followed by a gradual decline, reflecting either maturation of the field or a shift toward newer therapeutic approaches. This study highlights the foundational contributions and evolving trends in TNF-α inhibitor research. The findings provide valuable insight into influential work and emerging directions supporting future research, collaborations, and evidence-based clinical applications.
Abstract Background Immune thrombocytopenia (ITP) represents an autoimmune disorder defined by a dual mechanism of accelerated platelet clearance and compromised thrombopoiesis. Reliable biomarkers for diagnosis and treatment response prediction remain limited. Objective To measure serum level of Fetuin B (FETUB) in patients diagnosed with primary immune thrombocytopenia and assess its diagnostic value and correlation to the response to treatment with corticosteroid. Methodology A total of 60 adult subjects with primary ITP were enrolled in this study (30 steroid responders and 30 steroid resistant) and 20 matched healthy controls. Serum Fetuin-B level was measured using ELISA. Results Serum Fetuin-B concentrations were found to be significantly elevated in ITP patients relative to the control group ( p < 0.001). Diagnostic accuracy was evaluated using ROC analysis, which yielded superior results (AUC = 0.992, sensitivity = 95%, specificity = 100% at 7.8 ng/mL cutoff). But no significant predictive value for the response to the treatment. Conclusion Elevated Fetuin-B in adult patients with ITP supporting its diagnostic value, and its role as a novel biomarker of immune dysregulation.
