Abstract Objectives Pneumatic tube systems (PTS) accelerate clinical blood sample transport but may introduce preanalytical bias through mechanical stress and hemolysis. Effects on neurofilament light chain (NfL), neuron-specific enolase (NSE), cardiac biomarkers, and hemolysis-sensitive analytes remain incompletely defined. We assessed the impact of routine PTS transport on these analytes under controlled paired transport conditions. Methods Paired blood samples from 20 healthy volunteers were transported simultaneously by PTS or manual courier. Three-axis acceleration and temperature loggers quantified transport-associated mechanical stress and temperature exposure. NfL, NSE, cardiac biomarkers, and hemolysis-sensitive analytes were measured using routine diagnostic platforms. PTS and courier results were compared by paired analyses, and percentage bias was calculated relative to courier-transported samples. Results After Benjamini–Hochberg correction, only NfL and lactate dehydrogenase (LDH) remained significantly elevated in PTS-transported samples. Mean biases were 12.01 % (95 % CI, 7.05–16.97 %) for NfL and 10.08 % (95 % CI, 7.23–12.93 %) for LDH. NSE exhibited the largest percentage bias but did not remain statistically significant after correction. Cardiac biomarkers, including troponin-I, N-terminal pro-B-type natriuretic peptide, creatine kinase (CK), CK-MB, and high-sensitivity C-reactive protein, were not significantly affected. Potassium, bilirubin, aspartate aminotransferase, and alanine aminotransferase were likewise not significantly changed. Conclusions PTS transport significantly increased NfL and LDH concentrations, whereas cardiac biomarkers remained constant under the tested conditions. NSE showed a non-significant trend toward higher concentrations after PTS transport. These findings indicate analyte-specific vulnerability to transport-associated mechanical stress and support analyte-specific PTS route validation before routine clinical implementation.
Abstract Background The zlog transformation was developed in 2016 as a method-independent and unit-independent standardization of laboratory results for the German Electronic Health Record (ePA). Based on the assumption of a log-normal distribution and the known lower and upper reference limits, it maps any result to a z-score on a logarithmic scale with a fixed reference interval of −1.96 to +1.96. A prerequisite for valid zlog calculation is that the reference limits entered reflect a true reference interval – not a clinical decision limit or therapeutic target – and have been properly verified for the local analytical method and population. Content Since its publication, the zlog concept has been adopted across a broad range of medical disciplines and analytical applications. We review 19 publications from 2017 to 2025 spanning laboratory medicine, cardiology, neonatology, machine learning, and data visualization, and discuss the growing ecosystem of software tools that support correct reference interval estimation as the necessary foundation. Opinion Beyond its regulatory role in the ePA, the zlog value represents a conceptual bridge between clinical and laboratory medicine, as well as data science and artificial intelligence. Color-coded longitudinal laboratory reports based on zlog values can intuitively communicate complex clinical trajectories, as illustrated by an intensive care example. Standardization at the level of individual measurements is a prerequisite for meaningful multivariate analysis, automated interpretation, and interoperable data exchange across research repositories and public health systems. Outlook The log-normal assumption underlying zlog is examined critically, and a more flexible Box-Cox transformation is identified as a promising but statistically challenging refinement. The zlog framework is further proposed as the natural foundation for extending univariate reference intervals to multivariate reference regions.
Abstract Objectives Hemoglobinopathies are among the most common monogenic disorders worldwide and are a significant global health problem. However, diagnosing these disorders, especially those involving complex genotypes ( HBA/HBB ), is challenging. This issue must be addressed, even in regions with historically low disease prevalence. Methods 565 patients were tested for hemoglobinopathies using functional and genetic methods. In addition to a complete blood count, clinical chemistry parameters, and hemoglobin high-performance liquid chromatography, Sanger sequencing and MLPA were performed to detect pathogenic variants in the HBA and HBB gene cluster. Results As part of our routine diagnostic procedures, we have tested 565 patients for hemoglobin abnormalities between 2010 and 2025. 374 (66.2 %) carried at least one pathogenic variant, 88 (15.6 %) had a combined disorder, which is a combination of qualitative and quantitative globin chain defects or defects in the HBA and HBB gene clusters. 20 retrospectively selected cases are presented here. Conclusions Molecular hemoglobinopathy/thalassemia diagnostics should always be performed alongside functional tests such as a complete blood count, testing for iron deficiency, and hemoglobin analysis. However, a functional evaluation without genetic confirmation of the abnormalities is equally insufficient, particularly with regard to assessing the severity of the condition and providing genetic counseling for the family. Consistent findings in functional and molecular analyses ensure high sensitivity and specificity of the testing strategy even in complex syndromes.
Abstract Laboratory medicine is central to modern healthcare while facing growing workforce shortages, increasing diagnostic complexity, and rising regulatory demands. In Germany, the situation is further complicated by heterogeneous and largely non-academic postgraduate training pathways for natural scientists, which lack integration within a unified academic framework and do not culminate in a formally recognized academic degree. This fragmentation results in inconsistent competency profiles, limited professional recognition, and frequently observed gaps in fundamental medical knowledge. At the same time, European initiatives for harmonization of specialist training among EU Countries led by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), including the syllabus, the Register of Specialists, and the proposed Common Training Framework (CTF), emphasize the need for harmonized, competency-based education of specialists in Laboratory Medicine aligned with formal academic qualification structures. This article analyses the current training landscape in Germany and identifies structural gaps with respect to the EFLM Syllabus and the proposed CTF. It proposes the postgraduate Master’s programme “Medical Laboratory” within specialization training to address these challenges by strengthening medical knowledge alongside scientific and methodological competencies. When integrated with professional society–based specialist training, the programme provides a formally recognized academic framework that enhances coherence and transparency in qualification pathways. The programme is designed in accordance with the EFLM Syllabus and the competencies defined in the proposed EFLM CTF. By integrating medical foundations, diagnostic principles, and professional practice, it complements existing specialist training pathways while promoting transparency, professional mobility, and the recognition of Specialists in Laboratory Medicine across Europe. In conclusion, such programmes represent a key structural element for workforce development and European alignment.
Abstract Personalized medicine has advanced in diabetology over the past decade. Diabetes is diagnosed based on measures of glycaemia, i.e. glycated hemoglobin (HbA 1c ) and glucose, and the classification distinguishes type 1, type 2, gestational diabetes, and specific forms. Especially type 2 diabetes has clinically long been recognized as a heterogeneous metabolic disorder driven by diverse pathophysiological mechanisms. Data-driven approaches have identified distinct sub-phenotypes, offering a more nuanced understanding of diabetes and prediabetes heterogeneity. Identified subgroups differ in clinical characteristics, the risk of disease progression and developing long term complications. Implementing pathophysiology-based classification and emerging therapeutic decision tools requires additional laboratory biomarkers to estimate beta-cell function and insulin resistance. Fasting C-peptide has emerged as the most informative and broadly applicable biomarker and analytical comparability between laboratories has become a prerequisite for translating research findings into guidelines and clinical practice. Efforts to standardize C-peptide measurement have shown that results from different laboratories and assay manufacturers vary widely, even when using the same WHO reference material. Studies consistently demonstrate that recalibrating assays with serum-based, matrix-appropriate reference samples – rather than pure reference reagents – greatly improves agreement across methods. Although a full reference measurement system is now available, significant variability persists and broad implementation remains incomplete despite compelling evidence supporting its effectiveness. The remaining challenge is therefore no longer the development of appropriate reference materials or analytical procedures, but their consistent implementation across manufacturers. Addressing this final step is essential for enabling personalized diabetes care and will ultimately benefit both patients and manufacturers by improving clinical decision-making.
Anti-neutrophil cytoplasmic antibody (ANCA)-positive infective endocarditis (IE) frequently mimics primary ANCA-associated vasculitis, particularly in subacute presentations with renal involvement, and may lead to diagnostic delay or inappropriate immunosuppression. From a laboratory perspective, we reviewed published individual case reports of ANCA-positive IE with explicit microbiological identification and reported outcomes. Fifty-two cases were analyzed using a structured dataset focusing on pathogen distribution, blood-culture status, ANCA assay patterns, renal manifestations, and immune-complex–associated serologies. Bartonella species were the most common pathogens (16/52, 30.8 %) and were uniformly associated with culture-negative IE (16/16, 100 %), contributing substantially to the overall frequency of culture-negative cases (21/52, 40.4 %). PR3-ANCA–predominant results accounted for 78.8 % of cases, whereas MPO-ANCA predominance was rare (1.9 %). Renal involvement was frequent: acute kidney injury occurred in 73.1 % of patients, and rapidly progressive or crescentic glomerulonephritis in 55.7 %. Immune-complex–related findings were common, including hypocomplementemia (59.6 %), rheumatoid factor positivity (44.2 %), and cryoglobulinemia (26.9 %); renal pathology was heterogeneous, with both immune-complex and pauci-immune patterns reported. These case-level data highlight a distinct laboratory signature of ANCA-positive IE characterized by Bartonella-driven culture-negative infection, PR3-ANCA predominance, and severe renal involvement – features that promote diagnostic anchoring toward vasculitis. Integrated laboratory diagnostics, including early laboratory–clinician communication, context-aware interpretation of ANCA results, optimized blood-culture strategies, and targeted testing for fastidious organisms (notably Bartonella), in conjunction with echocardiographic evaluation, are essential to improve diagnostic accuracy and avoid inappropriate immunosuppression.
Objectives: Isovaleric acidemia (IVA) disrupts leucine metabolism and can lead to life-threatening neonatal metabolic crises. Biallelic IVD gene variants cause IVA. This case report describes two novel IVD variants in an Iranian neonatal case. Methods: A 5-day-old Iranian male neonate was referred to the Children Medical Center due to poor feeding, lethargy, and progressive encephalopathy. A comprehensive clinical evaluation was performed. Isovalerylcarnitine (C5) quantification was performed from dried blood spots (DBS) using flow injection analysis tandem mass spectrometry (FIA-MS/MS), and urine organic acid analysis was conducted via gas chromatography-mass spectrometry (GC-MS). Metabolic screening was applied followed by whole IVD gene sequencing, parental segregation analysis, and in silico structural pathogenicity assessments. Results: The child was presented with metabolic acidosis, hyperammonemia (>700 mu mol/L), and elevated C5 (11.5 mu mol/ L). Two novel variants were detected: c.883A>T (p.M295L) and c.1138+6T>G, alongside four benign SNPs. Parental testing confirmed autosomal recessive inheritance. Structural modeling predicted that p.M295L may alter the enzyme's alpha-helical configuration and surface solvent accessibility (C-score: -0.57), potentially impairing catalytic activity. Conclusions: This case expands the IVD mutational spectrum and highlights two novel variants, underscoring the critical role of molecular diagnostics in confirming diagnosis and guiding genetic counseling. Although newborn screening (NBS) is generally effective, the early neonatal symptoms in this case occurred before NBS results were available, precluding any direct screening benefit. Prompt recognition and tailored metabolic management remain essential to improve clinical outcomes.
Objectives: The anti-TPO assays are known for the method variability. The new aTPOII assay (Siemens Healthineers) has a different TPO antigen and detecting antibody source and it is also traceable to another international standard compared to the old aTPO assay (Siemens Healthineers). The aims of this study were to verify the new assay through a method comparison (n=860) with the old aTPO assay from the same manufacturer and to verify the reference range (n=60) on Atellica Immunoanalyzer (Atellica IM). Methods: A total of 860 patient serum samples were measured using the Atellica IM aTPO and Atellica IM aTPOII assays and the positive percent agreement, negative percent agreement, and overall percent agreement (OPA) were calculated along with their corresponding 95 % confidence interval (CI). The reference interval verification on 60 euthyroid patient samples was done. Results: In view of the substandard quantitative agreement between methods, a qualitative assay comparison was performed and demonstrated that there was good sensitivity (81.5 %; 95 % CI: 77.1-85.3 %), specificity (99.6 %; 95 % CI: 98.6-99.9 %) and OPA (92.6 %; 95 % CI: 90.6-94.1 %). The computed Cohen kappa was 0.84 (95 % CI: 0.80-0.88) which reflects a very good strength of qualitative agreement. The manufacturer's reference interval (cut-off <= 13.8 U/mL) was verified and confirmed. Conclusions: Using the new aTPOII assay more patients will have negative results. Even though assays claim to be referenced to the corresponding WHO International reference preparation, this standardization does not ensure cut-offs and/ or results that are identical and does not guarantee method agreement and assays could not be used interchangeably.
Objectives The Acinetobacter baumannii complex (ABC) is a hospital-acquired pathogen that exhibits high resistance, particularly to beta-lactam antibiotics. The rise of beta-lactamase enzymes, including carbapenemases, limits treatment options. New beta-lactam/beta-lactamase inhibitor (BL-BLI) combinations show promise, but information on their use in Indian hospitals is inadequate. The current study was designed to investigate the effectiveness of BL-BLI against ABC isolates, assess the impact of co-harboring various resistance genes on antibiotic effectiveness, and map the distribution pattern of these genes in clinical A. baumannii strains obtained from patients admitted at different wards and units of a tertiary care hospital using cluster analysis.Methods For the study, a total of 155 non-repetitive ABC isolates were isolated from specimens (n=9,753) collected from various critical care units and different inpatient departments of a tertiary care hospital. Antimicrobial susceptibility testing was performed on the isolates using Vitek-2 and Kirby-Bauer disc diffusion methods. Conventional PCR was performed to identify beta-lactamase genes, including blaCTX-M, blaTEM, blaKPC, blaNDM, blaOXA-48, and blaOXA-23. The genetic relationships between ABC and the respective hospital wards from which they were isolated were studied using a dendrogram.Results Among BL-BLI combinations, sulbactam-durlobactam showed the highest effectiveness against blaOXA-23, blaKPC, and blaOXA-48 producing ABCs. However, it had limited activity against blaNDM-positive strains, whether alone or in combination. The PCR results reveal that the most widespread genes were blaOXA-23 (65.1 %) and blaNDM (60 %), respectively.Conclusions The high prevalence of carbapenemase genes in ABC isolates, which underscores the limited effectiveness of newer BL-BLI against NDM-positive strains.
Objectives Triton X-100 is a nonionic surfactant used for solvent/detergent viral inactivation, disrupting lipid-enveloped viruses while preserving proteins. At 1 % in plasma, it inactivates SARS-CoV-2 within 10 min with >= 6 log10 titer reduction and is compatible with many immunoassays. Because LC-MS/MS bile acid analysis relies on chromatographic resolution, detergents could alter analytes via mixed micelle formation and matrix effects, making the effect of Triton X-100 on bile acid measurement clinically important yet untested.Methods We assessed 1 % Triton X-100 on LC-MS/MS bile acid quantification in serum from three critically ill, SARS-CoV-2-negative adults. Serum aliquots were untreated or incubated with 1 % Triton X-100, spiked with deuterated internal standards, extracted with methanol, and analyzed by HPLC-ES-MS/MS using water and an acetonitrile/methanol mobile phase with 0.1 % formic acid and 20 mM ammonium acetate. Analytes were quantified by retention times, MRM transitions, and peak areas normalized to internal standards in SCIEX OS Software.Results and conclusions Bile acid concentrations in treated vs. untreated samples were compared using Mann-Whitney U and Bland-Altman analyses. Differences were minimal and not statistically significant, indicating that 1 % Triton X-100 inactivation preserves LC-MS/MS bile acid quantification while improving biosafety.
Objectives As our understanding of the pathophysiology of migraine continues to improve, so too do targeted treatments. It is now known that vasoactive neuropeptides, including calcitonin gene-related peptide (CGRP), play a role in migraine pathophysiology and CGRP antagonists are utilized in treatment. Urotensin II (U-II) represents the most potent vasoconstrictor peptide and research into its association with migraine remains scarce. The current study endeavors to elucidate the biochemical mechanisms which underpin migraine pathophysiology.Methods The study comprised patients suffering from migraine and tension-type headache alongside a healthy control group. The control group was selected from healthy volunteers of matching gender and age. In the interictal period, plasma samples were collected from patients with migraine and tension-type headache. The study compared plasma U-II levels of 33 migraine patients, 30 tension-type headache patients, and the control group.Results Plasma U-II levels were significantly higher in the migraine group compared to both the tension-type headache group and the control group. Furthermore, plasma U-II levels were slightly higher in the tension-type headache group than in the control group, however, a statistically significant difference was not observed.Conclusions These preliminary findings suggest that U-II may be involved in migraine pathophysiology. Higher interictal plasma U-II levels in the migraine group support further investigation of U-II as a possible biomarker candidate. However, given the cross-sectional design and limited sample size, these results should be considered hypothesis-generating and require confirmation in larger prospective studies.
Objectives Bronchoalveolar lavage (BAL) is a key diagnostic tool for evaluating pulmonary disorders. Manual microscopy is the reference standard for BAL cytology but is time-consuming. Although automated digital morphology platforms such as the Sysmex DI-60 Body Fluid (BF) application module have shown promise for other BFs, their performance in BAL analysis has not been systematically assessed. Therefore, we compared the performance of the Sysmex DI-60 BF application to manual microscopy for BAL differential white blood cell (WBC) counting and morphological assessment.Methods We evaluated 50 BAL samples processed according to standardized laboratory protocols for WBC counts and morphological features such as blood contamination, macrophage characteristics and epithelial cells. Cytospin slides stained with May-Gr & uuml;nwald-Giemsa were analyzed using the DI-60 BF application. WBC were first automatically classified ('pre-classification') into neutrophils, lymphocytes, monocytes/macrophages and eosinophils. Trained technicians reviewed and corrected classifications ('post-classification'). Manual microscopy on parallel slides served as the reference method.Results DI-60 post-classification results showed moderate to strong correlations with manual counts across WBC subtypes (rho=0.643-0.979). Bias of digital microscopy compared to manual microscopy was minimal for all WBC classes (range, -2.36 % to +2.56 %). Morphological assessments demonstrated 98-100 % agreement.Conclusions The BF module of the Sysmex DI-60 analyzer provided accurate BAL differential counts and morphological assessments with minimal bias compared to manual microscopy. Hence, the DI-60 may represent a useful alternative for BAL cytology within a routine laboratory workflow, provided optimized pre-analytical preparation and expert review for atypical cases are maintained.
Objectives Diabetic kidney disease (DKD) is a prevalent complication of diabetes mellitus and a leading cause of end-stage renal disease worldwide. The C-reactive protein/high-density lipoprotein cholesterol (CRP/HDL-C) ratio (CHR) is a novel inflammatory-lipid composite index. We aim to determine whether it is an independent risk factor for DKD. Methods This study analyzed data from 2,621 participants in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2020. We employed weighted logistic regression, interaction effect assessments, and smooth curve fitting to verify the research objectives. Results There was a positive association between the CRP/HDL-C ratio and the incidence of DKD, post-adjustment for possible confounding variables. Elevated levels of CHR correlated with a heightened risk of developing DKD (odds ratio=1.12; 95 % confidence interval=1.02-1.23, p<0.05). Conclusions Our findings reveal a significant positive correlation between CHR and DKD among patients with type 2 diabetes mellitus. CHR serves as an independent risk factor for DKD.
Objectives Faecal calprotectin levels closely reflect the quantity of neutrophils within the intestinal lumen, enabling the sensitive detection of acute inflammatory responses in the gut. A novel, automated chemiluminescent immunoassay (CLIA) was developed for the quantification of faecal calprotectin.Methods All CHORUS CLIA Calprotectin reagents, both reagents and the recombinant protein used for the calibration of the test, were produced in-house. To validate the assay, the limit of detection (LoD) and quantification (LoQ), precision, and reliability were determined. The assay was compared with the Calprest (R) NG (Eurospital n. 9,069) by Spearman's correlation coefficient, Passing-Bablok, and Bland-Altman analyses.Results The assay was linear in the concentration range between the LoQ, and no differences emerged in the intra-assay and inter-assay precision; the LoD was 22.2 mg/kg. Compared to Calprest (R), CHORUS CLIA Calprotectin showed excellent agreement: the Passing Bablok equation was y=-0.5177 + 0.9954x with a Spearman correlation coefficient of 0.98 (95 %CI: 0.97-0.98). In the Bland-Altman test, the mean difference was -4.38 (95 %CI: -18.174-9.408) with upper and lower limits of 135.96 and -144.73, respectively.Conclusions CHORUS CLIA Calprotectin was accurate and reliable in determining the concentration of faecal calprotectin and may become a useful tool in clinical practice. The assay proves to be highly precise, robust, and capable of accurately measuring calprotectin across the full clinical range, reliably distinguishing between physiological and pathological levels. Comparative analysis confirms that the CHORUS CLIA Calprotectin assay delivers results in strong agreement with Calprest NG used as the reference method.
Objectives This study aimed to characterize proteome in serum and liver samples from women with morbid obesity (MO) and metabolic dysfunction-associated steatotic liver disease (MASLD) to identify proteins and metabolic pathways. Methods HPLC-MS/MS proteomics was performed on serum and liver samples from 174 women with MO, classified by hepatic histology into three group: normal liver (NL, n=44), simple steatosis (SS, n=66) and metabolic dysfunction-associated steatohepatitis (MASH, n=64). All MASH cases presented mild-moderate hepatic inflammation without fibrosis. Results Serum proteomics identified 257 proteins. In MASLD group, we found most increased levels (log2FC>1.6) of fructose-bisphosphate aldolase, clusterin and collectin-10, and most decreased levels (log2FC < -1.6) of Adiponectin and sex hormone-binding globulin compared with NL group. These proteins were mainly linked to three complement cascade pathways: regulation (33.33 %), initiation (33.33 %) and activation (33.33 %). Liver proteomics identified 2,081 proteins. Comparative liver proteomics between MASLD, SS or MASH groups and NL did not reveal significant differences. However, comparison between MASH and SS identified 72 significantly upregulated and 84 downregulated proteins. Biological processes enrichment analysis of these protein groups revealed that these proteins were mainly involved in these pathways: amino acid metabolism (31.25 %), antimicrobial defense (20 %) and fatty acid metabolism (17.5 %) and others. Conclusions This study identifies serum and liver proteome that could be associated with MASLD and MASH. The study of these proteins and their associated metabolic pathways may be useful for physiopathological research. These findings warrant further validation in independent and diverse cohorts.
Objectives Direct patient access to laboratory results and the widespread use of AI-based chatbots for medical information have shifted laboratory value interpretation into digital, largely unsupervised settings. Because numerical laboratory values are only meaningful when interpreted against appropriate reference intervals, this study investigated whether laypersons provide this essential context when seeking online advice. Methods A retrospective analysis was conducted of 207 complete blood count-related questions posted on the Reddit forum AskDocs between October 2021 and May 2023. Extracted variables included self-reported age and gender, title and text length, and the presence or absence of reference intervals and units. Descriptive statistics and group comparisons were performed using nonparametric tests. Results In 55 % (114/207) of the laboratory medicine-related questions, no reference intervals were provided, and in 51 % (106/207) no units were specified. The inclusion of units was a strong predictor of the presence of reference intervals (OR=5.03; 95 % CI 2.81-9.22; p<0.001). Posts that included reference intervals were significantly longer than those without such information (median 160 vs. 126 words; p=0.004). Age and sex did not differ significantly between the groups. Conclusions Layperson inquiries about laboratory results in online health forums frequently lack essential contextual information required for valid interpretation. The widespread omission of reference intervals and units underscores persistent challenges in health literacy and highlights the need for improved laboratory reporting formats and patient-oriented interpretive support.
Objectives The utility of plasma methylated septin 9 (mSEPT9) as a biomarker for colorectal cancer (CRC) surveillance is underexplored. The aim of this study was to evaluate its role in recurrence monitoring and prognostic assessment among Chinese CRC patients.Methods A total of 315 patients with CRC and 142 subjects with benign colorectal polyps from August 2019 to August 2023 were enrolled. Post-operative mSEPT9 testing was performed, with recurrence-free survival (RFS) measured from surgery to recurrence.Results The sensitivity and specificity of post-operative mSEPT9 in identifying recurrent CRC (n=67) versus non-recurrent (n=248) were 85 and 96 %, respectively. mSEPT9 (area under the curve, AUC: 0.91) outperformed CEA (AUC: 0.74), CA19-9 (AUC: 0.66), CA72-4 (AUC: 0.55), and combined biomarkers (AUC: 0.85) in detecting recurrence. The detection rate of mSEPT9 declined most post-surgery, indicating tumor load reduction. mSEPT9 positivity within one year post-operatively was strongly linked to poorer RFS (hazard ratio, HR: 17.20), with a stronger predictive power than CEA (HR: 4.73) and CA19-9 (HR: 3.38). After adjusting for covariates, only mSEPT9 within one year post-operatively remained significantly associated with RFS (adjusted HR: 15.20).Conclusions Plasma mSEPT9 shows superior potential for CRC recurrence surveillance over traditional markers and may serve as a reliable indicator of surgical treatment efficacy and prognostic assessment in CRC patients.
Objectives Endothelial dysfunction plays a pivotal role in the pathophysiology of acute coronary syndromes (ACS), contributing to vascular instability and impaired perfusion. The endothelial activation and stress index (EASIX), originally developed for hematologic conditions as a marker of endothelial stress, has recently attracted interest in cardiovascular prognostication. However, its utility in ACS remains insufficiently defined. This study aimed to evaluate the prognostic performance of the original EASIX and its simplified (s-EASIX) and modified (m-EASIX) variants in predicting 30-day in-hospital mortality in ACS patients.Methods We retrospectively analyzed 368 patients with ACS admitted to a coronary intensive care unit between June 2022 and June 2024. EASIX-based scores were calculated from admission laboratory parameters. The primary endpoint was all-cause in-hospital mortality, defined as death occurring during hospitalization or within 30 days of admission. Predictive accuracy was assessed using receiver operating characteristic (ROC) curve analysis, multivariate Cox regression, and model fit via Akaike information criterion (AIC).Results In-hospital mortality occurred in 19 patients (5.2 %). All three scores were significantly higher among non-survivors (p<0.01). m-EASIX demonstrated the highest AUC (0.818) and sensitivity (88.2 %), followed by EASIX (AUC: 0.789) and s-EASIX (AUC: 0.709). In multivariate Cox analysis adjusted for conventional clinical variables, all scores independently predicted mortality, with s-EASIX yielding the highest hazard ratio (HR=2.149; p<0.01). EASIX achieved the best model fit (AIC=123.123).Conclusions EASIX and its variants are independent predictors of short-term mortality in ACS. Among them, the original EASIX exhibited the most consistent overall performance, supporting its potential role in early risk stratification of critically ill cardiac patients.
