Background/Aim:Rapid risk stratification is crucial in managing upper gastrointestinal bleeding (UGIB). This study evaluated the prognostic value of the age-adjusted shock index (ASI), blood urea nitrogen (BUN)/haemoglobin ratio and BUN/platelet ratio for predicting adverse clinical outcomes. Materials and Methods:This single-centre retrospective observational cohort study included 204 adult patients (age ≥ 18 years) presenting to the emergency department with UGIB between 1 January 2022 and 31 December 2022. Patients with oesophageal variceal bleeding, lower gastrointestinal sources, trauma, pregnancy, malignancy, prior diagnosis at another institution or incomplete data were excluded. Receiver operating characteristic (ROC) curve analysis was the primary statistical method used to determine prognostic performance. Results:Among the 204 included patients, the intensive care unit (ICU) admission rate was 14%, and the in-hospital mortality rate was 5.4%. ROC curve analyses for in-hospital mortality revealed statistically significant predictive capabilities across all evaluated parameters. The BUN/haemoglobin ratio demonstrated an area under the curve (AUC) of 0.779 at an optimal cut-off of > 8.45, yielding a high negative predictive value (NPV) of 97.26%. The BUN/platelet ratio produced an AUC of 0.747 at a cut-off of > 0.17, with an NPV of 98.32%. Additionally, the ASI achieved an AUC of 0.780 at an optimal cut-off of > 61.72 and an NPV of 98.03%. Conclusion:The ASI, BUN/haemoglobin and BUN/platelet ratios are rapid, inexpensive and easily calculable parameters upon admission. Their notably high NPVs make them effective complementary tools to established scoring systems, aiding clinicians in safely identifying low-risk patients who can be managed in the general ward rather than the ICU.

Aim: To evaluate the quality and ergonomic impact of three infant chest compression techniques the two-thumb encircling technique (TTHT), the cross-thumb technique (CTT), and the one-hand open-palm technique (OHT) during two-rescuer infant cardiopulmonary resuscitation (CPR) utilizing a 15:2 compression-to-ventilation ratio. Materials and Methods: This prospective, randomized, crossover simulation study included 50 registered nurses who performed three 2-minute CPR sequences on an infant manikin, each using one of the three techniques. The primary outcomes were the depth of the compression, the percentage of target-range compressions, and the chest compression fraction (CCF). Secondary outcomes encompassed compression rate, recoil, hand position accuracy, excessive compressions, fatigue, pain, perceived difficulty, and hand slippage. We used repeated-measures statistical models to look at the data. Results: Both thumb-based methods (TTHT and CTT) yielded significantly deeper compressions, elevated proportions of target-range compressions, increased CCF, and enhanced accuracy in hand positioning in comparison to OHT (all p<0.01). TTHT and CTT exhibited similar mechanical performance in all primary outcomes. However, CTT had much less fatigue, hand pain, and perceived difficulty than TTHT (all p<0.01). OHT caused shallower compressions, the lowest CCF, more over-depth compressions, and the highest rate of hand slippage. Conclusion: During two-rescuer infant resuscitation, TTHT and CTT are better than OHT at biomechanical CPR quality. CTT has the same compression quality as TTHT but is more comfortable to use, making it a good choice when thumb-based techniques are feasible. OHT should only be used when it is not possible to wrap the chest. More clinical studies are needed to support these simulation results.

BACKGROUND:The de Winter (dW) pattern, sign, and syndrome is an ST-elevation myocardial infarction (STEMI) equivalent. The first two forms describe the electrocardiographic characteristics of this phenomenon, while dW syndrome additionally has symptoms indicative of acute coronary syndrome. Emerging evidence suggests that dW pattern precedes or alternates with STEMI patterns. AIM:To improve the recognition of the dW pattern, dW sign, or dW syndrome, urge early aggressive treatment, and determine whether sex matters, by integrating contemporary knowledge through a systematic scoping review and data analysis. METHODS:A comprehensive search was conducted across PubMed/MEDLINE and Google Scholar (November 2008 to June 2025), and literature data were analyzed. This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews checklist. RESULTS:A total of 322 patients presenting with dW pattern were identified. Most patients were young males. Risk factors were primarily smoking, hypertension, and dyslipidemia. Sixteen cardiac arrest events occurred during hospitalization. The main culprit vessel was the left anterior descending artery (LAD) at 88.5%. Compared with the younger group, older patients had more LAD (84% vs 80%) and right coronary artery involvement (4% vs 1.0%). Left main coronary artery occlusion was more prevalent in the younger group (5.0% vs 2.4%). The frequency of total or near-occlusion of LAD and left main coronary artery was similar in the two age groups. Males showed a higher rate of severe LAD stenosis than females did (45.2% vs 17.7%). dW pattern followed by STEMI was noted in 40 cases, STEMI followed by dW pattern in 8 cases, and simultaneous STEMI and dW pattern in 10 cases. The overall mortality rate was 3%. CONCLUSION:dW pattern, dW sign, and dW syndrome are commonly used interchangeably describing the dW phenomenon. Patients presenting with this phenomenon have unique demographics, risk factors, pathophysiology, and angiographic characteristics (i.e., distinct culprit lesions and coronary artery involvement). Early identification with a high index of suspicion is crucial and necessitates urgent intervention.

This study aims to compare emergency physicians' performance with that of general-purpose large language models (LLMs), such as ChatGPT and Gemini, for pneumothorax (PTX) detection on chest radiographs (CXRs). This single-center, retrospective study of adults was conducted between January 2015 and February 2025 and included 265 PTX cases and 267 non-PTX controls. Exclusions included diagnoses made only by computed tomography, absence of CXR, initial treatment at another center, or incomplete data. Thirteen emergency physicians independently and blindly reviewed CXRs and recorded a binary decision. ChatGPT and Gemini evaluated the same images with a standardized yes/no prompt, with memory cleared between cases to prevent carryover. The primary outcome was LLM diagnostic performance for PTX, while the secondary outcome compared LLMs with physicians. ChatGPT and Gemini exhibited distinct diagnostic performance profiles for PTX detection on CXRs. Gemini demonstrated a sensitivity of 52.5%, whereas ChatGPT demonstrated a sensitivity of 44.5%. Conversely, ChatGPT achieved a specificity of 95.5% and an overall accuracy of 70.1%, while Gemini demonstrated a specificity of 79.0% and an accuracy of 65.8%. Agreement with the reference standard was moderate for ChatGPT, with a kappa value of 0.401, and fair for Gemini, with a kappa value of 0.315. Increasing case difficulty was associated with a reduction in diagnostic accuracy for both models, with correlation coefficients of - 0.438 for ChatGPT and - 0.274 for Gemini. For contextual clinical comparison, emergency physicians demonstrated a sensitivity of 64.5%, a specificity of 99.6%, and an overall accuracy of 82.1%. This study demonstrates model-specific differences in PTX detection by general-purpose AI systems, with Gemini showing higher sensitivity and ChatGPT showing superior specificity and accuracy, both declining with increasing case difficulty. Physician performance remained higher, but was secondary for context. Despite their accessibility and low cost, these models should be considered only adjunctive tools until task-specific optimization and clinical validation are achieved.

Background/Objectives: Renal denervation (RDN) has re-emerged as an adjunctive treatment option for patients with uncontrolled or resistant hypertension, with contemporary sham-controlled trials showing a modest but reproducible reduction in out-of-office blood pressure. However, in routine practice, apparent treatment resistance often reflects pseudoresistance caused by the white-coat effect, poor measurement quality, therapeutic inertia, or nonadherence. This review aimed to summarize the contemporary evidence on renal denervation in uncontrolled or resistant hypertension and to propose a pragmatic, measurement-first framework for patient selection, integration into routine care, and a structured post-procedural response assessment. Methods: This article is a narrative, implementation-focused review. A structured search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was performed from database inception through January 2026. We prioritized the randomized sham-controlled RDN trials, major meta-analyses, guidelines, consensus documents, and studies addressing ABPM, HBPM, medication adherence, and telemonitoring. Results: The contemporary sham-controlled trials support RDN as an adjunctive option with a modest blood pressure-lowering effect, which is best assessed by out-of-office measurements. The placebo-adjusted reductions in ambulatory systolic blood pressure were generally in the 4-6 mmHg range. Appropriate use requires the confirmation of sustained uncontrolled hypertension, the exclusion of pseudoresistance, the optimization of treatment, and an adherence assessment. We identified three phenotypes most likely to benefit and proposed a three-axis framework for a response assessment at 3 and 6 months. Conclusions: RDN should be viewed not as a substitute for antihypertensive therapy but as a program-based adjunct for carefully selected patients. The measurement-first care pathway presented here should be interpreted as a pragmatic clinical model intended to operationalize the available trial and guideline evidence in routine care, rather than as a prospectively validated algorithm or formal consensus recommendation.

Objectives:This study primarily aimed to evaluate the association of EDACS and GRACE scores with angiographically significant coronary lesions in patients presenting with NSTEMI. The secondary objective was to assess their relationship with 30-day mortality. Methods:This retrospective single-center study included adults diagnosed with NSTEMI between January 2022 and December 2024. Demographic and clinical characteristics, GRACE and EDACS scores, angiographic findings, and 30-day mortality were obtained from electronic hospital records. Significant coronary lesions were defined as ≥70 % stenosis or the need for stent placement. Statistical analyses included Mann-Whitney U, Chi-square, logistic regression, and ROC analyses. Results:Among 332 patients, both GRACE and EDACS scores were significantly higher in non-survivors. GRACE high-risk classification was strongly associated with mortality, whilst EDACS (≥16) showed a non-significant trend. EDACS demonstrated superior discriminatory ability for significant coronary lesions, whereas GRACE was more closely associated with mortality risk. An EDACS cut-off >12.5 yielded 87.7 % sensitivity and 40.0 % specificity. Logistic regression identified male sex, hypercholesterolaemia, EDACS ≥16, and systolic blood pressure as independent predictors of significant lesions. Conclusions:GRACE predicted mortality, whereas EDACS better identified significant coronary lesions; combined use showed marginal improvement in model fit but did not significantly enhance discriminatory performance.

Cardiogenic pulmonary edema (CPE) is a serious condition that can result in impaired gas exchange and acute respiratory failure, often leading to high mortality. Diuretics are considered to be the cornerstone of CPE treatment. The doses of furosemide should be individualized according to the patient status and response. Lung ultrasonography has emerged as a reliable bedside tool for diagnosing and monitoring pulmonary congestion. By considering the extent of extravascular lung water and the inferior vena cava (IVC) size, clinicians can obtain objective data to guide them in determining the appropriate level of diuresis for the safe and effective treatment of pulmonary edema. However, data on the use of structured ultrasound protocols, such as the Reverse-FALLS protocol, to guide and monitor diuretic therapy in the emergency department are limited. This prospective, single-center observational study was conducted between April 1 and June 30, 2023, in an emergency department. Adult patients diagnosed with acute CPE were included. Bedside lung ultrasonography and IVC measurements were performed using the Reverse-FALLS protocol before and after intravenous loop diuretic therapy. The number of B-lines in 4 lung regions and IVC diameter changes were recorded. The primary outcome was the change in B-line counts following diuretic treatment. Secondary outcomes included IVC diameter changes and clinical outcomes. A total of 40 patients (mean age 73.7 ± 12.7 years; 65% female) were included. After diuretic therapy, 82.5% of patients demonstrated a significant reduction in B-lines on lung ultrasonography. B-line counts decreased significantly in all lung regions (right upper P = .005, right lower P = .013, left upper P < .001, left lower P < .001). The mean interval between ultrasound assessments was 6.2 ± 3.4 hours. Changes in IVC diameter were not statistically significant (P = .061). Higher brain natriuretic peptide levels were significantly associated with worse clinical outcomes (P = .021). Bedside lung ultrasonography using the Reverse-FALLS protocol effectively demonstrated a reduction in pulmonary congestion following diuretic therapy in patients with CPE. Monitoring B-line changes may allow individualized diuretic management without significant intravascular volume depletion, supporting the clinical utility of ultrasound-guided treatment in the emergency department.

BACKGROUND:Cardiac arrest in children is associated with high morbidity and mortality, primarily due to neurological injury. Biomarkers linked to brain injury, released into circulation from compromised elements of the neurovascular unit, act as significant prognostic indicators in patients suffering from hypoxic-ischemic brain injury (HIBI) subsequent to the restoration of spontaneous circulation (ROSC) after pediatric cardiac arrest. The aim of this systematic review and meta-analysis is to evaluate the prognostic utility of brain injury biomarkers in predicting neurological outcomes and survival in patients following cardiac arrest in the pediatric population. METHODS:Bibliographic databases (PubMed, the Cochrane Library, and Embase) were searched from their inception to November 2024. A random-effect model was used for all analyses. RESULTS:Our meta-analysis demonstrates significant associations between various biomarkers and survival or neurological outcomes after cardiac arrest. Neuron-specific enolase (NSE) levels were consistently elevated in non-survivors and patients with unfavorable neurological outcomes, with pronounced differences observed on Days 2 and 3 (e.g., Day 3 mean difference: -88.48, 95%CI: -146.77 to -30.19, P = 0.003). Emerging biomarkers, including UCH-L1 and GFAP, showed striking differences, such as elevated UCH-L1 levels on Day 1 (mean difference: -415.41, 95%CI: -474.41 to -356.61, P < 0.001) and GFAP levels exceeding 4000 ng/mL in non-survivors on Day 2 (P < 0.001). CONCLUSIONS:Our findings underscore the significant prognostic value of biomarkers in predicting survival and neurological outcomes following cardiac arrest. Neuron-specific enolase (NSE) consistently demonstrated its reliability across multiple time points, while emerging biomarkers like UCH-L1 and GFAP showed promising potential for early outcome stratification.

Aim: Critical illness in the emergency department (ED) of a hospital requires rapid assessment and intervention. This study aimed to investigate the diagnostic and prognostic levels of D-lactate and SCUBE-1 in critically ill patients being admitted to the ED. Material and Methods: This prospective observational case-control study consisted of 45 critically ill patients and 45 healthy controls. Serum D-lactate and SCUBE-1 levels were measured upon admission to the ED, and clinical scores (APACHE II, GCS, RTS) were calculated for critically ill patients. The primary outcome was 28-day mortality. Results: Both D-lactate and SCUBE-1 levels were significantly higher in critically ill patients as compared to controls (p<0.001). In multivariate logistic regression analysis, SCUBE-1 (OR=2.16, 95%CI:1.65-3.43, p<0.001) and D-lactate (OR=1.86, 95%CI:1.11-2.41, p=0.012) were independent predictors of mortality. ROC analysis revealed that SCUBE-1 >43 ng/mL predicted mortality with 56.2% sensitivity and 72.4% specificity, while D-lactate >279 mmol/L showed 51.5% sensitivity and 68.3% specificity. D-lactate and SCUBE-1 levels are promising biomarkers for the prediction of mortality in critically ill ED patients. Discussion: These markers, when used in conjunction with clinical scoring systems, may prove useful when risk stratification and guide management decisions are made in the ED.

Background Upper gastrointestinal bleeding (UGIB) is a common and life-threatening emergency with a mortality rate of 2–8%. Although prognostic assessment often relies on the Glasgow-Blatchford Score (GBS) and Rockall Score (RS), their inclusion of multiple parameters limits use in acute settings. The shock index (SI), derived from heart rate and systolic blood pressure, provides a simple and rapid alternative. This study investigates the relationship between the SI and established risk scores (GBS and RS) in patients with UGIB. Methods This retrospective study included patients over 18 years of age who presented to the emergency department between January 1 and December 31, 2021. Of the 246 patients who underwent endoscopy, 106 were excluded due to variceal bleeding, pregnancy, incomplete or missing data, loss to follow-up, referral, or trauma. Clinical and laboratory information, including endoscopic findings, laboratory results, treatment details, and clinical follow-up, were collected. GBS, RS, and SI were calculated for each patient to evaluate the effectiveness of the SI in UGIB by examining its relationship with the GBS and RS. Result We enrolled 140 patients (62.9% male, n = 88; 37.1% female, n = 52). The mean age was comparable between the low and high SI groups (57.08 ± 20.20 vs. 54.75 ± 18.67 years, p = 0.482). Female patients had a significantly higher mean age than males (p < 0.001). The high SI group demonstrated significantly higher GBS scores compared with the low SI group (9.26 ± 3.50 vs. 6.29 ± 3.47, p < 0.001). The mean RS was significantly higher in the high SI group compared with the low SI group (4.42 ± 2.11 vs. 3.30 ± 2.20, p = 0.003). Conclusions In our study, both GBS and RS were significantly higher in patients with elevated SI, indicating that the Shock Index closely reflects bleeding severity and hemodynamic instability. Given that SI can be calculated rapidly, at no cost, and without the need for laboratory data, it may provide an early estimate of bleeding severity and prognosis before more comprehensive scoring systems such as GBS or RS are determined in the emergency department.

Hypercapnic acute respiratory failure (ARF) is a common complication of chronic obstructive pulmonary disease (COPD). Respiratory support is required in ARF, which usually has a high mortality risk. The objective was to compare the effectiveness of noninvasive mechanical ventilation (NIV), which is the traditional treatment protocol for COPD, with high-flow nasal cannula oxygen therapy (HFNT) as an emerging treatment method. This study was performed between August 20, 2019 and December 20, 2019, as a prospective randomized controlled study. Patients who were admitted with ARF due to COPD were included in the study. With randomization, 30 patients were treated with HFNT, whereas 31 patients were treated with NIV. The pH value of the HFNT group was significantly higher at the 1st hour of treatment (p=0.001). While there were no significant differences in subsequent pH values in the HFNT group (p=0.130), the pH value in the NIV group was found to have changed significantly (p=0.030). Compared to the NIV group, the 1st hour PaCO2 value in the HFNT group was significantly higher (p<0.001). The PaCO2 value decreased and PaO2 value increased significantly during follow-up in both groups (p<0.001). There were no significant differences in intra-group lactate and HCO3 values in the HFNT group, whereas the corresponding changes in the NIV group were significant (p=0.002). Compared to the HFNT group, the NIV group length of stay in the intensive care unit (ICU) was significantly longer (p=0.039). The use of HFNT, especially in more serious COPD patients, can be described as an intervention that could be beneficial in the acute period and could reduce the frequency of nosocomial infections by shortening ICU stay.

A thyroid storm (TS) or thyrotoxic crisis is an infrequent, life-threatening endocrinological emergency due to the worsening of the hyperthyroid state. Thyroid hormones (THs) influence almost all the body cells and tissues' differentiation, growth, and energy metabolism. Consequently, excess THs are expected to lead to profound organ function, regulation, and hemodynamic changes. In addition to their roles in metabolism and thermoregulation, THs play critical role in maintaining cardiovascular homeostasis through both genomic and non-genomic mechanisms. Receptors for THs are expressed in myocardial and vascular endothelial tissues, allowing fluctuations in circulating hormone levels to directly influence cardiovascular function. Excess TS induces a hyper-dynamic cardiovascular state, characterized by increased ventricular contractility and improved systolic and diastolic performance. The chronotropic and inotropic properties of THs result in dysregulation of blood pressure, heart rate, contractility, cardiac output, and systemic vascular resistance. This could lead to serious consequences such as cardiomyopathy, heart failure, and life-threatening arrhythmia, ultimately contributing to cardiocirculatory collapse and cardiac death. The management of TS necessitates a systematic approach that emphasizes the significance of resuscitation and identification of the underlying causes. It is crucial to prioritize assessing cardiac function in patients with TS. This review explores the clinical impact of TS on the heart and its clinical repercussions, emphasizing the intricate molecular and pathophysiological mechanisms and the interplay between TS and key cardiovascular parameters. This review summarizes the current knowledge of pathophysiology, pharmacological and mechanical interventions, ranging from beta-blocker use to the surgical approach.

Introduction:Gastrointestinal system (GIS) bleeding is one of the most common reasons for emergency department visits. The aim of this study is to investigate the impact of base excess, lactate, and alactic base excess-parameters that can be quickly assessed through blood gas analysis-on predicting the clinical outcome in patients presenting to the emergency department with GIS bleeding. Materials and Methods:The study was retrospective and conducted at a single center from January 1 to December 31, 2022. The collected data included age, gender, blood gas (lactate and base excess), and outcomes (discharge, intensive care, and death). Results and Conclusions:The study included 205 patients (135 males and 70 females). Deceased individuals had a lower average base excess and higher lactate levels. There were no significant differences in ward admission based on alactic base excess status. A base excess cutoff value of ≥ -0.65 was used to predict ward admission, yielding a sensitivity of 57.71%, specificity of 63.33%, PPV of 90.18%, and negative predictive value of 20.43%. According to the data obtained in our study, we observed that a lactate cutoff value ≥ 2.07 could be effective in predicting ICU admission for patients. We also found that a base excess cutoff value ≥ -0.65 could be effective in predicting admission to the ward. The mean base excess was lower in patients who resulted in death compared to survivors, while the mean lactate level was higher. However, no significant result was found regarding alactic base excess.

Background/Objectives: Effective infant cardiopulmonary resuscitation (CPR) relies on high-quality chest compressions, yet the optimal technique for single-rescuer scenarios remains debated. Although widely used, the two-finger technique (TFT) is associated with an inadequate compression depth and increased rescuer fatigue. While the two-thumb encircling hands technique (TTHT) provides a superior compression depth, its application in single-rescuer scenarios is impractical. This study evaluates a novel technique (nT) as a potential alternative, aiming to optimize both compression efficacy and rescuer endurance. Methods: This randomized crossover study assessed the efficacy of the TFT, TTHT, and nT in a simulated infant CPR setting. Medical students trained in newborn and infant resuscitation performed all three techniques in a controlled environment using a high-fidelity neonatal simulator. We objectively measured and compared key CPR performance metrics, rescuer fatigue, and hand pain among the techniques. Results: The nT and TTHT outperformed the TFT in compression depth, rescuer endurance, and overall CPR quality. The nT achieved the highest adequate compression rate (92.4% vs. 78.6% for TTHT and 65.2% for TFT) while minimizing fatigue (RPE: 3.1 vs. 4.5 for TTHT and 6.2 for TFT) and hand pain (NRS: 1.8 vs. 3.9 for TTHT and 5.4 for TFT). TTHT produced the deepest compressions (mean: 44.2 mm vs. 42.9 mm for nT and 38.6 mm for TFT, p < 0.001). Rescuer anthropometric factors (sex, weight, and height) affected all techniques similarly, suggesting no inherent advantage based on body characteristics. Conclusions: Both the nT and TTHT outperformed the TFT, with the nT demonstrating superior rescuer endurance while maintaining high-quality compressions. Given its ergonomic benefits and effectiveness, the nT emerges as a promising alternative for single-rescuer infant CPR and warrants consideration for future resuscitation guidelines.

Ovarian cancer is among the most lethal gynecologic malignancies, often diagnosed at advanced stages due to a lack of effective screening tools. Recent studies suggest that the platelet-to-lymphocyte ratio (PLR), an indicator of systemic inflammation, may serve as a potential biomarker for diagnosing and staging ovarian cancer. We conducted a systematic review and meta-analysis, adhering to PRISMA guidelines. We searched the PubMed/Medline, Scopus, Web of Science, and EMBASE databases. We pooled data using a random-effects model to assess the sensitivity, specificity, and diagnostic performance of PLR in ovarian cancer. The meta-analysis of 22 studies comprising 5740 participants showed significantly elevated platelet-to-lymphocyte ratio (PLR) values in ovarian cancer patients compared to healthy controls, with a mean difference of 46.84 (p < 0.001). Additionally, PLR demonstrated utility in distinguishing benign from malignant lesions and early-stage from advanced-stage ovarian cancer. While PLR shows potential as a cost-effective and accessible biomarker for ovarian cancer diagnosis and staging, its diagnostic accuracy remains moderate. Therefore, combining PLR with other diagnostic tools enhances clinical decision-making.

Individual studies suggest that administering prehospital blood products such as plasma to injured patients is feasible, may lower mortality, and improve coagulation. By compiling all existing evidence, we aimed to investigate whether prehospital plasma (PHP) transfusion can be safely administered and improve the clinical outcomes of trauma patients. A systematic review (SR) and meta-analysis were conducted in accordance with the PRISMA guidelines to assess the effectiveness and safety of PHP transfusion compared to the standard of care in trauma patients. A literature search (2012 and 2024) was performed in PubMed, MEDLINE, EMBASE, and the Cochrane Library using the terms: “plasma resuscitation,” “prehospital plasma,” “prehospital blood components,” “emergency transfusion,” “trauma hemorrhage management,” “lyophilized plasma,” “freeze-dried plasma " “LyoPlas,” FlyPlas,” and “thawed fresh frozen plasma .“Studies focused on pediatric patients, in-hospital settings, feasibility only, or non-plasma interventions were excluded. Primary outcomes included early (24 hours) and late (28 or 30 days) mortality, and secondary outcomes included 24-hour transfusion units, vasopressor use, multiple organ failure, transfusion reaction, acute lung injury, and sepsis. The quality of studies was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. The review was registered with PROSPERO. Sensitivity analyses were performed, excluding small studies with high variance and studies with combined blood products. Twelve studies comprising 3,193 trauma patients (1,579 intervention and 1,614 control arm) and seven SRs were included. There was no significant difference between the PHP and control groups for early and late mortality; however, the sensitivity analysis favored the PHP transfusion for 24-hour mortality. Without statistical significance, the total 24-hour volume of RBC units and vasopressor use was lower in the PHP group than in the controls. There was no significant difference between the PHP transfusion and control groups for the incidence of organ failure, adverse events, transfusion reactions, and sepsis. Observational studies were mostly of good quality, with two studies showing a moderate risk of bias. In contrast, RCTs had some concerns but were generally at a low risk for most domains. The overall pooled analysis revealed no significant benefit to PHP transfusion in trauma patients; however, sensitivity analyses showed a significant association of PHP and lower 24-hour mortality. PHP did not significantly decrease vasopressor use or late mortality; however, it may reduce the total use of RBCs in the first 24 h. Regarding safety, the review findings should be interpreted cautiously. Umbrella review was not conducted due to the heterogeneity and inconsistent inclusion criteria and outcomes. Further studies are needed to address the inconsistency in the existing evidence and determine whether PHP transfusion should be recommended for trauma patients with clearer and standardized endpoints and adverse event reporting.

Background: The role of Cystatin C (CysC) in the diagnosis and prognosis of cardiovascular disease, particularly acute coronary syndrome (ACS), is increasingly significant. The goal of this meta-analysis was to assess the diagnostic and prognostic value of CysC in patients with ACS, as well as its association with major adverse cardiovascular events (MACE), defined as mortality, myocardial infarction, heart failure, and stroke. Methods: The present study is a systematic review and meta-analysis. Using PubMed, Web of Science, Cochrane Library, and Embase, a literature review of cohort and case control studies reporting MACE and using the terms ACS and Cystatin C was conducted, excluding studies published after August 1st, 2024. The meta-analysis using a random effects model. Results: CysC concentrations were significantly higher in patients with ACS compared to controls [mean difference (MD) = 0.36, p < 0.001], and in acute myocardial infarction (AMI) vs. unstable angina (MD = 0.18, p < 0.001). No significant differences were observed between ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Patients with MACE had higher CysC levels than those without (MD = 0.25, p < 0.001). Hospital survivors had lower CysC levels compared to those who died (MD = -0.25, p < 0.001). Higher CysC concentrations were associated with increased risks of MACE, cardiac death, overall mortality, myocardial reinfarction, and stroke, both during hospitalization and beyond. Conclusions: CysC is a promising biomarker for both diagnosis and prognosis in patients with ACS, especially in the context of predicting MACE, mortality and heart failure risk. The use of CysC may improve risk stratification and support therapeutic decision-making in clinical practice.