Internal and Emergency Medicine最新文献

Hyponatremia is the most common electrolyte disorder. Accurate assessment of extracellular fluid volume status (hypovolemic, euvolemic, or hypervolemic) is essential for determining the underlying etiology and guiding treatment. Point-of-care ultrasound (PoCUS) has emerged as a complementary bedside tool to objectively assess volume status in hyponatremia. We systematically reviewed the relevant literature up to June 2025. The aim of this systematic review was to evaluate the role of PoCUS in the assessment and management of hyponatremia. The evidence suggests that combined lung, cardiac, and abdominal PoCUS (including the venous excess ultrasound score, VExUS) helps overcome the limitations of physical examination. PoCUS leads to a more accurate etiologic diagnosis and optimized treatment. PoCUS also aids in monitoring treatment response, enabling real-time adjustment of diuretics or fluids based on serial examinations. Its role may be limited by operator dependency and inability to detect non-ultrasound-revealed pathologies such as hypothyroidism. Integrating bedside ultrasound into hyponatremia management improves volume assessment accuracy and supports a more individualized approach. Although current evidence is mainly derived from small studies and case series, findings consistently support using PoCUS as an adjunct to traditional evaluation.

Venous congestion is a major contributor to morbidity and mortality in several clinical settings. Relying on traditional methods for bedside evaluation of congestion often leads to inadequate decongestion and increased hospital readmissions. The Venous Excess Ultrasound Score (VExUS) was introduced by Beaubien-Souligny to improve assessment of systemic congestion by integrating inferior vena cava size and Doppler patterns from hepatic, portal, and intrarenal veins. This review aims to describe how to perform VExUS and summarize the current state of evidence based on original data studies either supporting its clinical use or recognizing limitations. Most of the knowledge regarding VExUS comes from studies assessing its prognostic role in predicting death, re-hospitalization, and acute kidney injury. VExUS proved to be a valuable prognostic tool in cardiologic settings such as patients admitted in intensive care unit after cardiac surgery and those hospitalized for heart failure; conversely its predictive performance is less consistent in more heterogeneous populations where patients are less prone to develop venous congestion. Importantly limited evidence supports VExUS utility in guiding management strategies. Further research is needed to establish whether the integration of a VExUS-guided decongestive diuretic therapy improves outcomes across different clinical settings. Moreover, concerns regarding its complexity, redundancy with single-site Doppler indices, and the absence of validation in broader populations have been raised.

Cardiac implantable electronic device (CIED) implantation is a minor surgical procedure, with a low complication incidence. Neoplasm occurrence at the CIED pocket is a rare event, and sporadic cases are reported without a comprehensive evaluation. This hybrid study aims to fill this gap through a three-part approach: a new case report, a scoping review with individual patient data (IPD) analysis, and a clinical survey. In March 2024, a male patient with a history of high-grade urothelial cancer referred to our Department with a mass at the CIED pocket. Incisional biopsy confirmed the diagnosis of high-grade urothelial carcinoma. The patient died after 4 months. Through our scoping review and IPD analysis, we collected 56 patients affected by primary neoplasms [40 (71.4%)] and metastasis [16 (28.6%)] at the CIED pocket. Among the primary neoplasms, adenocarcinoma (12; 30.0%) was most frequent in females, while sarcoma (10; 25.0%) was predominant in males. On the other hand, metastasis types were represented by breast cancer (3; 18.8%) in females, and myeloma (2; 13.3%) and melanoma (2; 13.3%) in males. The clinical survey showed data from 471 patients who underwent CIED implantation. No primary neoplasm or metastasis developed at the CIED pocket, also in subjects with history of cancer. Although rare, both primary and metastatic neoplasms may occur at the site of CIED implantation. Vigilant monitoring of CIED patients is essential, particularly when changes at the pocket site arise. Early biopsy and oncologic assessment should be considered in such cases to enable timely diagnosis and intervention.

Background The objective of this study was to ascertain whether cardiometabolic index(CMI), visceral adiposity index (VAI), dysfunctional adiposity index (DAI), and body adiposity index (BAI) are superior predictors of future hypertension risk when compared with conventional indicators such as waist circumference(WC), body mass index (BMI) and waist-to-height ratio(WHtR).

Material and methods: This is a post hoc analysis of the MONICA protocol. We selected 597 patients based on inclusions criteria. Data collection began in 1992, and follow-up was conducted on the same group of participants in 2007. The study collected anthropometric indexes and biochemical data.

Results: After adjusting for confounding factors using multivariate Cox regression analysis, the following results were observed: CMI [HR: 1.754 (1.240-2.480); P = 0.001], VAI [HR: 1.533 (1.074-2.187); P = 0.018], DAI [HR: 1.382 (0.982-1.945); P = 0.064], BAI [HR: 2.791 (1.790-4.352); P < 0.001], WC [HR: 2.234 (1.510-3.307); P < 0.001], WHtR [HR: 2.303 (1.589-3.339); P < 0.001], and BMI [HR: 2.488 (1.778-3.561); P < 0.001] were all significantly associated with the incidence of hypertension. ROC curve analysis showed that the area under the curve (AUC) for WC product was the highest (0.649, 95% CI: 0.605-0.693), followed by BMI (0.648, 95% CI: 0.603-0.692), WHtR (0.646, 95% CI: 0.601-0.690), and then by CMI (0.603, 95% CI: 0.557-0.649).

Conclusions: Although the CMI, VAI, DAI and BAI can all be utilised as independent predictors of hypertension, the predictive discriminatory power of these novel indicators for hypertension remains inferior to that of traditional indicators such as WC, BMI and WHtR.

Advanced lung disease, cardiovascular disease (CVD), infections, malignancies, and thromboembolic disease (TED) determine the mortality of patients with sarcoidosis. Our objective was to evaluate the main causes of admission and in-hospital mortality in patients with sarcoidosis in Spain. A retrospective and observational analysis of the National Registry of Hospital Discharges (RAE-CMBD) of patients admitted with a diagnosis of sarcoidosis between 2016 and 2021 was performed. A total of 18,887 admissions of patients with sarcoidosis were identified. The main causes of admission were infection (21%), sarcoidosis itself (16.4%), CVD (12.7%), and malignancies (7.1%). Overall, 892 (4.7%) patients died, mainly from infection (32.1%), CVD (16.3%) and neoplasms (12.4%), with case fatality rates of 7.2%, 6% and 8.3%, respectively. Factors associated with higher in-hospital mortality were Charlson comorbidity index (OR 1.30 95%CI 1.27-1.34), sarcoidosis pulmonary involvement (OR = 1.20, 95%CI 1.04-1.38), pulmonary fibrosis (OR 2.07; 95%CI 1.52-2.81) and CVD (OR 1.56; 95%CI 1.26-1.95), infection (OR 2.37; 95%CI 1.97-2.84), malignancies (OR 1.77; 95%CI 1.38-2.27) and TE-related admissions (OR 2.1, 95%CI 1.21-3.76). The main determinants of hospital admissions and mortality in patients with sarcoidosis are infections, CVD, neoplasm, VTE, pulmonary fibrosis, and a high comorbidity burden. While sarcoidosis itself is a common cause of admission, it is rarely the cause of death. Prevention of infections, VTE, and neoplasm, along with control of cardiovascular risk factors, may help reduce mortality in these patients.

This study aims to develop a predictive model based on the triglyceride-glucose (TyG) index to assess in-hospital mortality risk in older acute myocardial infarction (AMI) patients with multimorbidity. This retrospective study included 479 patients aged ≥ 65 years with AMI and multimorbidity, hospitalized at Qilu Hospital of Shandong University from September 2017 to March 2022. Patients were randomly divided into a training set (n = 384) and an internal validation set (n = 95). In addition, 90 patients admitted after April 2022 were included as an external validation set. Univariate Cox regression and least absolute shrinkage and selection operator regression were employed to select potential predictive variables, and a predictive model was constructed using Cox regression. Model performance was assessed using receiver operating characteristic (ROC) curves, concordance (C)-index, time-dependent ROC curves, calibration plots, and decision curve analysis (DCA). The predictive performance of the TyG-incorporated model was compared with models excluding TyG, as well as the global registry of acute coronary events and thrombolysis in myocardial infarction risk scores. During an average hospitalization of 9.8 days, 7.85% of patients experienced all-cause mortality. Key predictors included the TyG index, occupation, ≥ 2 Killip classification, hepatic insufficiency, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, Nicorandil and white blood cell. The TyG-incorporated model demonstrated superior predictive performance, with C-index values of 0.93 (95% CI 0.89, 0.97; P < 0.001) in the training set, 0.85 (95% CI 0.74, 0.96; P < 0.001) in the internal validation set, and 0.89 (95% CI 0.81, 0.97; P < 0.001) in the external validation set, indicating high predictive accuracy. Calibration plots demonstrated good model calibration, and DCA results indicated superior clinical applicability of the model. The predictive model based on the TyG index provides an effective tool for assessing in-hospital mortality risk in older AMI patients with multimorbidity, demonstrating strong predictive performance and significant clinical value.

Exertional heatstroke (EHS) often leads to multiple organ dysfunction syndrome (MODS) with high mortality. The liver is frequently early damaged in EHS, presenting as acute liver injury (ALI), including acute liver disease (ALD) and acute liver failure (ALF). This study investigates liver enzyme changes in EHS patients, assesses whether ALF independently predicts in-hospital mortality, and tries to create an ALF-based predictive model for EHS. This was a single-center retrospective study. The medical records of EHS patients admitted to the intensive care unit (ICU) of a tertiary hospital from January 1, 2008 to December 31, 2023, were recorded and analyzed. The characteristics of liver damage were analyzed by reviewing the enzymatic indices of EHS patients from day 1 to day 9 after admission. There were 176 male patients ultimately analyzed, comprising 160 survivors and 16 non-survivors. Univariate and multivariate logistic regression analysis showed that prolonged activated partial thromboplastin time (APTT) (OR = 1.029, P = 0.018), increased γ-glutamyltransferase (γ-GGT) (OR = 1.032, P = 0.013), and ALF (OR = 57.238, P = 0.002) were independent risk factors for predicting in-hospital mortality. Approximately half of the patients (48.3%) were diagnosed as ALI. Notably, 81.8% of the ALF cases were diagnosed within 5 days after EHS onset. The predictive model based on increased heart rate (HR) (OR = 1.065, P < 0.001), increased platelet (PLT) count (OR = 0.989, P = 0.034), and increased fibrinogen (Fib) (OR = 0.216, P = 0.002) level had a higher specificity and better predictive performance (SEN = 86.4%, SPE = 90.8%, AUC = 0.936) for occurrence of ALF in EHS. During the early stages of EHS, patients exhibited multiple organ injuries, with a high ALI incidence rate. ALF, prolonged APTT, and elevated γ-GGT levels were the independent risk factors for in-hospital mortality in EHS patients. The predictive model based on HR, PLT, and Fib levels was potentially suitable and practical for early identification and timely management of ALF in EHS patients.

Frailty is a complex syndrome marked by diminished physiological reserves and heightened susceptibility to negative health outcomes. The Atherogenic Index of Plasma (AIP), an indicator of lipid-associated cardiovascular and metabolic risk, has been widely studied in metabolic and cardiometabolic disorders; however, its relationship with frailty remains underexplored. This study seeks to investigate the association between AIP and frailty, as well as evaluate its viability as a predictive biomarker for frailty in older adults. This cross-sectional study encompassed 174 older adults from a geriatrics outpatient clinic. Frailty was evaluated with the Clinical Frailty Scale (CFS) version 2.0, whereas AIP was computed using the formula log(TG/HDL-C). Multivariable logistic regression analysis was conducted to determine independent factors that contribute to frailty. The efficacy of AIP in identifying frailty was assessed by receiver operating characteristic (ROC) curve analysis. Frailty was present in 29.3% (n = 51) of the participants. Logistic regression analysis identified AIP as an independent predictor of frailty (OR: 6.65, 95% CI 1.87-23.64, p = 0.003), along with lower Lawton-Brody Instrumental Activities of Daily Living (IADL) scores and lower Standardized Mini-Mental State Examination (SMMSE) scores. ROC analysis indicated that AIP predicted frailty with an AUC of 0.741 (95% CI 0.669-0.804, p < 0.0001). AIP serves as an independent predictor of frailty, highlighting the significance of lipid metabolism in the pathophysiology of frailty. Due to its significant correlation with dyslipidemia, systemic inflammation, and oxidative stress, AIP may serve as an important biomarker for the early identification of frailty and risk assessment.