Wiener Klinische Wochenschrift最新文献

Background: Hepatorenal dysfunction is a key prognostic factor in patients with symptomatic tricuspid valve regurgitation (TR). This study evaluated the prognostic value of hepatorenal dysfunction using the Model for End-stage Liver Disease (MELD), the modified MELD-XI score, and right heart hemodynamic parameters in patients undergoing transcatheter tricuspid valve interventions (TTVI).

Methods: This prospective, single-center cohort study included patients undergoing edge-to-edge or heterotopic tricuspid valve repair. The MELD and MELD-XI scores were calculated using creatinine, bilirubin and the international normalized ratio (INR). All patients underwent right heart catheterization. The predictive value of MELD/MELD-XI scores and hemodynamic parameters, individually and combined, was assessed for a composite endpoint of 3‑month mortality or rehospitalization using receiver operating characteristics (ROC) analysis.

Results: In this study 36 patients (mean age 80.2 ± 5.9 years; 33.3% male) were analyzed. Rehospitalization occurred in 25% and the 3‑month mortality was 11%. Both MELD-XI (area under the curve, AUC 0.96, 95% confidence interval, CI 0.88-1.00, p = 0.01) and MELD score (AUC 0.91, 95% CI 0.78-1.00, p = 0.023) showed excellent predictive values for mortality. The preinterventional MELD-XI score, right ventricular (RV) pressure (AUC 0.82, 95% CI 0.61-1.00, p = 0.029), right atrial (RA) pressure (AUC 0.86, 95% CI 0.70-1.00, p = 0.015) and pulmonary artery (PA) pressure (AUC 0.82, 95% CI 0.65-0.98, p = 0.029) were predictive for the combined endpoint. The predictive value of the MELD-XI for the combined endpoint was further improved when integrating PA pressure, RA pressure, and RV pressure in the model (AUC 0.91, 95% CI 0.77-1.00, p = 0.002).

Conclusion: This pilot study identified MELD-XI score as a potential risk score for 3‑month mortality after TTVI. Its prognostic value for the combined endpoint was increased after adding invasive hemodynamic parameters.

Background: Multiple sclerosis (MS) is treated with various disease-modifying therapies (DMTs) with differing efficacy and risks, yet the disease course varies markedly within and between individuals. Defining optimal treatment strategies through randomized trials is impractical because of the required sample sizes, costs and long follow-up. Large multicenter registries and prospective observational cohorts are therefore essential but demand harmonized, standardized, user-friendly data capture with rigorous quality control and data protection.

Objective: This project aims to establish standardized, nationwide MS data collection in Austria.

Methods: The project consists of five key components: (i) harmonization of data collection, (ii) creation of infrastructure for data sharing, (iii) retrospective harmonized data collection (Austrian MS Database, AMSD), (iv) prospective harmonized data collection (Austrian MS Cohort, AMSC) and (v) aggregated analyses.

Results: A comprehensive set of harmonized common data elements (CDE) comprising clinical and paraclinical data was developed and a common data collection infrastructure was generated using the web-based Research, Documentation, and Analysis platform (webRDA), an innovative data capture, processing and analysis system provided by the Medical University of Vienna offering pseudonymized storage of data supported by a robust permissions system fulfilling legal data protection and ethical requirements. The AMSC is set up as a standardized prospective collection of demographic, clinical, epidemiological, psychosocioeconomic, magnetic resonance imaging (MRI), and optical coherence tomography (OCT) data as well as body fluids.

Conclusion: The AMSD and AMSC will facilitate the evidence-based development of prognostic biomarkers, individualized therapy strategies and treatment sequences based on a high-quality, population-based dataset of more than 8000 people with MS.

Introduction: Respiratory syncytial virus (RSV) is a common pathogen of lower respiratory tract infections in infants 1 month to 1 year of age. Infections with RSV are the most common cause for hospitalization for respiratory infections and present with a high rate of complications. Different scores for severity assessment currently exist but only few of them are well validated. The "Inpatient clinical pathway for evaluation/treatment of children with bronchiolitis" from the Children's Hospital of Philadelphia (CHOP) provides clear and concise guidance for severity grading and inpatient management.

Aim: In 2019 we implemented a bronchiolitis scoring system and pathway in accordance with the CHOP pathway in our inpatient setting to assess and monitor children affected by bronchiolitis as well as to plan their discharge. This study investigated the length of stay before and after implementation of the score and the risk of readmission after regular discharge.

Methods: Data from all admitted infants 1 month to 1 year of age with a discharge diagnosis of acute bronchiolitis due to RSV (ICD 10-GM 2024 J21.0, n = 261) over a period of 9 years were evaluated, 5 winters (2014-2019, n = 140) before (group 1) and 4 winters (2020-2024, n = 121) after (group 2) implementation of the score.

Results: The study population did not differ before and after implementation of the score with respect to age (group 1: mean age = 99.9 ± 87.3 days vs. group 2: 120.2 ± 85.6 days) and sex. The groups were equally sized with a mean of 28-30 patients per season. The average length of stay was 5.5 ± 3.4 SD days. Although the length of stay before and after implementation decreased on average by 0.4 days the result was not significant (5.6 ± 3.8 SD vs. 5.3 ± 2.8 SD days, p = 0.2). The readmission rate in total was very low (5/261, 1.7%) and only 1 patient had to be readmitted after implementation of the score (4/140, 2.8% vs. 1/121, 0.8%, p = 0.38).

Conclusion: This structured clinical bronchiolitis pathway provides concise advice for outpatient as well as inpatient management. The length of stay did not differ before and after implementation. The score is a safe and useful tool for preventing readmission.

Neuropsychiatric manifestations occur in about 25% of patients with primary hyperparathyroidism (PHPT). Symptoms can range from depression, anxiety, fatigue or cognitive dysfunction which are commonly observed to more seldomly revealed states of mania, delirium or psychosis which warrant psychiatric intervention. The underlying pathophysiology is likely multifactorial, potentially explained by elevated parathormone and hypercalcemia, with subsequent direct and indirect effects on monoamine neurotransmission and neuroinflammation via monoamine oxidase, tyrosine hydroxylase, sodium-potassium adenosine triphosphatase transporter and interleukin‑6.This review aims to (1) give an overview of the hypothesized pathophysiologic understanding regarding neuropsychiatric manifestations, (2) to summarize the most common neuropsychiatric symptoms and (3) to equip clinicians with recommendations for evidence-based tools to detect neuropsychiatric symptoms effectively.Psychometric questionnaires depicting psychiatric symptom burden across PHPT research are highlighted. Cut-off values for psychiatric screening purposes and hypothesized cut-off values in PHPT research to indicate parathyroidectomy are provided. A practical approach on how screening for neuropsychiatric symptoms in PHPT might be implemented in routine clinical practice is outlined.Parathyroidectomy is recognized to alleviate neuropsychiatric symptoms in PHPT, with increasing evidence showing persistent improvements in symptoms of depression, anxiety, fatigue and cognitive dysfunction. Clinical practice guidelines still diverge on whether neuropsychiatric manifestations in PHPT warrant parathyroid surgery. A symptom-based treatment approach is recommended alongside evaluating surgical intervention.

Objective: To compare the call profiles, physician-delivered interventions and physician staffing of ground emergency medical services (GEMS) and helicopter emergency medical services (HEMS) in Austria.

Methods: This was a sub-analysis of the Austrian Emergency Day 2024 audit, which was a prospective, observational, nationwide study conducted across 98 out of 149 public physician-staffed emergency medical services (EMS) in Austria. During 24 hours all emergency calls, to which EMS physicians were dispatched, were documented. Data collection included characteristics of participating EMS bases and non-patient-related details of each emergency call.

Results: Included in the study were 79 GEMS bases conducting 338 calls and 19 HEMS bases conducting 60 calls were included. The proportion of primary calls was lower (71.7% vs. 83.7%) and the proportion of interfacility transfers higher (18.3% vs. 4.7%) in HEMS than GEMS (p < 0.001). The median (interquartile range, IQR) duration of emergency calls was longer for HEMS than GEMS missions with 62min (IQR 53-71min) vs. 47min (IQR 44-50min) (p < 0.001). The National Advisory Committee for Aeronautics (NACA) score was lower for GEMS than HEMS calls (3 (2-4) vs. 4 (3-5); p < 0.001). The over-triage rate was higher in the GEMS than HEMS group (58.4% vs. 29.6%; p < 0.001). Except for sonography use, no difference in the rate of diagnostic or therapeutic physician-delivered interventions was observed between GEMS and HEMS. Characteristics of physician staffing did not differ between GEMS and HEMS.

Conclusion: Relevant differences in the call profiles but not physician-delivered interventions or physician staffing exist between GEMS and HEMS in Austria. The HEMS are more frequently tasked to emergencies with a higher severity and conduct interfacility transfers more frequently than GEMS.

Assisted suicide is an emerging phenomenon in many western countries including Austria, with important implications for public mental health. From a suicide prevention and public health standpoint, it is essential that assisted suicide should neither be stigmatized nor romanticized or presented as the only option to address existential suffering. Balanced reporting is key to educate the public about available options at the end of life including palliative care.

Background: High-voltage electrical injuries (HVEI) and thermal burns are both classified as severe burn trauma, yet their clinical impact differs markedly. The HVEIs cause deep tissue destruction and systemic complications that are often underestimated in severity by conventional burn indices such as TBSA (Total Body Surface Area) and ABSI (Abbreviated Burn Severity Index).

Methods: A retrospective cohort analysis was performed on 1515 burn patients treated between 1994 and 2024. After exclusions 1489 patients were evaluated, including 92 with HVEI and 1397 with thermal burns. The demographics, burn size, ABSI, intensive care unit (ICU) stay and surgical procedures were analyzed using nonparametric tests.

Results: Across the cohort, the mean number of operations was 3.56 (median 3). The HVEI patients required significantly more procedures than thermally injured patients (mean 5.01 vs. 3.49; p < 0.001). Burn size (p < 0.001), ABSI (p < 0.001) and ICU stay (p < 0.001) were all significantly associated with the number of operations. No sex-related differences were observed (p = 0.67).

Conclusion: The HVEIs impose a disproportionately high surgical and intensive care burden compared to thermal burns. These findings highlight the limitations of current severity scores and emphasize the need for early recognition, repeated surgical management and tailored interdisciplinary care in patients with electrical trauma.

Objective: Despite Austria's highly ranked healthcare system, health literacy (HL) is lower than in other European countries, with Vienna falling below the national average in life expectancy and healthy life years. Following the 2016 WHO Strategy for Women's Health and Well-being, Austria introduced a Women's Health Action Plan in 2017, which highlighted a major lack of information about women's reproductive health. To date, data on reproductive health knowledge (RHK) and behavior (RHKB), and their relationship with HL remain scarce. The study aimed to examine these relationships among women in Vienna.

Methods: An online cross-sectional survey was conducted in 2023 among women of reproductive age (18-49 years) in Vienna. Collected data included information about sociodemographic characteristics, HL (HLS19-Q12-AT), RHK and RHKB (0-100% scale). Associations between RHK/RHKB and HL, alongside sociodemographic characteristics were examined using linear regression analyses.

Results: Among 386 participating women 41% had limited HL. Mean scores were 71% (SD = 21) for HL, 74% (SD = 16) for RHK, and 78% (SD = 14) for RHKB. The highest rate of incorrect responses concerned egg cell lifespan (61%), human papillomavirus (HPV) consequences (49%) and fertility age (40%). In univariate analyses RHK and RHKB were positively associated with older age and partnership and negatively associated with inadequate HL and certain religious affiliations. The RHKB was further associated with university education and parenthood. Multivariate analyses confirmed age and religion as significant factors.

Conclusion: Our study identified RHK gaps among women in Vienna, showed associations between RHKB and HL and highlighted the importance of information sources. Findings underline the need for targeted interventions to improve reproductive HL.

Musculocontractural Ehlers-Danlos syndrome (mcEDS) is a rare autosomal recessive connective tissue disorder characterized by fragility of skin, vasculature and musculoskeletal structures. We report a case of a young male with CHST14(Carbohydrate sulfotransferase 14)-related mcEDS who developed a massive subcutaneous hematoma following minor trauma, necessitating surgical evacuation. This case highlights the potential for life-threatening bleeding complications in mcEDS and underscores the importance of early recognition and multidisciplinary management.

Background: Artificial intelligence (AI) is a promising tool to achieve a high adenoma detection rate (ADR). The aim of this study is to evaluate the impact of a computer-aided detection (CADe) device on the ADRs of endoscopists with different levels of expertise.

Methods: Data were collected from patients who underwent colonoscopy with CADe within a 12-month period. Endoscopists were divided into three groups, a trainee group (< 500 colonoscopies), an intermediate group (500-1000 colonoscopies) and an expert group (> 2000 colonoscopies). Endoscopists with the same definition of experience without CADe support served as the control cohort. For the differences in ADR between the groups a 2-sided 95% confidence interval (CI) and odds ratios (OR) were calculated.

Results: In this study 335 patients (155 females, 177 males) with a mean age 62.1 years (SD ± 16.2 years) were included in the CADe cohort. In this cohort 508 polyps were resected. The ADRs for the groups and control groups (without CADe) were as follows: 42.9% (95% CI: 28.5-57.2%) and 21.5% (95% CI: 11.3-31.8%) in the trainee group, 41.3% (95% CI: 33.5-49.0%) and 36.8% (95% CI: 27.9-45.6%) in the intermediate group and 39.8% (95% CI: 30.9-48.8%) and 33.3% (95% CI: 26.3-40.4%) in the expert group. There were no significant differences among the CADe groups when trainees were compared to experts (p = 0.72, OR 1.13, 95% CI: 0.58-2.16) or when intermediate endoscopists were compared to experts (p = 0.81, OR 1.06, 95% CI: 0.65-1.74).

Conclusion: The use of AI appears to provide an opportunity to match the ADR-based quality of colonoscopy at an early stage of endoscopy training with experts.