European Journal of Internal Medicine最新文献

Background: Although patent foramen ovale (PFO) transcatheter closure lowers recurrent cryptogenic stroke (CS), identifying patients who benefit most remains challenging. We developed, validated and assessed the diagnostic performance of a new scoring system to predict high-risk PFO patients who may benefit from PFO transcatheter closure in secondary prevention.

Methods: The CRISP-PFO score was derived from 936 PFO patients with a RoPE score ≥7, enrolled in a single-center prospective registry from March 2003 to March 2025. The score was derived from 624 patients and validated in 312 patients. Significant baseline variables (p < 0.1) from univariable logistic regression were entered into a multivariable model. Model performance was assessed via receiving operating curves and calibration slope. Patients were stratified into low-, intermediate-, and high-risk groups.

Results: In the derivation cohort, multivariate analysis identified four independent predictors of CS: permanent right-to-left shunt (2 points), ischemic brain lesions (2 points), an antero-posterior left atrial (LA) diameter ≥43 mm (1 point), and atrial septal aneurysm (1 point). Based on these factors, patients were stratified into low (0-2 points), intermediate (3-4 points), and high (5-6 points) risk categories, with event rates increasing across these groups (p<0.001). The CRISP-PFO score demonstrated strong diagnostic performance, with an AUC of 0.80-0.81, C-statistics of 0.78-0.79, and Hosmer-Lemeshow p-values of 0.44-0.47 in the derivation and validation cohorts, respectively.

Conclusions: The CRISP-PFO score is a novel and straightforward tool that accurately identifies PFO patients at high risk for CS who may benefit from transcatheter PFO closure.

Background: Adrenal insufficiency (AI) is a common complication following glucocorticoid (GC) therapy. However, reliable predictors of AI and GC regimens that mitigate this risk remain unclear. Previous systematic reviews (SRs) have included many observational studies with imprecise reporting of GC dose and duration. We conducted a systematic review focusing exclusively on studies with well-defined GC exposure.

Methods: We searched Embase, Web of Science, and MEDLINE for original studies published since 2000 that investigated adults receiving protocolised systemic GC regimens and assessed all participants for AI using the adrenocorticotropic hormone (ACTH) stimulation test. Data extracted included AI prevalence, diagnosis, administration route, GC dose and tapering, treatment duration and timing of outcome assessment. Risk of bias was assessed using an adapted Newcastle-Ottawa Scale. Meta-analysis was performed using random-effects models in R.

Results: Of 1340 unique records identified, 12 studies (1170 participants) met inclusion criteria. AI was present in 423 individuals, with a pooled prevalence of 30% (95% CI: 19-45%) at the earliest time point tested. Reported prevalence ranged from 0 to 70%, and was not consistently associated with diagnosis, administration route, treatment duration, or study quality. AI was significantly less common in studies that included tapering (p < 0.01) and in those assessing AI ≥15 days after stopping GCs (15%, 95% CI: 8-26%) compared to testing at cessation (48%, 95% CI: 35-62%).

Conclusion: AI is frequent following systemic GC use, with considerable variability. Tapering regimens and delayed testing post-cessation appear to reduce the observed prevalence. No specific GC regimen reliably prevents AI.