Lancet Regional Health-Europe最新文献

{"title":"Efficacy of anakinra in reducing progression to organ dysfunction in patients with pneumonia (INSPIRE): a randomised, double-blind, placebo-controlled, phase IIa trial","authors":"Georgios Tavoulareas ,&nbsp;Olga Kontakou-Zoniou ,&nbsp;Nikolaos Antonakos ,&nbsp;Elisavet Tasouli ,&nbsp;George Adamis ,&nbsp;Nikolaos Kakavoulis ,&nbsp;Evangelos Michelakis ,&nbsp;Ilias Skopelitis ,&nbsp;Konstantina Dakou ,&nbsp;Christos Psarrakis ,&nbsp;Panagiotis Koufargyris ,&nbsp;Myrto Astriti ,&nbsp;Styliani Sympardi ,&nbsp;Evangelos J. Giamarellos-Bourboulis","doi":"10.1016/j.lanepe.2025.101573","DOIUrl":"10.1016/j.lanepe.2025.101573","url":null,"abstract":"<div><h3>Background</h3><div>Early recognition of risk of death in pneumonia and start of precision immunotherapy to improve outcomes is an unmet need. We hypothesized that a precision strategy approach combining early recognition of interleukin (IL)-1 activation coupled with Anakinra treatment may improve pneumonia outcome.</div></div><div><h3>Methods</h3><div>INSPIRE is a prospective, double-blind randomized placebo-controlled trial which recruited hospitalized adults with community-acquired or hospital-acquired pneumonia, with qSOFA (quick sequential organ failure assessment) equal to 1 and plasma presepsin (soluble CD14) more than 350 pg/ml. Patients were 1:1 randomised to standard-of-care medication plus either subcutaneous placebo or subcutaneous Anakinra 100 mg once daily for 10 days. The primary endpoint was progression into organ dysfunction defined as meeting at least one of the following two conditions; (i) at least 2-point increase of the baseline SOFA score by day 7 and/or (ii) death by day 90. This was analyzed in the intention-to-treat (ITT) population. This trial is registered with the EU Clinical Trials Register (2022-002390-28) and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT05785442</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>Patients were enrolled between March 2023 and June 2024; 30 patients in the placebo arm and 30 patients in the Anakinra arm were the ITT population. The primary endpoint was met in 50·0% (15 patients) of placebo-treated and in 20·0% (6 patients) of Anakinra-treated patients (difference 30·0% [5·9 to 49%]; p: 0·011). 90-day mortality was 43·3% (13 patients) and 20·0% (6 patients) (difference 23·3% [0 to 43·7%]; p: 0·029). The overall incidence of serious treatment-emergent adverse events (TEAEs) in the placebo group was 50% and in the Anakinra group 33·3%. None of the serious TEAEs was judged to be related to treatment assignment. Production of TNFα and ΙFNγ by blood mononuclear cells was decreased.</div></div><div><h3>Interpretation</h3><div>Presepsin-guided Anakinra treatment prevents progression of pneumonia to organ dysfunction and death. The mechanism of benefit is associated with attenuation of cytokine production.</div></div><div><h3>Funding</h3><div><span>Hellenic Institute for the Study of Sepsis</span>; <span>PHC Europe BV</span>; <span>Swedish Orphan Biovitrum AB</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101573"},"PeriodicalIF":13.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of welfare regimes on socioeconomic inequalities in edentulism: a cross-national analysis of 40 countries","authors":"Roger Keller Celeste ,&nbsp;Carol Guarnizo-Herreño ,&nbsp;Johan Fritzell ,&nbsp;Francine S. Costa ,&nbsp;Olalekan Ayo-Yusuf ,&nbsp;Aluisio J. Barros ,&nbsp;Huihua Li ,&nbsp;Ninuk Hariyani ,&nbsp;Donna M. Hackley ,&nbsp;Silvana Blanco ,&nbsp;Jorge A. Gamonal ,&nbsp;Gerardo Maupome ,&nbsp;Richard G. Watt ,&nbsp;Marco Aurelio Peres","doi":"10.1016/j.lanepe.2025.101578","DOIUrl":"10.1016/j.lanepe.2025.101578","url":null,"abstract":"<div><h3>Background</h3><div>We aim to evaluate the association between welfare regimes and edentulism (total tooth loss) and to investigate whether welfare regimes modify the magnitude of socioeconomic inequalities in edentulism.</div></div><div><h3>Methods</h3><div>The Lancet Commission on Oral Health gathered and analysed nationally representative available data from 40 high, middle- and low-income countries, collected between 2007 and 2018. The study included 117,397 individuals 20 years or older. The outcome was edentulism, defined as the absence of all natural teeth. We categorised countries into seven welfare regimes, which served as both the primary exposure and an effect modifier. Individual-level variables included sex, age and a composite measure of socioeconomic position: “wealth” measured in quintiles. Inverse probability of treatment weight and multilevel logistic regression were employed to estimate the odds of being edentulous, and cross–level interaction terms between wealth and country factors.</div></div><div><h3>Findings</h3><div>Individuals at the lowest wealth quintile had the highest prevalence of edentulism in all regimes. The highest age-sex standardised prevalence was found in Eastern European countries (8.4%, 95% Confidence Interval: 7.6–9.3), followed by Corporative (8.1%, 95% CI: 7.0–9.3), while the lowest was among the Insecurity regime (0.8%, 95% CI: 0.4–1.5), followed by the Scandinavian regime (4.7%, 95% CI: 3.5–6.1). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 20.6 (95% CI: 15.3–27.8) times higher likelihood of being edentulous and 17.3 percentage points (pp) higher prevalence. Low-income countries in the Insecurity regime presented the lowest level of inequality. Among high- and upper-middle income countries, the Scandinavian regime had the lowest absolute inequalities (5.5 pp difference between highest and lowest quintiles). The Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 2.20, 95% CI: 1.06–4.59).</div></div><div><h3>Interpretation</h3><div>Our findings indicate that some welfare regime policies may enhance oral health while decreasing socioeconomic inequalities. Higher prevalence and inequalities among industrialised countries may reflect higher levels of oral health hazards.</div></div><div><h3>Funding</h3><div>This was partially supported by a <span>National Institute for Health and Care Research</span> (UK) grant number <span><span>132731</span></span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101578"},"PeriodicalIF":13.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to coronary angiography and revascularization in 575,247 patients with STEMI from 2012 to 2023: a retrospective population-based cohort study","authors":"Paulina E. Stürzebecher ,&nbsp;Ulrich Laufs ,&nbsp;Philip Baum ,&nbsp;Johannes Diers ,&nbsp;Armin Wiegering ,&nbsp;Konstantin Uttinger","doi":"10.1016/j.lanepe.2025.101576","DOIUrl":"10.1016/j.lanepe.2025.101576","url":null,"abstract":"<div><h3>Background</h3><div>Rapid primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) reduces in-hospital and long-term mortality. This study analyzes time intervals to PPCI in STEMI, risk factors for delay of PPCI, and in-hospital mortality from 2012 to 2023.</div></div><div><h3>Methods</h3><div>This is a retrospective population-based analysis of hospital billing data of adult STEMI patients receiving PPCI in Germany. The time for transport to hospital (TTH) was estimated using geographic routing. The in-hospital time to angiography (IHTA) was calculated using time coding of PPCI in patient records.</div></div><div><h3>Findings</h3><div>A total of 575,247 patients were included. The median age was 64 years, 28.5% (164,016) were female. The population with IHTA ≤60 min increased from 44.5% (22,240/49,965) in 2012 to 57.7% (24,434/42,356) in 2023 with improved TTH + IHTA ≤120 min (56.6%, 28,280/49,965, in 2012–70.2%, 29,734/42,356, in 2023). IHTA improved from median 73.1 min (IQR 25.2–186.6) in 2012 to 46.4 min (IQR 17.5–111.6) in 2023 with a stable TTH (11.4–11.9 min). Risk factors for an IHTA &gt;60 min included age, female sex, comorbidity, presentation out of regular hours, and low-volume hospitals. In-hospital mortality increased (8.8%, 4406/49,965, in 2012, 10.4%, 4822/46,203, in 2021, 10.1%, 4272/42,356, in 2023), paralleling a rise in patient age and comorbidity. Risk factors for in-hospital mortality included female sex, increased age, comorbidity, high-volume hospitals, intervention of multiple coronary arteries, weekend admission, and presentation out of regular hours. IHTA &lt;40 min (90–120 min as reference) and TTH + IHTA &lt;80 min (≥120 min as reference) reduced the risk of death.</div></div><div><h3>Interpretation</h3><div>Combining hospital billing records with geographic routing enables benchmarking of both pre- and in-hospital delays in STEMI care. In hospital delay decreased between 2012 and 2023. Important areas for improving time delays and STEMI-related mortality include the timeliness of care outside of regular hours and a focus on women, older patients, as well as individuals with comorbidities.</div></div><div><h3>Funding</h3><div>There was no funding for this project or this publication.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101576"},"PeriodicalIF":13.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental wealth and mental disorders in Norway (2006–2023): a nationwide registry-based study of 1.4 million young people","authors":"Joakim Coleman Ebeltoft ,&nbsp;Eivind Ystrøm ,&nbsp;Ziada Ayorech ,&nbsp;Espen Moen Eilertsen","doi":"10.1016/j.lanepe.2025.101567","DOIUrl":"10.1016/j.lanepe.2025.101567","url":null,"abstract":"<div><h3>Background</h3><div>Young people from families with low socioeconomic position have higher rates of mental disorders. However, wealth is underexamined despite large wealth inequity worldwide. Here, we aim to investigate the relationship between early life parental wealth and mental disorders in young Norwegians.</div></div><div><h3>Methods</h3><div>We conducted a population study of associations between early-life parental wealth and 17 diagnostic categories of mental disorders in 1.4 M children (7–12), adolescents (13–18), and young adults (19–24) observed 2006–2023. Ranked parental socioeconomic indicators at age 0–6 (wealth, income, occupation, and education) and mental disorder diagnoses (ICD-10 and ICPC-2) were obtained from Norwegian Tax, Employment, Education, and Control and Payment of Health Reimbursements registries. Estimates were derived from mean prevalences, generalised estimating equations, and sibling comparison designs.</div></div><div><h3>Findings</h3><div>Parental wealth represents a gradient in young people's mental disorders across age, sex, diagnostic categories, and cohorts. The lowest wealth quintile demonstrated 87% [95% CI = 78–96%] higher 1-year prevalence than the highest quintile. In multivariable analyses, parental wealth was the strongest predictor of mental disorders relative risk in adolescents (1.83 [1.76–1.9]) and young adults (1.92 [1.8–2.04]), while wealth (1.53 [1.46–1.6]) and education (1.52 [1.45–1.6]) were the strongest predictors in children. Parental wealth has a significant within-family association with mental disorders (relative risks: children 1.57 [1.44–1.71], adolescents 1.34 [1.26–1.42], young adults 1.42 [1.31–1.54]).</div></div><div><h3>Interpretation</h3><div>Our study serves as a point of reference for understanding the relationship between parental wealth and mental health. Our findings establish early life parental wealth as a fundamental social gradient in young people's mental disorders.</div></div><div><h3>Funding</h3><div><span>European Research Council</span> consolidator grant (#<span><span>101045526</span></span>).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101567"},"PeriodicalIF":13.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doubling the diagnostic rate of at-risk metabolic dysfunction-associated steatohepatitis—leave no one behind: author's reply","authors":"Jeffrey V. Lazarus ,&nbsp;William Alazawi ,&nbsp;Christopher D. Byrne ,&nbsp;Cyrielle Caussy ,&nbsp;Paul N. Brennan","doi":"10.1016/j.lanepe.2025.101575","DOIUrl":"10.1016/j.lanepe.2025.101575","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101575"},"PeriodicalIF":13.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the effect of probiotics on severe necrotising enterocolitis in preterm infants born before 32 weeks gestation in England and Wales: a propensity-matched population study","authors":"Alice Aveline ,&nbsp;Lisa Szatkowski ,&nbsp;Janet Berrington ,&nbsp;Kate Costeloe ,&nbsp;Shalini Ojha ,&nbsp;Paul Fleming ,&nbsp;Cheryl Battersby","doi":"10.1016/j.lanepe.2025.101571","DOIUrl":"10.1016/j.lanepe.2025.101571","url":null,"abstract":"<div><h3>Background</h3><div>Necrotising enterocolitis (NEC) remains an important cause of morbidity and mortality in preterm infants. This study aimed to examine whether probiotics reduce the risk of severe NEC and other key neonatal morbidities including late onset sepsis and mortality.</div></div><div><h3>Methods</h3><div>Retrospective study using the United Kingdom National Neonatal Research Database. Infants &lt;32 weeks gestation in England and Wales (01/01/2016–31/12/2022) were included if alive on day four, without major congenital anomaly. A propensity score matched approach was applied matching for gestational age cohorts, birth year epochs and 17 further items. Comparators were infants who were exposed or not to probiotics within 14 days. Primary outcome was severe NEC (confirmed at laparotomy or postmortem or listed primary cause of death). Parent focus groups and former NICU patients supported this study but did not contribute to design or writing.</div></div><div><h3>Findings</h3><div>48,048 infants (45.2% (21,695/48,048) female), median gestational age 29.4 weeks (IQR 27.4–30.9) were included; 25.3% (12,161/48,048) were exposed to at least one of five available probiotics. 3.6% (1728/48,048) had severe NEC. Of 16,586 infants (8293 exposed and 8293 unexposed) in the propensity-matched analysis, incidence and odds ratios (OR) (95% CI) for exposed versus unexposed for severe NEC was 3.3% versus 4.2%, OR 0.80 (0.72–0.89); <em>other definitions of NEC yielded similar results.</em> Incidence for late onset sepsis (10.8% versus 11.5%, OR 0.94 (0.90–0.97)) and survival to discharge (96.6% versus 94.2%, OR 1.76 (1.65–1.88)). In infants &lt;28 weeks gestation, severe NEC (8.7% versus 9.8%, OR 0.88 (0.82–0.93) and for ≥28 weeks (1.0% versus 1.7%, OR 0.59 (0.47–0.73).</div></div><div><h3>Interpretation</h3><div>Probiotics were associated with a reduction in severe NEC including in those &lt;28 weeks gestation. We currently recommend neonatal units not already using probiotics, to consider the introduction of products meeting appropriate recommendations, in the context of their local morbidity rates.</div></div><div><h3>Funding</h3><div><span>NIHR Advanced Fellowship</span> (CB reference: NIHR300617), <span>Imperial College PhD studentship</span> (AA), <span>NIHR RfPB</span> grant (NIHR203590, SO), <span>Imperial NIHR Biomedical Research Centre</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101571"},"PeriodicalIF":13.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cruciate ligament reconstruction combined with anterolateral ligament reconstruction using hamstring autograft versus anterior cruciate ligament reconstruction using bone–patellar tendon–bone autograft: a randomised controlled trial with 5-year follow-up","authors":"Bertrand Sonnery-Cottet ,&nbsp;Alessandro Carrozzo ,&nbsp;Hervé Poilvache ,&nbsp;Jean-Marie Fayard ,&nbsp;Benjamin Freychet ,&nbsp;Mathieu Thaunat ,&nbsp;Thais Dutra Vieira ,&nbsp;Adnan Saithna","doi":"10.1016/j.lanepe.2025.101561","DOIUrl":"10.1016/j.lanepe.2025.101561","url":null,"abstract":"<div><h3>Background</h3><div>Anterior Cruciate Ligament (ACL) rupture is common knee injury. Although ACL reconstruction (ACLR) is standard, graft failure rates remain high in young active patients. This study investigated whether combining ACLR with anterolateral ligament (ALL) reconstruction (ALLR) reduces grafts failure compared with ACLR.</div></div><div><h3>Methods</h3><div>In this prospective, single-centre, randomised controlled trial conducted at the Santy Orthopedic Center in Lyon, France, patients aged 18–35 years with symptomatic ACL rupture were randomly allocated (1:1) to ACL + ALL reconstruction using hamstring tendon autograft (ACLR + ALLR) or ACLR with bone-patellar tendon-bone autograft (ACLR). Randomisation was performed with a block size of four using telematic software by an independent study coordinator, with concealed allocation. Surgeons were informed of the assigned procedure on the morning of surgery. Outcome assessors were not blinded. The primary outcome was graft failure at 5 years, assessed clinically and by magnetic resonance imaging (MRI) by an independent sports medicine physicians not involved in the index surgery. Efficacy analyses were performed on the Full Analysis Set in accordance with the intention-to-treat principle, while safety analyses were conducted on the Safety Set. Trial registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, ID <span><span>NCT03740022</span><svg><path></path></svg></span>. The trial has been completed.</div></div><div><h3>Findings</h3><div>Between November 11, 2016, and January 20, 2020, 593 patients were randomized (297 assigned to ACLR + ALLR and 296 to ACLR). The mean age was 25.0 years (SD 4.5); 447 (75%) participants were male and 146 (25%) female. Of these 593 patients, 556 (94%) completed a mean 5-year follow-up. Graft failure occurred in 12/283 (4.2%) with ACLR + ALLR versus 28/273 (10.3%) with ACLR (p = 0.006; adjusted odds ratio 2.54 [95% CI 1.27; 5.36]—p = 0.008). The number needed to treat was 17 overall, and 9 in patients younger than 25 years.</div></div><div><h3>Interpretation</h3><div>In our study of young, active adults with ACL rupture, who are considered high-risk for graft failure, combining ACL reconstruction with anterolateral ligament reconstruction (ACLR + ALLR) significantly decreased graft failure compared with ACLR. These results suggest that ACLR + ALLR might be beneficial for young or highly active individuals and provide a basis for future research to refine patient selection, evaluate long-term outcomes beyond five years, and explore benefits in other subgroups of patients with ACL injuries.</div></div><div><h3>Funding</h3><div><span>GCS Ramsay Santé pour l'Enseignement et la Recherche</span> funds the scientific activity at the Santy center.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101561"},"PeriodicalIF":13.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doubling the diagnostic rate of at-risk metabolic dysfunction-associated steatohepatitis—leave no one behind","authors":"Elamin Abdelgadir ,&nbsp;Fatheya Alawadi ,&nbsp;Fauzia Rashid ,&nbsp;Alaaeldin Bashir ,&nbsp;Jörn M. Schattenberg","doi":"10.1016/j.lanepe.2025.101572","DOIUrl":"10.1016/j.lanepe.2025.101572","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101572"},"PeriodicalIF":13.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic disparities in long-term mortality after infective endocarditis in Denmark: a nationwide cohort study","authors":"Søren K. Martiny ,&nbsp;Morten Schmidt ,&nbsp;Jonas A. Povlsen ,&nbsp;Kirstine K. Søgaard ,&nbsp;Hans E. Bøtker ,&nbsp;Henrik T. Sørensen","doi":"10.1016/j.lanepe.2025.101568","DOIUrl":"10.1016/j.lanepe.2025.101568","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic position (SEP) influences several determinants of infective endocarditis (IE) progression. Whether IE mortality differs by SEP remains unclear. We examined 5-year mortality after IE by individual-level SEP.</div></div><div><h3>Methods</h3><div>Using nationwide Danish registries, we identified patients with first-time IE (2010–2022). SEP was assessed by educational and affluence level, categorised as low, medium, and high. The Kaplan–Meier estimator provided 30-day, 1-, 3-, and 5-year mortality risks, risk differences, and risk ratios. Time-varying hazard ratios were derived from flexible parametric models. We estimated attendance at outpatient and dental follow-up visits (indicating adherence to follow-up) using the Aalen-Johansen estimator and modelled hospitalisation rate during follow-up (indicating comorbid disease burden) using a joint frailty model, treating death as a competing event in all models.</div></div><div><h3>Findings</h3><div>The 5-year mortality by educational level was 63.1% (95% CI: 60.8%–65.2%) for low, 53.1% (95% CI: 51.3%–54.9%) for medium, and 45.8% (95% CI: 42.5%–48.8%) for high education. The excess mortality was particularly pronounced within the first 2 years. Within one year after discharge, 65.2% (95% CI: 62.9%–67.4%) of low, 73.6% (95% CI: 72.0%–75.2%) of medium, and 74.5% (95% CI: 71.8%–77.2%) of high-education patients had an outpatient contact. The corresponding five year dental visit proportions were 44.0% (95% CI: 41.6%–46.5%), 64.0% (95% CI: 62.2%–65.9%), and 74.0% (95% CI: 71.2%–76.9%), respectively. The hazard ratio for hospitalisations was 1.35 (95% CI: 1.25–1.49) when comparing low <em>vs.</em> high education and 1.19 (95% CI: 1.10–1.27) for low <em>vs.</em> medium. Estimates and time-dependent patterns were similar for affluence level.</div></div><div><h3>Interpretation</h3><div>Patients with low SEP had higher IE mortality, particularly within the first 2 years. Reduced adherence to follow-up care and comorbid diseases may contribute to this. Determining how the excess mortality is directly linked to the IE episode warrants further investigation.</div></div><div><h3>Funding</h3><div><span>Independent Research Fund</span> Denmark (grant no. 3101-00102B) and Center for Population Medicine, <span>Department of Clinical Epidemiology</span>, <span>Aarhus University</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101568"},"PeriodicalIF":13.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood culture practices and microbiological capacity for sepsis diagnostics in Europe (2021–2022): a cross-sectional analysis of the European Sepsis Care Survey","authors":"Christian S. Scheer ,&nbsp;Evangelos J. Giamarellos-Bourboulis ,&nbsp;Djillali Annane ,&nbsp;Antonio Artigas ,&nbsp;Abdullah Tarik Aslan ,&nbsp;Gabriella Bottari ,&nbsp;Hjalmar R. Bouma ,&nbsp;Vladimir Černý ,&nbsp;Renata Curić Radivojević ,&nbsp;Ken Dewitte ,&nbsp;Daniela Filipescu ,&nbsp;Matthias Gründling ,&nbsp;Johanna Hästbacka ,&nbsp;Said Laribi ,&nbsp;Annmarie Lassen ,&nbsp;Konstantin Lebedinskii ,&nbsp;Adam Linder ,&nbsp;Jan Máca ,&nbsp;Manu L.N.G. Malbrain ,&nbsp;Gianpaola Monti ,&nbsp;Zuzanna Górska","doi":"10.1016/j.lanepe.2025.101570","DOIUrl":"10.1016/j.lanepe.2025.101570","url":null,"abstract":"<div><h3>Background</h3><div>Blood cultures (BCs) are key diagnostic elements for sepsis patients. Accurate preanalytical procedures are substantial, and results should be available as soon as possible to guide adequate antimicrobial treatment. This study aimed to evaluate BC collection practices and diagnostic capacity across European hospitals.</div></div><div><h3>Methods</h3><div>This cross-sectional survey investigated BC diagnostics in acute care hospitals across 37 European countries in the years 2021 and 2022. Analyses included BC guidelines, collection sites, number of BC sets in emergency departments (EDs), wards, and intensive care units (ICUs). We also examined transfer after collection, the use of on-site vs. external laboratories, opening hours, rapid testing capacity, and turn-around times of BCs processed in microbiology laboratories with different infrastructures.</div></div><div><h3>Findings</h3><div>Responses were collected from 907 hospitals in Europe. BC guidelines were available in 84·4% (741/878) of the hospitals. BCs were preferably collected by multiple-site sampling in EDs (62·7%, 461/735), in wards (64·0%, 513/802) and ICUs (68·5%, 518/756). One BC set was preferred in EDs in 38·4% (270/704), in wards in 40·5% (314/775), and ICUs in 34·9% (261/748). Two BC sets were preferred in EDs in 31·0% (218/704), in wards in 28·1% (218/775), and ICUs in 39·2% (293/748). 48·0% (402/838) of hospitals used on-site and 52·0% (436/838) external microbiology laboratories. Around-the-clock microbiological services were available in 10⋅0% (91/907), and rapid pathogen identification in 43·7% (396/907) of hospitals. Infrastructure with around-the-clock microbiological service and rapid testing was available in 7·4% (62/840) of hospitals, and probability of a final microbiological result within two days was highest in these hospitals compared to hospitals with limited microbiology service (for BC collected on wards: 19·6% vs. 52·7%, Odds Ratio 4·59 [95% CI 2·50–7·79], p &lt; 0·0001).</div></div><div><h3>Interpretation</h3><div>Despite the availability of BC guidelines in many hospitals, current recommendations for BC collection were often neglected. Rapid testing capacity was limited in most microbiological laboratories, and around-the-clock service for BCs was very rare. As delay in results may have a detrimental impact on patient outcomes, strategies to improve these processes are urgently needed.</div></div><div><h3>Funding</h3><div>The <span>European Sepsis Alliance</span> and a grant by Becton and Dickinson.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101570"},"PeriodicalIF":13.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}