Nontraumatic cerebral hemorrhage (NCH) is a major cause of mortality and long-term disability in critically ill patients, and reliable prognostic biomarkers are required. The lactate-to-albumin ratio (LAR) is a validated prognostic indicator in critical care; however, its predictive value in NCH patients remains unclear. A retrospective cohort study using the Medical Information Mart for Intensive Care IV database enrolled 1010 intensive care unit (ICU)-admitted critically ill NCH patients, with LAR calculated from lactate and albumin levels within 24 hours of admission. The primary and secondary endpoints were the in-hospital and ICU mortality rates. Kaplan-Meier, log-rank tests, receiver operating characteristic analysis, univariate/multivariable Cox regression, restricted cubic splines, and subgroup analyses were used for relevant assessments. Median admission LAR was 0.47 (interquartile range: 0.33-0.70); in-hospital and ICU mortality rates were 26.63% and 27.13%. Elevated LAR was an independent correlate of both mortalities (P < .001), with a higher area under the curve for mortality prediction than lactate or albumin alone. LAR was consistently associated with mortality in most of the demographic and clinical subgroups. LAR reliably predicts in-hospital and ICU mortality in critically ill patients with NCH and may optimize early risk stratification and clinical management.

Hyperlipidemia impacts global mortality, and the neutrophil-percentage-to-albumin ratio (NPAR) is a novel inflammatory marker, but its association with mortality in hyperlipidemic adults is unknown. Using National Health and Nutrition Examination Survey data (1999-2018), this study examined NPAR's association with all-cause and cardiovascular disease (CVD) mortality in hyperlipidemic adults via multivariate Cox models and restricted cubic splines, with threshold effects and subgroup analyses also evaluated. Among 35,356 participants, NPAR showed a U-shaped link with all-cause mortality (inflection = 11.7; hazard ratio (HR) = 0.94, 95% confidence interval (CI) 0.91-0.98 below; HR = 1.14, 95% CI, 1.12-1.15 above) and a positive linear association with CVD mortality (HR = 1.12, 95% CI, 1.10-1.15). The all-cause mortality risk from higher NPAR was greater in physically inactive individuals. Among US adults with hyperlipidemia, a U-shaped association was identified between NPAR and all-cause mortality, while a linear positive correlation was noted with CVD mortality. An NPAR of 11.7 may be optimal, and physical activity might reduce risks from higher NPAR levels. NPAR may help identify high-risk patients for closer monitoring and targeted prevention strategies.

Assessing health literacy has become important as a component of strategies to increase self-care behaviour for patients with cardiovascular disease (CVD).

This study aimed to develop a scale for measuring health literacy in patients with CVD and to evaluate its reliability and validity.

This is an instrument development study with a psychometric analysis. The initial questions were based on the components identified in a concept analysis, and the reliability and validity were evaluated with 391 patients visiting outpatient hospitals due to CVD such as myocardial infarction, arrhythmia and heart failure.

The final scale consisted of 22 items across four factors: 'Understanding and searching for health information', 'Actively selecting and evaluating health information', 'Utilization of health information resources' and 'Interacting with healthcare providers'. The four-factor structure demonstrated acceptable model fit in confirmatory factor analysis. Convergent and criterion validity were supported by significant correlations with established health literacy tools. Internal consistency was high (Cronbach's α = 0.891), and test-retest reliability was satisfactory.

This health literacy scale for patients with CVD can be utilized in future surveys or intervention studies to enhance the self-care behaviour of individuals with CVD. Its psychometric analysis should be repeated with CVD patients in other countries or hospital settings.

Atrial fibrillation (AF) is a major cause of thromboembolic events, including ischemic stroke and transient ischemic attack (TIA). While Vitamin K antagonists (VKAs) have long been used for stroke prevention, Direct Oral Anticoagulants (DOACs) have emerged as potential alternatives due to improved pharmacologic profiles and safety. This systematic review and meta-analysis aimed to compare the efficacy and safety of DOACs versus VKAs in patients with non-valvular AF, with a focus on cerebrovascular ischemic outcomes.

A comprehensive search of PubMed, ClinicalTrials.gov, and Cochrane Library was performed in accordance with PRISMA 2020 guidelines. Randomized controlled trials and comparative observational studies reporting cerebrovascular events, major bleeding, and all-cause mortality were included. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.

Eleven studies encompassing 814 716 patients were included. DOAC use was associated with a significantly lower risk of recurrent cerebrovascular ischemic events compared with VKAs (RR 0.83, 95% CI 0.78-0.88, p < 0.0001). The risk of major bleeding was also reduced with DOACs (RR 0.77, 95% CI 0.71-0.82, p < 0.0001). All-cause mortality was similar between groups (RR 1.02, 95% CI 0.34-3.13), though sensitivity analysis excluding one heterogeneous study favored DOACs (RR 0.79, 95% CI 0.63-0.98).

In patients with non-valvular AF, DOACs demonstrate superior efficacy in reducing cerebrovascular ischemic outcomes and lower bleeding risk compared to VKAs, with comparable mortality outcomes. These findings support current guidelines recommending DOACs as first-line anticoagulation for stroke prevention in AF.

To analyze the treatment response in patients with primary angiitis of the central nervous system (PACNS) in a large vasculitis cohort.

In this single-center retrospective observational study, we assessed treatment, relapses, remission, and outcome of patients with PACNS. We pooled the patients' relapses under different treatments as well as various immunotherapies. Multivariate logistic regression analysis was performed to determine factors independently associated with relapse and those associated with good functional status. The time of observation was 96 months.

The cohort comprised 80 patients, with 38 diagnosed with pathologically confirmed PACNS and 42 with clinically diagnosed PACNS, with a median follow-up duration of 18 months (range 3-96). Treatment comprised acute-phase induction therapy with high-dose corticosteroids, alone or combined with immunosuppressive agents, followed by remission-phase maintenance immunosuppressive therapy, primarily with cyclophosphamide, rituximab, or mycophenolate mofetil. Following treatment, 49 patients (61.3%) achieved remission and 70 (87.5%) attained favorable functional outcomes. The overall relapse rate was 35%. Group 3 demonstrated significantly higher baseline disease severity (p < 0.05). Multivariate analysis identified seizures and cognitive impairment as predictors of relapse.

This study demonstrates that a majority of PACNS patients exhibit a favorable response to therapy. For patients presenting with more severe disease at diagnosis, long-term maintenance therapy following remission induction with glucocorticoids or immunosuppressive agents is required.

To establish patterns of macro- and microscopic anatomy and topography of myocardial bridges over the coronary arteries and their branches according to coronary angiography data and on preparations of hearts of adults of both sexes.

An observational, retrospective, non-randomized study was conducted. The frequency of myocardial bridges over the coronary arteries and their branches was studied according to the data of retrospective analysis of the results of coronary angiography (1986 protocols), morphological study was performed on 30 isolated preparations of the hearts of adults of both sexes (18 women and 12 men) aged from 31 to 99 years (median 70). The trunks of the right and left coronary arteries and their branches were isolated by the method of dissection. The presence of myocardial bridges over the branches of the coronary arteries was detected, their length and the thickness of the myocardium over the branches of the arteries were recorded. A histological examination of the heart areas with detected myocardial bridges was performed. It was found that the frequency of detection of myocardial bridges during coronary angiography is significantly lower than their occurrence during autopsy.

The presence of myocardial bridges in the right coronary artery system may correlate with its presence in the left coronary artery system and other abnormalities in heart development. Myocardial bridges are more common in men and are mainly localized in the middle third of the anterior interventricular branch of the left coronary artery. Isolated myocardial bridges are more common. The length of myocardial bridges on average ranges from 9.2 to 22.3 mm, the thickness - from 0.2 to 3 mm. A relationship has been found between the length of the bridges and the dimensions of the ventricular complex of the heart. The intramural segment of the coronary artery is usually completely immersed in the myocardium, but sometimes a semi-tunnel passage occurs, in which the coronary artery is covered by myocardium by 2/3 or 3/4 of the circumference of its cross-section. In all sections of the coronary arteries of the heart, regardless of their location in relation to the myocardial bridge, there was atherosclerotic lesion of the coronary artery of varying degrees of severity.

Delirium is a common and serious complication in critically ill patients, particularly those with acute heart failure (HF). The lactate/albumin ratio (LAR) has emerged as a potential biomarker reflecting metabolic and nutritional status, serving as an indicator for delirium risk. This study aims to investigate the association between LAR and delirium incidence in acute heart failure patients.

We conducted a retrospective observational cohort analysis using the Medical Information Mart for Intensive Care IV (MIMIC-IV-3.1) database, which includes ICU admissions from 2008 to 2022. A total of 1,695 patients diagnosed with acute heart failure were enrolled. LAR was calculated by dividing serum lactate levels by serum albumin levels. Bivariate analyses assessed the relationship between LAR and delirium, while mediation analysis and propensity score matching controlled for confounding variables.

We found a significant association between elevated LAR values and increased delirium risk. Patients with higher LAR exhibited a markedly higher delirium incidence compared to those with lower levels. Age, body mass index (BMI), and specific comorbidities significantly mediated the relationship between LAR and delirium risk, underscoring the multifactorial nature of delirium development in this population.

Our findings suggest that LAR is a valuable biomarker for predicting delirium risk in critically ill acute heart failure patients. Recognizing at-risk patients may enable timely interventions to mitigate delirium and improve ICU outcomes. Further research is warranted to validate these findings and explore targeted management strategies.

Right ventricular (RV) dysfunction in chronic kidney disease (CKD) remains underrecognized. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP) reflects RV-pulmonary arterial coupling, but its relationship with CKD severity is unknown. To evaluate the association between TAPSE/sPAP ratio and CKD stage severity and assess age-related effect modification.

This cross-sectional study enrolled 120 participants: 40 patients with stage I-II CKD, 40 with stage III-IV CKD, and 40 healthy controls. All underwent echocardiography and nephrologist evaluation. Proportional odds regression models adjusted for cardiovascular risk factors evaluated the TAPSE/sPAP-CKD association. ROC analysis assessed discriminatory performance. Age-stratified analyses (<65 vs. ≥65 years) evaluated effect modification.

TAPSE/sPAP ratio declined progressively across CKD stages (controls: 0.67 ± 0.11, stage I-II: 0.61 ± 0.13, stage III-IV: 0.53 ± 0.13 mm/mmHg; p < 0.01). Each 0.10-unit decrease was independently associated with advanced CKD (adjusted OR 2.08, 95% CI 1.49-2.89, p < 0.001). TAPSE/sPAP ratio achieved the highest AUC (0.734, 95% CI 0.625-0.833), outperforming TAPSE alone (AUC 0.615; DeLong p = 0.049), while statistically comparable to sPAP (AUC 0.715; DeLong p = 0.400). Age-stratified analysis revealed excellent performance in patients <65 years (AUC 0.819, sensitivity 78.6%, specificity 86.8%) but limited utility in those ≥65 years (AUC 0.579; p = 0.015). Random forest analysis identified age (35.8%) and TAPSE/sPAP (22.0%) as dominant predictors.

TAPSE/sPAP ratio is an independent marker of CKD severity enabling non-invasive detection of RV-PA uncoupling, with excellent discriminatory performance in younger but limited utility in older patients, suggesting that age-specific interpretation and integration with renal biomarkers are recommended.

Intracerebral haemorrhage (ICH) is a leading cause of mortality and morbidity worldwide. Identifying early prognostic biomarkers is crucial to optimise clinical management of critically ill patients with ICH. The haemoglobin-to-red cell distribution width ratio (HRR) has recently emerged as a potential predictor in various critical illnesses, but its role in ICH remains unclear. This study aimed to evaluate associations between HRR and mortality in patients with ICH.

This retrospective cohort study included the data of adults (≥18 years) extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (version 1). HRR was calculated from the first available haemoglobin and RDW measurements within one day of each other. Patients were categorised into HRR quartiles. The primary outcomes were 28-day and 1-year all-cause mortality. Associations were assessed using Cox proportional hazards models.

The data of 1915 patients (mean age 67.5 years) were analysed retrospectively. After adjusting for possible confounders, compared with the lowest HRR quartile (Q1), patients in Q3 and Q4 had significantly lower 28-day mortality (Q3: adjusted hazard ratio (aHR) = 0.72; 95% CI = 0.54, 0.97; Q4: aHR = 0.67; 95% CI = 0.49, 0.90). Similarly, higher HRR quartiles were associated with reduced 1-year mortality risk (Q3: aHR = 0.64; 95% CI = 0.49, 0.84; Q4: aHR = 0.56; 95% CI = 0.42, 0.75).

Lower HRR at admission is independently associated with higher short-term and long-term mortality in ICU patients with ICH. HRR may serve as a candidate prognostic biomarker for early risk stratification in this high-risk population. Further prospective studies are warranted to confirm these findings.

Guidelines discourage prediction of neurological outcome in comatose patients within the first 72 h after cardiac arrest. Increasing evidence suggests that patients with the most severe brain injury and those with no or minimal brain injury may be identified before 72 h using novel methods. We present a protocol for the EARLY-NEURO study, which aims to evaluate whether good and poor outcomes can be reliably predicted already from 24 h after cardiac arrest using the most commonly available methods.

Protocol for a prospective international multicenter substudy within the Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial where adults post-arrest are randomized to minimal or deep sedation, fever treatment with or without a temperature management device and to two different targets of mean arterial blood pressure. Patients sedated or still unconscious at 24 h are examined with head computed tomography (CT) and electroencephalogram (EEG). Blood samples are collected at 24 h after randomization, and stored for analysis of the brain injury marker neurofilament light. CT and EEG examinations will be centrally evaluated for signs of a likely poor or good outcome applying standardized criteria by raters blinded to treatment allocations and patient outcomes. Intensive care treatment, neurological prognostication, and criteria for withdrawal of care will be according to the STEPCARE protocol. Timepoint and reasons for withdrawal of life-sustaining therapy (WLST) will be recorded. WLST prior to 72 h after randomization based on a presumed futile neurological prognosis is strongly discouraged. Primary outcome will be good or poor functional outcome, assessed by the modified Rankin Scale (dichotomized as 0-3 versus 4-6) at 6 months. Results will be reported in accordance with the Standards for Reporting Diagnostic Accuracy (STARD).

Earlier prognostication aims to balance the avoidance of premature treatment withdrawal in patients with favorable potential against the prevention of unnecessary intervention in patients with a definitely poor prognosis.