Am J Med Sci
· 2026 Jul · PMID 41794397
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BACKGROUND: The relationship between telomere attrition and all-cause mortality among U.S. adults has been inconsistent. Additionally, the combined effect of age and race/ethnicity on this association has rarely been inv...BACKGROUND: The relationship between telomere attrition and all-cause mortality among U.S. adults has been inconsistent. Additionally, the combined effect of age and race/ethnicity on this association has rarely been investigated. METHODS: We utilized two publicly available datasets, the National Health and Nutrition Examination Survey (1999-2002) and the 2019 Linked Mortality File, including data on adults aged 25 years or older (n = 6516 and 2163 deaths). Telomere length (TL) was measured as a standardized value expressed in kilobase pairs (kbp). We specified TL as continuous and categorical variables using quartile distribution (Q). Cox proportional hazards regression was used to quantify the association between TL and all-cause mortality using hazard ratios (HR) and 95% confidence intervals (CI). To test this association, we fitted three models: an unadjusted model, a model adjusted for sociodemographic variables, and a final model additionally adjusted for health risk factors and chronic diseases. We also tested for effect modification by age group and race/ethnicity. RESULTS: After adjusting for baseline sociodemographic characteristics, health risks, and chronic health conditions, a kbp decrease in TL was associated with 1.36 higher rate of all-cause mortality (95% CI: 1.17, 1.58). The rate of all-cause mortality was 1.57 times higher among adults with the shortest TL (Q1) relative to the longest TL (Q4) (95% CI: 1.25, 1.98). We did not find evidence of an effect modification by age and race/ethnicity. CONCLUSIONS: These findings highlight a significant association between TL and all-cause mortality, supporting telomere attrition as a predictor.
Sharifi I, Razzeto A, Sacco SB
… +4 more, Zamin M, Valencia V, Aoun ML, Varghese RT
Am J Med Sci
· 2026 Jun · PMID 41794396
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Mucormycosis is an aggressive angioinvasive fungal infection that commonly involves the paranasal sinuses, orbit, lungs, and central nervous system (CNS). Patients with diabetic ketoacidosis (DKA) are uniquely susceptibl...Mucormycosis is an aggressive angioinvasive fungal infection that commonly involves the paranasal sinuses, orbit, lungs, and central nervous system (CNS). Patients with diabetic ketoacidosis (DKA) are uniquely susceptible because hyperglycemia and acidosis enhance fungal invasion and blunt innate immune defenses. We present a brief vignette of rhino-orbito-cerebral mucormycosis in a patient with recent diagnosis of type 1 diabetes mellitus (DM), and use it to frame a short review of epidemiology, pathogenesis, diagnosis, and management. Rapid recognition, urgent surgical debridement, prompt initiation of high-dose liposomal amphotericin B, and reversal of metabolic derangements remain cornerstones of care. Emerging developments include broader use of isavuconazole and posaconazole as step-down therapy and expanding molecular diagnostics, including serum Mucorales polymerase chain reaction, that may enable earlier detection and treatment monitoring. Because outcomes are strongly time-dependent, clinicians should maintain a low threshold for multidisciplinary evaluation when invasive fungal sinusitis is suspected in patients with DM.
Cintron SA, Diaz FJ, Krebill R
… +4 more, Hitchcock SR, Kasuske L, Yang FM, Pierce JD
Am J Med Sci
· 2026 Jun · PMID 41791507
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BACKGROUND: Post-acute COVID-19 is a syndrome characterized by the persistence of clinical symptoms beyond 4 weeks from the onset of acute symptoms. Over 250,000 Department of Defense service members have recovered or ar...BACKGROUND: Post-acute COVID-19 is a syndrome characterized by the persistence of clinical symptoms beyond 4 weeks from the onset of acute symptoms. Over 250,000 Department of Defense service members have recovered or are recovering from acute COVID-19, and the range of symptoms and physiological changes can impact the medical readiness of military service members. Understanding the chronic illness among some of the active-duty personnel with this virus is needed to begin finding treatments to reduce their symptoms and improve their health outcomes. METHODS: This was a longitudinal, descriptive study designed to examine the prevalence and persistence of the symptoms of active-duty military persons who have post-COVID-19 syndrome. We obtained data from electronic health records (EHRs) of clinics and hospitals of the armed services from U.S. military bases. The de-identified data set came from the Department of Defense Military Health System Data Repository (MDR) which is a centralized data repository established to capture, archive, validate, integrate, and distribute Defense Health Agency (DHA) data worldwide. RESULTS: The most prevalent symptom was pulmonary related, affecting 22.4 % of individuals with post-COVID-19 syndrome. The second most prevalent symptom was neurological problems (14.6 %), followed by fatigue (13.5 %), digestive issues (12.5 %), and fever (11.5 %). Approximately 3.7 % of military personnel with post-COVID-19 experienced cognitive symptoms however, they had the greatest persistence, followed by pulmonary related, fatigue, and neurological symptoms. CONCLUSIONS: Based on the symptoms identified, finding treatments for post-COVID-19 syndrome is needed particularly for military personnel to maintain fitness and readiness.
Golchin N, Lesperance T, Scheuring J
… +4 more, Wan V, Hofer K, Collet JP, Patel A
Am J Med Sci
· 2026 Jun · PMID 41747937
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BACKGROUND: Progressive pulmonary fibrosis (PPF) has only recently been defined. This study aimed to estimate the global incidence and prevalence of PPF and assess regional variations. METHODS: MEDLINE®, Embase, and Coch...BACKGROUND: Progressive pulmonary fibrosis (PPF) has only recently been defined. This study aimed to estimate the global incidence and prevalence of PPF and assess regional variations. METHODS: MEDLINE®, Embase, and Cochrane Database of Systematic Reviews were searched from 01/01/2000 to 11/07/2023 for English-language studies reporting incidence or prevalence of PPF. A DerSimonian-and-Laird random-effects model was used to calculate pooled weighted-mean incidence/prevalence estimates. RESULTS: Of 3823 abstracts, five studies were included for meta-analysis. Pooled global incidence across four studies was 10.9/100,000 (95% confidence interval: 1.3-20.5). In Europe, pooled incidence across two studies was 6.7/100,000 (2.2-11.3). Reported incidence rates were 2.4/100,000 in South Korea and 27.6/100,000 in the United States (US). Pooled global prevalence across all studies was 37.0/100,000 (23.6-50.5). Within Europe, pooled prevalence from two studies was 30.2/100,000 (0.0-61.9); prevalence estimates were 6.4 in South Korea, and 57.8 and 60.7 in two US studies. CONCLUSIONS: PPF appears rare globally, with higher incidence and prevalence in the US. Standardized definitions are needed for more accurate estimates.
Betsikos A, Theodorakopoulou MP, Korogiannou M
… +6 more, Marinaki S, Kamperidis V, Iatridi F, Boletis J, Tsioufis C, Sarafidis P
Am J Med Sci
· 2026 Jun · PMID 41724266
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BACKGROUND: Cardiovascular disease is the leading cause of death in end-stage kidney disease and the chronic cardiomyopathy of chronic kidney disease contributes significantly to this. Kidney transplantation (KTx) is ass...BACKGROUND: Cardiovascular disease is the leading cause of death in end-stage kidney disease and the chronic cardiomyopathy of chronic kidney disease contributes significantly to this. Kidney transplantation (KTx) is associated with improved survival compared to dialysis. This systematic review and meta-analysis (CRD42022371202) aimed to assess the changes in echocardiographic indices in patients before and following KTx. METHODS: The literature search involved PubMed, Web-of-Science and Scopus databases, manual search of article references and grey literature. The primary outcome measure was left-ventricular mass index (LVMI). RESULTS: Thirty-three studies with 2364 patients were included in the metanalysis for the primary outcome. LVMI was significantly decreased after KTx compared to pre-transplantation values [WMD -21.99 g/m, 95 %CI (-28.10, -15.87) I = 89 %, P < 0.00001]. In subgroup analyses, higher differences were evident among 6 studies (N = 163) evaluating LVMI≤6 months after KTx [WMD -41.54 g/m2, 95 %CI (-51.31, -31.78), I = 13 %, P < 0.001] and lower differences among 26 studies (N = 2095) evaluating LVMI >6 months after KTx [WMD -18.96 g/m2, 95 %CI (-25.44, -12.47), I2 = 89 %, P < 0.001]. In sensitivity analyses, patients receiving kidney from living kidney donors [(WMD; -76.90 g/m2, 95 %CI (-122.13, -31.67), I2 = 88 %, P < 0.001)] and those on hemodialysis before KTx [WMD;-33.76 g/m2, 95 %CI (-51.51, -16.00), I2 = 92 % P < 0.001] presented higher LVMI reductions following transplantation. CONCLUSIONS: KTx is associated with significant reductions in LVMI compared to the pre-transplantation levels. This could be another factor contributing to the lower cardiovascular risk observed after KTx compared to dialysis.
Am J Med Sci
· 2026 Jul · PMID 41722906
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OBJECTIVE: In 1912, the Titanic struck an iceberg and sank. The question of why the iceberg was detected too late to avoid collision has been debated ever since. The potential role of sleep deprivation and circadian rhyt...OBJECTIVE: In 1912, the Titanic struck an iceberg and sank. The question of why the iceberg was detected too late to avoid collision has been debated ever since. The potential role of sleep deprivation and circadian rhythm disturbance has not previously been explored scientifically. Given that the diagnosis of sleep disturbances rests primarily on patient history and circumstantial evidence, this study systematically examines these factors. METHODS: An online search and literature review were conducted, drawing on extensive documentation provided by witnesses and experts who testified before the American and British inquiries held shortly after the disaster. RESULTS: The lookouts in the crow's nest served continuous rotations of two hours on duty followed by four hours off, while the Officer of the Watch (OOW) on the bridge served four hours on duty followed by eight hours off. At the time of the accident, those on watch were working their fifth consecutive night shift and the lookouts had less than four hours between duties for personal hygiene, meals, and sleep. Although the OOW had longer rest periods, his off-duty time was frequently interrupted by additional responsibilities. This duty pattern, particularly for the lookouts, was likely to have produced sleep restriction, poor sleep quality, and circadian disruption. Fatigue and sleepiness remain significant contributors to accidents in modern maritime operations. CONCLUSIONS: The Titanic's lookouts, more so than the OOW, were likely to have been affected by sleep loss and circadian misalignment. Sleep-related performance impairment continues to pose a threat to safety in maritime transport today.
Moh'd Mari AA, Alamin F, Le MA
… +2 more, Rizvi A, Mansi IA
Am J Med Sci
· 2026 May · PMID 41698506
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INTRODUCTION: Some studies suggested that glucagon-like peptide-1 receptor agonists (GLP-1RA) reduce colorectal cancer (CRC) risk, whereas others suggested that GLP-1RA promote tumorigenesis. This study aimed to examine...INTRODUCTION: Some studies suggested that glucagon-like peptide-1 receptor agonists (GLP-1RA) reduce colorectal cancer (CRC) risk, whereas others suggested that GLP-1RA promote tumorigenesis. This study aimed to examine the association of GLP-1RA with incident CRC and colonic polyps. METHODS: This is a retrospective propensity score (PS)-matched cohort study (years 2006-2021) using a new-user, active comparator design. The study included adults who initiated either GLP-1RA or dipeptidyl peptidase-4 inhibitors (DPP4i), the latter as active comparator. We created PS using 61 variables (main cohort). A second PS-matched cohort excluded patients with colonic polyps at baseline (no-polyp cohort). The primary outcomes were incident CRC and colonic polyps. RESULTS: We matched 86,083 pairs in the main cohort without residual differences. There was no significant difference in CRC incidence between GLP-1RA users (0.2 %) and DPP4i users (0.3 %), odds ratio (OR): 0.99; 95 % confidence interval (95 %CI): 0.84-1.17. However, GLP-1RA users had a higher incidence of colonic polyps (5.9 %) compared to DPP4i users (5.3 %); OR: 1.12 (95 %CI: 1.08-1.17). Results were similar in the no-polyp cohort. CONCLUSIONS: The use of GLP-1RA in patients with DM was not associated with a decreased or increased risk of CRC but was associated with a higher risk of incident colonic polyps compared to DPP-4i use.
Am J Med Sci
· 2026 Jun · PMID 41698505
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BACKGROUND: Sleep apnea (SA), a common diagnosis, has been shown to exhibit increased prevalence in patients with end-stage renal disease (ESRD). There is no clear consensus on the impact of SA on renal transplant outcom...BACKGROUND: Sleep apnea (SA), a common diagnosis, has been shown to exhibit increased prevalence in patients with end-stage renal disease (ESRD). There is no clear consensus on the impact of SA on renal transplant outcomes. METHODS: We performed a retrospective analysis of the United States Renal Data System (USRDS) to evaluate the impact of SA on renal transplant outcomes, including transplant failure or rejection, post-transplantation new onset chronic kidney disease (CKD) levels 3, 4, or 5, and mortality. Demographic variables of interest included age at transplant, race, sex, ethnicity, and Charlson Comorbidity Index (CCI). Cox proportional hazards (CPH) modeling was used to examine the association of SA with transplant outcomes. RESULTS: When examining the final multivariable CPH models, patients with SA were less likely to experience a transplant failure or rejection (HR: 0.93, CI: 0.89-0.96). SA did not have a significant effect on mortality (HR: 1.04; CI: 0.99-1.09) in the final analysis. SA was significantly associated with new onset CKD 3 (HR: 1.22; CI: 1.19-1.27), CKD 4 (HR: 1.20; CI: 1.13-1.27), and CKD 5 (HR: 1.08; CI: 1.01-1.14). DISCUSSION: SA significantly increases the risk of post-transplantation progression to CKD 3, 4, and 5. SA mildly decreases the risk of transplant failure or rejection with no significant effect on mortality. The protective effect of SA on transplant failure and rejection is of unclear clinical significance. CONCLUSIONS: This study elucidates a potential link between SA and renal transplant outcomes. Further studies are required to better characterize the association and develop treatment guidelines.
Desai R, Mohammed AS, Ahmed H
… +9 more, Adompreh-Fia KS, Reddy Ganampet N, Sampath S, Bhanushali AK, Muslehuddin Z, Behera A, Bandaru RR, Bandaru SK, Allamneni R
Am J Med Sci
· 2026 Jun · PMID 41690518
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Am J Med Sci
· 2026 Jun · PMID 41690517
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BACKGROUND: Acute pancreatitis (AP) is a prevalent inflammatory condition that can result in multiple organ failure. Previous research has established a correlation between serum osmolality and outcomes in critically ill...BACKGROUND: Acute pancreatitis (AP) is a prevalent inflammatory condition that can result in multiple organ failure. Previous research has established a correlation between serum osmolality and outcomes in critically ill patients. However, the specific relationship between serum osmolality and AP remains ambiguous. METHODS: Our retrospective cohort study employed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We utilized multivariable Cox regression analysis, Kaplan-Meier survival curves, restricted cubic spline (RCS) curves, and threshold effect analysis to evaluate the impact of serum osmolality on mortality. Subgroup analyses were performed, and interactions were assessed. Additionally, sensitivity analysis was conducted by excluding samples with missing data. RESULTS: The final cohort comprised 914 patients diagnosed with AP (mean age, 58.7 ± 17.5 years; 57.3 % male), with a 30-day mortality rate of 15.3 %. Elevated serum osmolality emerged as an independent prognostic factor for mortality (hazard ratio [HR], 1.11; 95 % confidence interval [CI], 1.06-1.16; P < 0.001). A nonlinear dose-response pattern was demonstrated, with thresholds identified at 298.5 mmol/L based on RCS analysis and threshold effect analysis. Kaplan-Meier analysis revealed patients with high serum osmolality have lower survival rates. Subgroup and sensitivity analyses demonstrate the robustness of the results. CONCLUSIONS: Serum osmolality demonstrated a nonlinear relationship with 30-day all-cause mortality among AP patients. A significant threshold was observed at 298.5 mmol/L, beyond which elevated serum osmolality was associated with 30-day all-cause mortality.
Luo P, Liu S, Wang H
… +3 more, Zhang B, Han T, Jin Z
Am J Med Sci
· 2026 May · PMID 41687777
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OBJECTIVE: Obesity is a recognized risk factor for arthritis. However, traditional anthropometric measures such as body mass index (BMI) have limitations in reflecting visceral fat distribution. Body size index for Adult...OBJECTIVE: Obesity is a recognized risk factor for arthritis. However, traditional anthropometric measures such as body mass index (BMI) have limitations in reflecting visceral fat distribution. Body size index for Adults (ABSI) is a new measure that combines waist circumference, height, and BMI to better predict obesity-related health risks. METHODS: A cross-sectional study was conducted using data from 36,856 participants (aged ≥18 years) in the 1999-2023 NHANES cycles. Participants were categorized into arthritis, RA, and OA groups based on self-reported physician-diagnosed conditions. Multivariate logistic regression, restricted cubic splines, and threshold effect analysis were performed to assess associations, adjusting for demographics, lifestyle factors, and comorbidities (e.g., hypertension, diabetes). RESULTS: ABSI was positively correlated with overall arthritis (OR = 2.54, 95%CI = 2.37-2.73, P < 0.001) and OA (OR = 1.15, 95%CI = 1.02-1.31, P = 0.024). But there was no correlation with RA (OR = 0.98, P = 0.832). ABSI had a threshold effect on arthritis (threshold = 7.435,P < 0.001) and OA (threshold = 8.015,P = 0.005). CONCLUSIONS: ABSI was a potential predictor of arthritis, especially OA, highlighting its potential for clinical risk stratification. The nonlinear association suggests different pathological mechanisms at higher ABSI thresholds, so longitudinal studies are necessary to verify causality and explore biological pathways.
Zhao F, Zhao J, Shan Y
… +8 more, Zheng Y, Shi Y, Song C, Cheng Y, Li Y, Guo S, Chang C, He D
Am J Med Sci
· 2026 May · PMID 41687776
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BACKGROUND: Based on the age of onset, rheumatoid arthritis (RA) can be classified into elderly-onset RA (EORA) and young-onset RA (YORA), which exhibit significant differences in clinical manifestations, comorbidities,...BACKGROUND: Based on the age of onset, rheumatoid arthritis (RA) can be classified into elderly-onset RA (EORA) and young-onset RA (YORA), which exhibit significant differences in clinical manifestations, comorbidities, and laboratory findings. Understanding these differences is crucial for the individualized diagnosis and treatment of RA. METHODS: This cross-sectional study included 490 RA patients hospitalized in 2023 at Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. Detailed demographic data, clinical characteristics, and laboratory parameters were collected and analyzed using R version 4.4.1 for statistical analysis. RESULTS: EORA patients exhibited a higher incidence of joint deformities and higher DAS28-ESR scores compared with the YORA group, suggesting a potentially greater level of disease activity. Regarding comorbidities, the prevalence of interstitial lung disease, hypertension, and osteoporosis was significantly higher in EORA patients. Laboratory findings showed that ESR, D-dimer, and IgA levels were also significantly elevated in the EORA group compared with YORA patients, while no significant differences were observed between the two groups across the 12 cytokine measurements. In addition, EORA patients displayed higher levels of several activated and suppressive T-cell subsets, whereas YORA patients had higher cytotoxic T-cell levels. However, multivariable regression analysis indicated that these differences were not independently driven by disease-onset classification but were instead primarily associated with age, disease exacerbation, and disease duration. CONCLUSIONS: Significant differences exist among EORA and YORA groups in terms of disease manifestations, comorbidities, and biochemical markers. Future research should further investigate the underlying mechanisms of these differences and assess the long-term outcomes of different treatment approaches.
Am J Med Sci
· 2026 May · PMID 41605312
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PURPOSE: By elucidating the association between specific PUFA and the risk of liver fibrosis, this study aims to provide a theoretical basis for nutritional interventions and risk stratification in diabetes populations w...PURPOSE: By elucidating the association between specific PUFA and the risk of liver fibrosis, this study aims to provide a theoretical basis for nutritional interventions and risk stratification in diabetes populations with liver fibrosis. METHODS: Data for this cross-sectional study were obtained from the 2011-2014 NHANES database. We defined liver fibrosis through the FIB-4. The clinical cutoff was set at FIB-4 ≥ 1.3 for adults < 65 years and FIB-4 ≥ 2.0 for elderly patients aged ≥ 65 years. Different models were constructed using logistic regression analysis to explore the association of omega-6, omega-3, their subcategories, and the mega-6/omega-3 ratio with liver fibrosis in diabetes patients. Sensitivity analyses were performed using E-values. RCS analysis was employed to further explore the nonlinear relationship between associated PUFA and liver fibrosis. RESULTS: A total of 725 diabetes patients were included in the analysis, with 34.897% (253/725) classified in the indeterminate/high-risk liver fibrosis group. Logistic analysis indicated that the omega-6/omega-3 ratio and LNA may be associated with liver fibrosis (all P < 0.05). RCS results revealed that LNA was significantly related to liver fibrosis with a non-linear relationship (P for overall<0.001, P for nonlinear< 0.001). The omega-6/omega-3 ratio was significantly linked to liver fibrosis with a linear negative association (P for overall<0.05, P for nonlinear> 0.05). CONCLUSIONS: The subcategory of omega-6- LNA and the omega-6/omega-3 ratio were associated with liver fibrosis in diabetes patients. Clinicians should monitor the omega-6/omega-3 ratio in diabetes patients and provide personalised management guidance for high-risk individuals.
Am J Med Sci
· 2026 May · PMID 41580285
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BACKGROUND: Cardiometabolic index (CMI) is a novel marker reflecting metabolic and cardiovascular health, but its role in spondyloarthritis (SpA) remains unclear. This study aimed to investigate the association between C...BACKGROUND: Cardiometabolic index (CMI) is a novel marker reflecting metabolic and cardiovascular health, but its role in spondyloarthritis (SpA) remains unclear. This study aimed to investigate the association between CMI and SpA and its potential impact on individual health. METHODS: A total of 340 participants were included after propensity score matching, stratified into SpA and non-SpA groups. Baseline characteristics were analyzed, followed by collinearity analysis. The importance of CMI in SpA was assessed using two machine learning methods. Restricted cubic splines (RCS) and logistic regression analyses were conducted to evaluate the association between CMI and SpA. Interaction and subgroup analyses further examined potential modifying effects. The association of CMI with health-related quality of life (HRQoL) indicators was analyzed using regression models. Finally, mediation analysis was performed. RESULTS: CMI was significantly higher in the SpA group (P < 0.001) and emerged as the most influential factor in SpA classification models. RCS analysis demonstrated a positive association between CMI and SpA. Multivariate regression revealed that higher CMI tertiles were associated with increased SpA risk (T3 vs. T1: OR = 3.368, P = 0.001). Hypertension significantly modified this relationship (P for interaction = 0.046). Additionally, higher CMI was linked to poorer self-rated health and increased physically unhealthy days (P < 0.05). Mediation analysis indicated that SpA mediated the relationship between CMI and health outcomes. CONCLUSIONS: CMI is associated with SpA and HRQoL indicators. SpA mediates the relationship between CMI and physical health, highlighting the importance of CMI in SpA risk assessment and patient management.
Nukala N, Shepard R, Iqbal H
… +6 more, Mehmood BF, Huynh N, Golston AC, de Brito RN, Roytman M, Sivasubramanian G
Am J Med Sci
· 2026 May · PMID 41580284
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BACKGROUND: Patients with cirrhosis and end-stage liver disease (ESLD) are highly susceptible to severe infections due to cirrhosis-associated immune dysfunction (CAID). The clinical features and outcomes of coccidioidom...BACKGROUND: Patients with cirrhosis and end-stage liver disease (ESLD) are highly susceptible to severe infections due to cirrhosis-associated immune dysfunction (CAID). The clinical features and outcomes of coccidioidomycosis in this population remain poorly described. METHODS: We conducted a retrospective cohort study of adults with cirrhosis and/or ESLD diagnosed with coccidioidomycosis between 2010 and 2025 at a tertiary referral center in California's San Joaquin Valley. Demographics, clinical features, diagnostics, management, and outcomes were abstracted from electronic health records. RESULTS: Forty-six patients met inclusion criteria. The mean age was 52 years, 74 % were male, and 67 % identified as Hispanic. Alcohol-related liver disease was the most common etiology, and 67 % had decompensated cirrhosis. Respiratory symptoms predominated, with cough, dyspnea, and fever most frequent; 96 % had abnormal chest imaging, most commonly diffuse infiltrates. Disseminated or complicated pulmonary disease occurred in 35 %. Median diagnostic delay was 28 days. Antifungal therapy was given to 89 % (primarily fluconazole); hepatotoxicity occurred in 26 %. Hospitalization was required in 63 %, ICU care in 24 %, and relapse occurred in 24 %. All-cause mortality was 33 %, with a median time-to-death of 369 days. CONCLUSIONS: Coccidioidomycosis in cirrhosis represents a high-risk clinical syndrome marked by delayed diagnosis, high rates of hospitalization, treatment complications, and significant mortality. Early recognition and optimized anti-fungal management are urgently needed, and prospective studies should define best practices for this vulnerable population.