Am J Med Sci
· 2026 Feb · PMID 41130568
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Since its discovery in 1958, the orthopox monkeypox virus, a cause for mpox, has remained endemic in the African continent. Recently, a major epidemiological change in mpox virology is causing a global emergence. This re...Since its discovery in 1958, the orthopox monkeypox virus, a cause for mpox, has remained endemic in the African continent. Recently, a major epidemiological change in mpox virology is causing a global emergence. This review focuses on the novel mpox clades and explores transmission methods which are critical for public health measures and infection prevention.
Lambuk L, Noor AAM, Lambuk F
… +5 more, Kub TNT, Sadikan MZ, Yusop N, Mohamud R, Nik Hashim NHH
Am J Med Sci
· 2026 Feb · PMID 41130567
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Hepatitis B virus (HBV) infection remains a global public health burden, despite widespread vaccination programs. Although vaccination has drastically reduced transmission, millions of individuals with past or chronic HB...Hepatitis B virus (HBV) infection remains a global public health burden, despite widespread vaccination programs. Although vaccination has drastically reduced transmission, millions of individuals with past or chronic HBV infection are susceptible to reactivation, particularly under immunosuppression. This review examines recent clinical studies exploring HBV reactivation, focusing on risk assessment, screening challenges, preventative strategies, early detection, and optimal management approaches. We discuss varied clinical presentations of reactivation, ranging from asymptomatic to severe hepatitis, and highlight the critical role of identifying risk factors for the timely initiation of antiviral prophylaxis and treatment. Recent advancements in medications, novel biomarkers, and comprehensive management strategies are explored, emphasising the importance of early detection and optimal management to prevent reactivation-related complications. This review also addresses challenges in global HBV elimination, emphasising the need for improved vaccination coverage, early diagnosis, and accessible healthcare to achieve effective control and reduce the burden of HBV and its complications.
Am J Med Sci
· 2026 Jan · PMID 41130566
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BACKGROUND: Fecal elastase testing of stool is increasingly utilized for the diagnosis of exocrine pancreatic insufficiency (EPI). However, testing is being used in other settings such as evaluation of diarrhea where int...BACKGROUND: Fecal elastase testing of stool is increasingly utilized for the diagnosis of exocrine pancreatic insufficiency (EPI). However, testing is being used in other settings such as evaluation of diarrhea where interpretation may be inaccurate resulting in unwarranted additional testing and prescription of pancreatic enzymes. METHODS: Over a 24-month period, we prospectively evaluated all patients referred to a pancreas clinic for evaluation of EPI using the fecal elastase (FE-1) measurement. A thorough history was obtained to determine the nature and duration of the complaints, risk factors for pancreatic disease, stool characteristics as well as laboratory and imaging evaluation. RESULTS: Over the study period, 54 patients (67 % female, median age 59 years (mean age 55 ± 16.5 years) were referred for "EPI" all of whom were evaluated for alteration in bowel habits. The median FE-1 concentration was 130 µg/g (range; 22 - >500 µg/g). Submitting a diarrheal stool for testing was prevalent. Established risk factors for pancreatic disease were present in 6. Because of the FE-1 results, additional cross-sectional abdominal imaging and/or endoscopic ultrasound were performed in 30 (56 %) and 15 (28 %) patients, respectively. The most common final diagnosis was irritable bowel syndrome (61 %); only 3 patients were considered to have chronic pancreatitis and true EPI. CONCLUSIONS: Based upon our findings, most patients referred for EPI with an abnormal FE-1 measurement do not have malabsorption or EPI. Irritable bowel syndrome was the most common diagnosis. FE-1 testing is often misinterpreted, potentially overutilized and greater education is needed for its appropriate use and interpretation.
John JC, Mathur M, Sharma SV
… +4 more, Liaw W, Stotts AL, Northrup TF, Murphy TJ
Am J Med Sci
· 2026 Jan · PMID 41130565
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BACKGROUND: Vulnerable populations experience multiple adverse non-medical drivers of health (NMDOH) that contribute to poorer health outcomes and increased healthcare utilization. This cross-sectional study examined the...BACKGROUND: Vulnerable populations experience multiple adverse non-medical drivers of health (NMDOH) that contribute to poorer health outcomes and increased healthcare utilization. This cross-sectional study examined the associations between NMDOH and hospital-based outcomes in a 2018 Medical Legal Partnership pilot study. METHODS: Composite scores generated for socio-economic and housing-environmental conditions were categorized to reflect the cumulative burden of unmet needs. Logistic regression models examined associations between these scores and the number of ED visits (≥3 visits in the past year) and Hospital stays (≥2 days in the past year), controlling for age, sex, race, and income. RESULTS: In this sample of 174 participants (mean age=52.5 years; 68.2 % female; 55 % Black, 28 % Hispanic; and average monthly income =$1,196), 74 % were food insecure, 68.3 % had ≥2 social and economic needs, and 47.6 % reported >1 housing-environmental concern. There were significantly greater odds of ≥3 ED visits (AOR: 7.3; P=0.003) and similarly greater odds of a Hospital stay of ≥2 days. (AOR: 5.6; P=0.032) among those with ≥4 vs. <4 personal SDOH needs. CONCLUSIONS: Having ≥4 social and economic conditions was strongly associated with poor hospital-related outcomes, indicating the need for a strong response and targeting of the NMDOH that impact healthcare utilization outcomes.
Masoodi WTA, Radhi SW, Al-Hakeim HK
… +1 more, Abdalsada HK
Am J Med Sci
· 2026 Mar · PMID 41130564
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BACKGROUND: Long-COVID is defined by persistent symptoms following an initial COVID-19 infection. The normal immune function depends on a precise balance of trace elements, which can provide fresh insights into prospecti...BACKGROUND: Long-COVID is defined by persistent symptoms following an initial COVID-19 infection. The normal immune function depends on a precise balance of trace elements, which can provide fresh insights into prospective therapeutic strategies while maintaining oxidative balance and limiting excessive inflammation. Zinc, copper, cobalt, and manganese deficits or excesses can alter the immune system's normal functions and oxidative stress. The study aims to study the trace element profile for predicting long-COVID. METHODS: The levels of serum copper and zinc were measured spectrophotometrically. In contrast, cobalt and manganese were measured using flameless atomic absorption spectrophotometry in 60 long-COVID patients and compared with the 30 controls who had previous SARS-CoV-2 infection but were free from long-COVID symptoms. RESULTS: Serum levels of copper, cobalt, manganese, and the copper/zinc ratio were considerably elevated in long-COVID patients compared to the control groups. Nonetheless, there was no significant change in zinc levels relative to the control group. The cobalt concentration increases with the duration of the disease and inflammation. Serum manganese level is significantly and negatively correlated with weight. The duration of disease is inversely linked to serum zinc concentrations. There is a substantial correlation between serum copper levels and the period of recovery from acute SARS-CoV-2 infection. CONCLUSIONS: Long-COVID is associated with alterations in serum trace elements (copper, cobalt, and manganese). The imbalances in the trace elements are associated with inflammation, duration of disease, and age. These imbalances may contribute to prolonged symptoms and greater disease severity, suggesting that trace element monitoring could be beneficial in managing long-COVID.
Chen DW, Hu G, Mao L
… +8 more, Wang G, Tian Y, He J, Qian S, Yang W, Zheng Y, Lin L, Pei W
Am J Med Sci
· 2026 Jan · PMID 41120089
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BACKGROUND: Matrix metalloproteinases (MMPs) have been implicated in the pathogenesis of gout. However, the causal nature of their associations remains unclear. This study aimed to evaluate the potential causal effects o...BACKGROUND: Matrix metalloproteinases (MMPs) have been implicated in the pathogenesis of gout. However, the causal nature of their associations remains unclear. This study aimed to evaluate the potential causal effects of MMPs on gout. METHODS: The study was performed using two-sample Mendelian randomization (MR) analyses with publicly available genome-wide association study (GWAS) summary statistics of ten MMP types and gout. Four complementary MR methods were employed, with Inverse-variance weighted (IVW) analysis as the primary approach, supplemented by MR-Egger, weighted median, and weighted mode. The robustness of the causal estimates was further evaluated through sensitivity analyses, including MR-Egger intercept, Cochran's Q test, leave-one-out (LOO) analysis, and the MR pleiotropy residual sum and outlier (MR-PRESSO) test. RESULTS: Genetically predicted MMPs showed no evidence of a causal effect on gout. In particular, previously reported candidates such as MMP3 and MMP9 demonstrated no significant associations (MMP3: OR = 0.993, 95 % CI: 0.955 - 1.033, P = 0.739; MMP9: OR = 0.974, 95 %CI: 0.928 - 1.022, P = 0.278). Results from MR-Egger, weighted median, and weight mode analyses were consistent with those of IVW. No substantial heterogeneity or horizontal pleiotropy was observed across analyses. CONCLUSIONS: This two-sample MR study provides no evidence supporting a causal relationship between MMPs and gout. Further research is warranted to clarify their potential roles and underlying biological mechanisms.
Acosta RAH, Adelman MW, Jacob JT
… +1 more, Miller WR
Am J Med Sci
· 2026 Feb · PMID 41115504
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The emergence of antibiotic resistance is a leading challenge in the treatment of infections due to Gram-negative organisms. Increasing rates of resistance are commonly seen in healthcare-associated infections, and recen...The emergence of antibiotic resistance is a leading challenge in the treatment of infections due to Gram-negative organisms. Increasing rates of resistance are commonly seen in healthcare-associated infections, and recently introduced and emerging treatment options require an understanding of the underlying resistance mechanisms for effective use. This review covers the mechanism, identification, and treatment of resistant Gram-negative organisms including extended spectrum β-lactamase (ESBL) producing, AmpC producing, and carbapenem resistant Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, and carbapenem-resistant Acinetobacter baumannii. It is designed to help the non-infectious diseases clinician to understand the changing landscape in the treatment of drug-resistant infections.
Am J Med Sci
· 2026 Feb · PMID 41115503
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The COVID-19 pandemic, emerging in late 2019, rapidly evolved into a global health crisis of unprecedented scale. Initially marked by widespread transmission and severe illness, the pandemic overwhelmed healthcare system...The COVID-19 pandemic, emerging in late 2019, rapidly evolved into a global health crisis of unprecedented scale. Initially marked by widespread transmission and severe illness, the pandemic overwhelmed healthcare systems, disrupted economies, and exposed deep-rooted inequalities. Over 775 million cases and an estimated 18-33 million global deaths were recorded by 2024. The crisis illuminated critical vulnerabilities in pandemic preparedness, healthcare infrastructure, and public health communication. Key lessons included the need for resilient supply chains, robust data systems, equitable healthcare access, and sustained investment in public health. Misinformation significantly hindered response efforts, underscoring the importance of aligned scientific and public health messaging. The pandemic also triggered debates over civil liberties and public health authority. While rapid vaccine development was a major achievement, the overall response highlighted systemic gaps. These insights offer a roadmap for improving future pandemic responses and safeguarding global health security.
Am J Med Sci
· 2026 Feb · PMID 41115502
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Chimeric antigen receptor (CAR) T cell therapy has shifted the therapeutic landscape of hematological malignancies in the last decade, and bispecific antibodies (BsAb) are an emerging treatment for this patient populatio...Chimeric antigen receptor (CAR) T cell therapy has shifted the therapeutic landscape of hematological malignancies in the last decade, and bispecific antibodies (BsAb) are an emerging treatment for this patient population. Immunosuppression associated with these therapies can lead to a variety of infectious complications. In this narrative review, we explore the epidemiology, risk factors and prevention of bacterial, viral and fungal infections after CAR T cell and BsAb therapy.
Shen G, Sun H, Guan X
… +5 more, Chen Y, Wang L, Li X, Gong J, Hu B
Am J Med Sci
· 2026 Jan · PMID 41106778
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BACKGROUND: Primary biliary cholangitis (PBC) is a chronic liver disease leading to irreversible cirrhosis and liver failure. This study aims to evaluate the relationships between genetically predicted nine lifestyle fac...BACKGROUND: Primary biliary cholangitis (PBC) is a chronic liver disease leading to irreversible cirrhosis and liver failure. This study aims to evaluate the relationships between genetically predicted nine lifestyle factors and PBC by Mendelian randomization (MR). METHODS: Genome-wide association study (GWAS) data were utilized to identify genetic variants significantly associated with specific lifestyle factors, employing a stringent significance threshold of P-value< 5 × 10 and linkage disequilibrium [LD] r <0.01 with a clumping distance cutoff of 5000 kb. Subsequently, univariable and multivariable MR analyses were conducted, where the inverse variance weighted (IVW) method was considered as the primary analytical approach and then followed by sensitivity analysis. RESULTS: Non-oily fish intake was causally associated with an increased risk of PBC, with an odds ratio (OR) of 578 (95% confidence interval (CI) 24.17-1.39 × 10). Conversely, the intake of oily fish did not demonstrate a significant decrease in the risk of PBC (P > 0.05). There were suggestive associations observed between bread intake and household income (0.0056<P < 0.05). Furthermore, multivariable MR revealed that only non-oily fish intake remained statistically significant (OR=152, 95%CI=1.51-1.55 × 10, P = 0.0327). CONCLUSIONS: Our findings underscore the causal relationship between non-oily fish intake and an elevated risk of PBC, as ascertained through both univariable and multivariable MR analyses. These findings hold potential clinical implications for the prevention of PBC.
Faheem MSB, Ikram F, Iqbal MS
… +7 more, Mazhar MO, Fatima H, Akhtar A, Irfan U, Ashfaq MO, Faraz A, Ahmed R
Am J Med Sci
· 2026 Mar · PMID 41077249
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BACKGROUND: Hypertensive renal disease impacts approximately 753 million individuals worldwide each year. This study evaluates trends in hypertensive renal disease mortality from 1999 to 2020 in the US, focusing on dispa...BACKGROUND: Hypertensive renal disease impacts approximately 753 million individuals worldwide each year. This study evaluates trends in hypertensive renal disease mortality from 1999 to 2020 in the US, focusing on disparities related to gender, race, and urbanization by examining the Age-Adjusted Mortality Rate (AAMR) to inform targeted intervention and improve outcomes. METHODS: The CDC WONDER database analyzed hypertensive renal disease with renal-failure-related mortality from 1999 to 2020, calculating mortality rates and a 95 % confidence interval to assess national trends. RESULTS: Throughout the study period, males constantly exhibited a higher Age-Adjusted Mortality Rates (AAMR) for hypertensive renal disease with renal-failure-related mortality 148.92 (95 % CI: 148.37 - 149.48) than females 106.11 (95 % CI: 105.73 - 106.49). African American individuals exhibited the highest overall AAMR at 286.29 (95 % CI: 284.68 - 287.9), starting at 186.23 in 1999 (95 % CI: 179.34 - 193.13) and increasing to 529.72 in 2020 (APC: 5.27; 95 % CI: 520.77 - 538.67). From 1999 to 2020, AAMR rose in metropolitan areas from 197.57 (95 % CI: 187.88-207.26) to 1112.12 (APC: 10.00; 95 % CI: 1093.39-1130.85), and in non-metropolitan areas from 97.35 (95 % CI: 90.63-104.08) to 643.06 (APC: 11.81; 95 % CI: 627.76-658.37).AAMRs varied significantly by state, from 61.23 (95 % CI: 59.29-63.16) in Connecticut to 225.06 (95 % CI: 214.96-235.16) in the District of Columbia. CONCLUSIONS: From 1999 to 2020, the mortality rate from hypertensive-related renal diseases rose uncertainly, with a sharp incline starting from 2013 to a sudden surge in 2020 due to COVID-19-related renal complications. Higher deaths were observed in males, African American ethnicity, and individuals living in non-metropolitan areas. Addressing these problems requires a multifactorial public health approach focusing on early detection, equitable care, and targeted intervention to reduce disease burden.
Erismis B, Simsekoglu N, Gurdal MFD
… +3 more, Erken N, Pasin O, Sahiner ES
Am J Med Sci
· 2026 Jan · PMID 41047122
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OBJECTIVES: Health literacy (HL) is a key determinant of health outcomes, particularly in managing chronic conditions like diabetes mellitus (DM). This study investigates Hl levels in diabetic patients and examines its a...OBJECTIVES: Health literacy (HL) is a key determinant of health outcomes, particularly in managing chronic conditions like diabetes mellitus (DM). This study investigates Hl levels in diabetic patients and examines its association with chronic complications. METHODS: A cross-sectional study was conducted with 207 diabetic patients between April and July 2024. HL was assessed using the Turkey Health Literacy Scale, categorizing patients into four levels: inadequate, problematic, adequate, and excellent. Demographic data, laboratory results, and microvascular/macrovascular complications were analyzed using non-parametric statistical tests. RESULTS: The mean HL score was 29.83, and 32.8 % of participants experiencing chronic microvascular complications. HL levels were significantly associated with education, gender, and occupation but showed no direct correlation with chronic complications or HbA1c levels. However, patients with lower HL had higher rates of microalbuminuria and poor glycemic control. CONCLUSIONS: Although HL was not directly linked to chronic DM complications, inadequate HL may contribute to a higher risk of specific complications, such as diabetic nephropathy. Addressing HL through targeted interventions can enhance diabetes self-management and reduce complication risks. PRACTICE IMPLICATIONS: Routine HL assessments and personalized education strategies-incorporating digital tools and community support-could enhance patient outcomes and alleviate healthcare burdens. Policymakers and researchers should prioritize HL in chronic disease management strategies.
Am J Med Sci
· 2026 Jan · PMID 41047121
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Osteoimmunology, which emerged in the early 2000s, was paradigm-shifting in its integration of immunology and skeletal research, recognizing the pivotal role of immunoreceptors on preosteoclasts, immune cells, and proinf...Osteoimmunology, which emerged in the early 2000s, was paradigm-shifting in its integration of immunology and skeletal research, recognizing the pivotal role of immunoreceptors on preosteoclasts, immune cells, and proinflammatory cytokines contributing to inflammatory bone remodeling. Numerous immunoreceptors and key signaling pathways were defined that regulate osteoclastogenesis. A dynamic interplay between lymphocytes and osteoclasts was found to be fundamental to maintaining bone homeostasis and contributing to pathological bone resorption in inflammatory arthritis or malignant metastasis. Osteoimmunology has expanded to include crosstalk between osteoclasts and osteoblasts, the role of bone marrow stromal cells in maintaining the hematopoietic stem cell niche, and the influence of the microbiome on lymphocytes that drive bone remodeling. Deciphering the intricate mechanisms that govern the immune system's regulation of bone remodeling remains a central objective in osteoimmunology, offering promising avenues for the development of targeted therapeutic strategies aimed at restoring skeletal equilibrium.
Xu X, Gao W, Pang L
… +3 more, Chen Y, Liang S, Wang X
Am J Med Sci
· 2026 May · PMID 41047120
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Systemic lupus erythematosus (SLE) is a classic autoimmune condition marked by inflammation in multiple organs and a malfunctioning immune system. Despite advances in immunosuppressive therapies, patients frequently expe...Systemic lupus erythematosus (SLE) is a classic autoimmune condition marked by inflammation in multiple organs and a malfunctioning immune system. Despite advances in immunosuppressive therapies, patients frequently experience relapses, organ damage, and significant quality-of-life impairment. Recent findings indicate that ferroptosis, a form of regulated cell death dependent on iron, has a substantial impact on the progression of lupus. However, the precise molecular interplay between reactive oxygen species (ROS) generation, iron metabolism dysregulation, and immune cell dysfunction in SLE remains incompletely understood. This review analyzes the ROS-ferroptosis axis in SLE, highlighting its role in promoting pathological immune responses and worsening tissue injury. It also discusses targeted therapies like iron chelators and GPX4 agonists, which show promise in preclinical models and early trials, identifies actionable targets, evaluates their translational potential for precision therapies, and bridges preclinical mechanisms with clinical applications to address unmet SLE management needs.
Nasir AB, Zouridis S, Aspichueta P
… +2 more, Manka P, Syn WK
Am J Med Sci
· 2026 Apr · PMID 41043608
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Depression is a frequent comorbidity in chronic liver disease (CLD), including Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), viral hepatitis, autoimmune hepatitis (AIH), primary sclerosing cholangitis...Depression is a frequent comorbidity in chronic liver disease (CLD), including Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), viral hepatitis, autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC), hemochromatosis, and Wilson's disease. It is associated with worse outcomes, accelerated disease progression, increased hospitalizations, and higher mortality. While antidepressants are commonly prescribed, their effects on liver disease, particularly on liver fibrosis, remain underexplored. This narrative review examines the relationship between depression, CLD, and antidepressants through a literature review of studies published between 2010 and 2024. Some evidence suggests that antidepressants may have antifibrotic properties, as seen in pulmonary fibrosis, but liver-specific data are limited. Understanding their potential role in both mental health and liver disease management could improve patient outcomes. However, significant research gaps remain, and further clinical trials are needed to determine whether antidepressants influence liver fibrosis, disease progression, and overall prognosis in CLD.
Am J Med Sci
· 2026 Jan · PMID 40967523
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BACKGROUND: Psoriasis is a chronic skin disease that shares common inflammatory pathways with atherosclerosis. Although psoriasis is known to increase risk of developing coronary artery disease, the impact of psoriasis o...BACKGROUND: Psoriasis is a chronic skin disease that shares common inflammatory pathways with atherosclerosis. Although psoriasis is known to increase risk of developing coronary artery disease, the impact of psoriasis on outcomes after coronary artery bypass grafting (CABG) remains less established. This study aimed to compare the in-hospital outcomes of isolated CABG between patients with and without psoriasis through a population-based analysis of a national database. METHODS: Patients underwent CABG were selected from National Inpatient Sample from Q4 2015-2021. Patients with age <18 years and concomitant procedures were excluded. A 1:2 propensity-score matching was used to match demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between psoriasis and non-psoriasis patients. In-hospital outcomes were assessed. RESULTS: There were 1,732 (0.95%) patients who underwent isolated CABG who had psoriasis. Patients with psoriasis were younger and more socioeconomically advantaged. After propensity-score matched to 3598 out of 191,175 non-psoriasis patients, patients with and without psoriasis had comparable in-hospital mortality rates (1.39% vs 1.03%, p = 0.27) and major adverse cardiovascular event (1.45% vs 1.86%, p = 0.31). Psoriasis patients had a slightly lower risk of venous thromboembolism (0.23% vs 0.67%, p = 0.04). All other in-hospital outcomes were comparable between psoriasis and non-psoriasis patients. CONCLUSIONS: The representation of psoriasis patients in CABG was lower than their prevalence in the general population. After propensity-score matching, outcomes for patients with and without psoriasis were comparable. Thus, despite the elevated cardiovascular risks associated with psoriasis, CABG may be as safe and as effective for these patients.
Am J Med Sci
· 2026 Jan · PMID 40967521
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BACKGROUND: Sepsis remains a significant public health challenge, with persistent mortality rates despite advancements in diagnosis and treatment. This study examined mortality trends for bacterial septicaemia in the US...BACKGROUND: Sepsis remains a significant public health challenge, with persistent mortality rates despite advancements in diagnosis and treatment. This study examined mortality trends for bacterial septicaemia in the US between 1999-2024. METHODS: Mortality data were obtained from the National Center for Health Statistics, National Vital Statistics System, Provisional Mortality WONDER Online Database. Bacterial septicaemia-related deaths were identified using ICD-10 codes, and Poisson regression analysis was performed to assess trends across demographics. RESULTS: Mortality for bacterial septicaemia declined from 1999 to 2012, showing a modest increase until 2019. A sharp rise occurred during the COVID-19 pandemic (2020-2022), with total deaths for bacterial septicaemia increasing by 21.2 % compared to the pre-pandemic period (17.4 % in females and 23.9 % in males). Mortality rates in males were consistently higher than in females throughout the study period. Poisson regression analysis did not reveal statistically significant long-term cumulative or sex-specific trends. Age-stratified analysis showed a sustained decline in mortality over time among children under 15 years, whereas mortality increased in adults in all age groups between 25 and 74 years. Age-stratified analysis excluding the early pandemic years showed a relative decline in mortality for bacterial septicaemia in those aged <1 to 24 years, a relative increase in the 45-74-year age group, and a stable trend in other age categories. CONCLUSIONS: Although cumulative mortality for bacterial septicaemia remained stable in the long term, rising deaths in middle-aged adults and pandemic-related increases highlight the need for reinforced prevention, timely diagnosis and accurate management strategies.
Am J Med Sci
· 2025 Dec · PMID 40967520
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BACKGROUND: There has been a lack of studies to describe the relationship between Gustave Roussy immune score (GRIm-s) and the risk of in-hospital mortality in patients with acute respiratory distress syndrome (ARDS) so...BACKGROUND: There has been a lack of studies to describe the relationship between Gustave Roussy immune score (GRIm-s) and the risk of in-hospital mortality in patients with acute respiratory distress syndrome (ARDS) so far. This study aimed to investigate the relationship between GRIm-s and hospital mortality in patients with ARDS and to compare the predictive ability of GRIm-s with common scoring systems for predicting mortality risk based on MIMIC-IV database. METHODS: GRIm-s was calculated based on albumin, neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH). The univariate and multivariate logistic regression analysis were used to explore association between GRIm-s and in-hospital mortality, with odds ratio (OR) and 95 % confidence intervals (CIs). The receiver operator characteristic (ROC) analysis was performed to verity the predictive power and the enhancement the predictive power of GRIm-s to NLR and sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPSII) and confusion, uremia, respiratory rate, blood pressure, age ≥65 years (CURB-65), with area under the curve (AUC) and 95 %CI. RESULTS: Totally 1238 eligible ARDS patients were included with the in-hospital mortality was 34.25 %. High GRIm-s was associated with higher risk of in-hospital mortality. The predictive value of GRIm-s was superior to NLR. GRIm-s can significantly improve the predictive power of a single score prediction system including SOFA, SAPSII, and CURB-65. CONCLUSIONS: High GRIm-s was associated with high risk of in-hospital mortality in ARDS patients. GRIm-s has a good predictive ability for the prognosis of ARDS patients.