Mowafy HL, Garin N, Katsounas A
… +3 more, Castellvi P, Rello J, ESGIE/ESGCIP study group investigators
Eur J Intern Med
· 2026 May · PMID 42115064
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BACKGROUND: Whether biological sex independently influences sepsis outcomes remains uncertain and historical data show heterogeneous findings. METHODS: We conducted this systematic review and meta-analysis according to P...BACKGROUND: Whether biological sex independently influences sepsis outcomes remains uncertain and historical data show heterogeneous findings. METHODS: We conducted this systematic review and meta-analysis according to PRISMA guidelines. PubMed, Scopus, and Web of Science were searched (January 2020 to April 2025) for studies reporting mortality outcomes in adult sepsis patients stratified by sex in Western Europe. We assessed studies' quality using the QUIPS tool. Report followed the Sex and Gender Equity in Research (SAGER) guidelines. RESULTS: From 3445 records, 18 studies comprising 671,861 participants were included. Pneumonia was the most common infection in both sexes-significantly more frequent among men-whereas urinary tract infections predominated in women. Men consistently exhibited higher baseline severity scores, but the difference was not statistically significant. The pooled analysis showed a significant lower odds ratio (OR) of short-term mortality in males compared with females (pooled OR = 0.96, 95% CI 0.94-0.98; low certainty); this difference was consistent in sensitivity analyses restricted to low-bias studies. In contrast, meta-analysis of studies reporting hazard ratios (HR) indicated a higher risk in males (pooled HR = 1.39, 95% CI 1.14-1.70; very-low certainty), although no difference was identified for 90-day mortality (HR = 1.00, 95% CI 0.92-1.08; low certainty). CONCLUSIONS: In contemporary Western Europe, sex alone is not a robust independent predictor of short-term sepsis mortality. Distinct sex-related patterns of infectious sites were identified. Age and infection sites modify the association, underscoring the need for sex-aware but not sex-determined prognostic assessment.
Morin J, Jarrot PA, Solignac J
… +9 more, Lefevre F, Brunet P, Kaplanski G, Burtey S, Daniel L, Torrents J, Faraut J, Jourde-Chiche N, Bobot M
Eur J Intern Med
· 2026 May · PMID 42108131
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INTRODUCTION: In ANCA-associated vasculitis (AAV), both the disease and its treatments contribute to systemic complications, among which, infections represent a major cause of morbidity and mortality. This study aimed to...INTRODUCTION: In ANCA-associated vasculitis (AAV), both the disease and its treatments contribute to systemic complications, among which, infections represent a major cause of morbidity and mortality. This study aimed to evaluate the prevalence and prognosis of infectious complications in AAV, to identify associated risk factors, and to describe long-term outcomes. METHODS: This retrospective monocentric study included patients followed in the Nephrology and Internal Medicine departments at Conception Hospital after a first episode or relapse of AAV between 2004 and 2024. Infection was considered if requiring hospitalization or an anti-infectious therapy. Follow-up was conducted until January 1, 2025. RESULTS: Among 264 patients included, the incidence of infection was 43.9%, with respiratory infections accounting for 49.1% of cases and bacterial infections for 75.3%, mainly with gram negative bacillus. Infection episodes were significantly associated with age >65 years (p =0.02), hypertension (p=0.04), diabetes (p =0.01), a high Five-Factor Score (p =0.005), a high BVAS (p =0.03), anti-PR3 positivity (p =0.03), acute kidney injury (p=0.004), cyclophosphamide (p =0.05), and intravenous corticosteroid for induction (p =0.03). In multivariate analysis, anti-PR3 positivity (aOR = 2.0, p=0.03) was independent risk factors, whereas methotrexate appeared protective (aOR = 0.08, p=0.001). Infections were independently linked to vasculitis relapses (aOR = 2.8, p=0.007) and cardiovascular events (aOR 3.0, p =0.01). Survival analysis demonstrated a significant association between mortality and infection (HR 2.14 [1.59-2.91], p<0.001). CONCLUSION: Infections are frequent complications in AAV, and exert an independent impact on mortality. Anti-PR3 positivity increases infection risk, whereas methotrexate appears protective.
Jaworski K, Wasilewski R, Windyga J
… +9 more, Kowalik I, Szwed H, Lipniacka A, Niedolistek M, Was J, Januszewicz A, Kreutz R, Messerli F, Dabrowski R
Eur J Intern Med
· 2026 May · PMID 42106273
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BACKGROUND: Acute intermittent porphyria (AIP), a rare disorder of heme biosynthesis, may manifest with neurovisceral crises affecting autonomic regulation. This study aimed to assess blood pressure (BP) pattern and hype...BACKGROUND: Acute intermittent porphyria (AIP), a rare disorder of heme biosynthesis, may manifest with neurovisceral crises affecting autonomic regulation. This study aimed to assess blood pressure (BP) pattern and hypertension prevalence in AIP patients. METHODS: This prospective case-control study included patients with overt AIP (at least one attack) and a control group, matched by age, sex and body mass index (BMI). All participants underwent detailed clinical assessment, biochemical and cardiovascular phenotyping with 24-hour BP monitoring and echocardiography in the tertiary centers. RESULTS: The study comprised 90 patients with AIP, of whom 42 (47%) were assessed also during attacks, and 90 controls (mean age 39±11 years, 79% female). Hypertension was more prevalent in AIP patients (58%) compared to controls (31%, P < 0.001). Additionally, AIP patients showed higher mean systolic BP (SBP, 123.7 ± 13.1 vs. 116.9 ± 10.8 mmHg, P < 0.001) and diastolic BP (DBP, 77.7 ± 9.5 vs. 73.2 ± 7.1 mmHg, P < 0.001). Nocturnal hypertension, a non-dipping BP pattern and left ventricular hypertrophy were more frequently observed in the AIP group. Age, BMI and history of paresis were independently associated with hypertension in AIP patients. During AIP attacks, BP was significantly higher than during remission (SBP 135.4 ± 18.4 vs. 121.9 ± 12.8 mmHg, P < 0.001; DBP 84.6 ± 13.8 vs. 76.5 ± 10.1 mmHg, P < 0.001). The differences correlated with changes in the plasma concentrations of normetanephrine. CONCLUSION: AIP is associated with a higher prevalence of hypertension, an unfavourable nocturnal BP profile and cardiac structural changes. BP rises significantly during AIP attacks, which is likely mediated by catecholaminergic surges. This underscores the need for cardiovascular monitoring in AIP patients. CLINICALTRIALS: gov, Number NCT05882136.
Ahn C, Lee GT, Kim JH
… +15 more, Ahn S, Hwang SY, Kim SM, Kim WY, Park SJ, Choi SH, Kwon WY, Kong T, Chung SP, Ko BS, Yoo KH, Lim TH, Shin TG, Kim K, Korean Shock Society
Eur J Intern Med
· 2026 May · PMID 42103537
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OBJECTIVE: To determine the optimal timing for initiating vasopressin in septic shock. METHODS: First, we performed a retrospective analysis of a multicenter registry of adults with septic shock to evaluate associations...OBJECTIVE: To determine the optimal timing for initiating vasopressin in septic shock. METHODS: First, we performed a retrospective analysis of a multicenter registry of adults with septic shock to evaluate associations between vasopressin initiation timing-defined by norepinephrine (NE) dose at initiation or time from first vasopressor use-and clinical outcomes. Second, we conducted a systematic review and meta-analysis integrating these registry data with randomized controlled trials (RCTs) and observational studies comparing early versus non-early vasopressin initiation. The primary outcome was mortality. RESULTS: The registry analysis included 2001 patients. Initiation of vasopressin at an NE dose ≥0.5 μg/kg/min (adjusted odds ratio [aOR] 2.15, 95% CI 1.59-2.92) and delays of 6-24 hours after initial vasopressor use (aOR 1.59, 95% CI 1.21-2.11) were associated with higher 28-day mortality compared with initiation at NE doses <0.25 μg/kg/min and within 2 hours, respectively. The meta-analysis included 15 studies (5 RCTs and 10 observational studies). In RCTs, early vasopressin initiation was not associated with reduced mortality (OR 0.84, 95% CI 0.66-1.07) but was associated with a lower requirement for renal replacement therapy (OR 0.46, 95% CI 0.26-0.81). In observational studies, early initiation was associated with lower mortality (OR 0.71, 95% CI 0.60-0.84) and shorter ICU LOS (mean difference -1.06 days, 95% CI -1.94 to -0.18). CONCLUSION: Earlier vasopressin initiation may offer clinical benefits in septic shock. However, as evidence is primarily observational and findings vary by study design, further high-quality randomized studies are warranted.
Tasbakan MS, Svedmyr S, Bergqvist J
… +14 more, Hein H, Mihaicuta S, Dogas Z, Trakada G, Fanfulla F, Joppa P, Testelmans D, Ludka O, Drummond M, Matthes S, Gouveris H, Staats R, Basoglu OK, ESADA Study Group
Eur J Intern Med
· 2026 May · PMID 42086371
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BACKGROUND: Hypertension (HTN) is one of the most prevalent cardiovascular comorbidities in patients with obstructive sleep apnoea (OSA). Although OSA severity measured by the apnoea-hypopnoea index (AHI) is a known risk...BACKGROUND: Hypertension (HTN) is one of the most prevalent cardiovascular comorbidities in patients with obstructive sleep apnoea (OSA). Although OSA severity measured by the apnoea-hypopnoea index (AHI) is a known risk factor, the role of hypoxic load in HTN remains less well established. METHODS: We analysed data from 12,141 patients with OSA enrolled in the European Sleep Apnea Database (ESADA). Clinical and sleep study parameters were assessed to identify factors associated with HTN. RESULTS: The cohort included 2650 patients with mild OSA, 3339 with moderate OSA, and 6152 with severe OSA. The mean age was 53.1 ± 12.5 years, the mean body mass index (BMI) 31.7 ± 6.2 kg/m², and 73.1% were male. HTN was present in 41.8% of the patients. In univariate analyses, older age, female sex, obesity, larger neck circumference, greater OSA severity as measured by AHI or oxygen desaturation index (ODI), minimum oxygen saturation (SpO₂), and increased hypoxic load (T90% ≥ 5%) were significantly associated with HTN. After adjustment for age, sex and BMI, increased neck circumference, higher AHI and T90% ≥ 5% remained independently associated with HTN. Notably, HTN prevalence was higher in mild-to-moderate OSA patients with T90% ≥ 5 than in severe OSA patients with T90% < 5 (51.5% vs. 42.8%, p < 0.001). Following propensity score matching, only minimum SpO₂ (p = 0.022) and T90% ≥ 5% (p = 0.044) remained significantly associated with HTN. CONCLUSIONS: Hypoxic load as reflected by T90% and minimum SpO, rather than AHI alone, is independently associated with hypertension in patients with OSA, underscoring the importance of oxygenation metrics in cardiovascular risk assessment.
Eur J Intern Med
· 2026 May · PMID 42070957
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AIM: To study whether the admission of unselected emergency medical patients, under either a Consultant with General Medicine (GIM) or Specialist accreditation, influenced either short or longer-term all-cause mortality....AIM: To study whether the admission of unselected emergency medical patients, under either a Consultant with General Medicine (GIM) or Specialist accreditation, influenced either short or longer-term all-cause mortality. METHODS: We report an observational cohort study of all emergency medical admissions admitted over 14 years between January 2011 and October 2024. The 30-day in-hospital and long-term all-cause mortality (10 year), were related to Consultant primary accreditation (GIM vs. Specialist), using logistic multiple variable regression or Cox proportional hazard models. RESULTS: There were 76,464 admissions in 42,104 unique patients over the period, with care delivered by 162 Consultants of whom 34 (21%) had a major GIM accreditation. The specialist load/on-call averaged 7.0 cases (IQR: 4.4, 9.0) in contrast to GIM at 12.1 cases (IQR: 11.7, 14.5). Over 14 years 30-day in-hospital all-cause mortality (per unique patient) declined from 2012 at 9.6% (95%CI: 8.4, 10.9) to 2024 at 2.9% (95%CI: 2.5, 3.4). Acute hospital mortality marginally favoured Specialty at 3.71% (95%CI: 3.54, 3.87) rather than GIM care GIM 4.10% (95%CI: 3.86, 4.34) with OR 1.12 (95%CI: 1.03, 1.22). Longer-term adjusted mortality was lower for the GIM admission cohort - HR 0.33 (95%CI: 0.24, 0.46) and for those admitted under Consultants with a higher volume (>5 cases) throughput - HR 0.77 (95%CI: 0.64, 0.94). CONCLUSION: These data suggest merits for GIM and Specialty care; short-term care favoured Specialist supervision, but overall long-term care proved better for GIM or higher volume Consultants.