Early Mortality Research Articles

Risk factors for early mortality and impaired quality of life in oral cavity cancer - head and neck cancer register study.

Treatment of locoregionally advanced oral cavity cancer (OCC) is associated with treatment-related complications, functional deficits, and even early mortality. High-quality register data could help in choosing between curative and non-curative intent treatment options. The Helsinki Head and Neck Cancer Register (HHNCR) is linked with the EORTC QLQ-H&N35 questionnaire automatically sent to all patients at diagnosis and predetermined intervals. We analyzed pretreatment data of all patients diagnosed with OCC during 2018-2023, focusing on risk factors for early mortality and impaired health-related quality of life after curative-intent treatment. Of 597 patients, 556 (93%) were treated with curative intent. Thirty-nine (7.0%) patients died within 6 months after diagnosis. The independent risk-factors for 6-month mortality identified in multivariable analysis were T3 stage (OR 8.3 [2.6-26.5], p < 0.001), T4 stage (OR 8.2 [2.5-26.8], p < 0.001), N3 stage (OR 10.6 [3.2-35.1], p < 0.001), and Adult Comorbidity Evaluation (ACE)-27 score 2-3 (OR 5.5 [2.4-12.5], p < 0.001). These risk-factors were used to create a predictive risk score for early death. Younger, healthier patients had significantly higher EORTC QLQ-H&N35 response rates compared with older patients with comorbidities. Six months after diagnosis, patients with a stage III-IV tumor had significantly higher scores in 15 of 18 items, compared with patients with a stage I-II tumor. Early mortality was associated with advanced tumor (T) and nodal (N) stage, and increased pretreatment comorbidity (ACE-27) scores. The strongest predictor for impaired quality of life was locoregionally advanced disease.

The role of online groups for autistic people in users’ autism information journeys

PurposeThe numbers of people with both diagnosed and suspected autism have risen exponentially worldwide over the last few decades. Autistic individuals face significant health and social disparities, including higher rates of poor health, early mortality and limited access to essential services. Understanding autistic people’s information needs and information journeys is therefore crucial.Design/methodology/approachThe research consisted of two consecutive qualitative studies. First, a sample of posts from an online autism group, made by group users who described themselves as autistic, was generated and analysed using reflexive thematic analysis. Fifteen semi-structured interviews were then undertaken with adults who used online groups for autistic people and stated that they had received a professional diagnosis of autism or were awaiting an autism assessment. Interview transcripts were analysed using thematic analysis.FindingsThe results identified some distinctive information behaviours connected by the participants to autism. A descriptive model was developed to represent the information journeys of people who use online groups for autistic people and are autistic or believe that they might be. The model shows how people who have been diagnosed with autism or who are awaiting professional assessment, seek and encounter online information about autism and the role of online groups for autistic people within users’ information journeys.Originality/valueThis research is the first attempt within the literature to describe and model the information journeys of people who are autistic or likely to be autistic and use online groups to find and share information. This is also the first study focussing specifically on the information behaviours of autistic adults.

Short and long-term outcomes of COVID-19-associated venous thromboembolism: a propensity score-matched cohort study.

Venous thromboembolism (VTE) is a recognized complication of SARS-CoV-2 infection, but its clinical features and both sort- and long-term outcomes remain incompletely characterized. We aimed to compare the clinical profile and outcomes of patients with VTE with and without recent COVID-19. We conducted a prospective cohort study including 2012 patients with objectively confirmed VTE. COVID-19-associated VTE was defined as VTE diagnosed within 30days of a microbiologically confirmed SARS-CoV-2 infection. Clinical characteristics, treatment, and outcomes were compared between groups. Propensity score matching (1:1) and competing risk models were used to adjust for confounding. The primary outcomes-assessed at both 30days and 365days-included all-cause mortality, major bleeding, and VTE recurrence. A total of 272 patients (13.5%) had COVID-19-associated VTE. Compared with non-COVID cases, these patients more often had pulmonary embolism, higher D-dimer levels, and greater use of unfractionated heparin. At 30days, COVID-19 was associated with increased mortality (HR 2.29; 95% CI 1.19-4.40) and major bleeding (HR 2.11; 95% CI 1.06-4.21). At one year, the bleeding risk remained higher (HR 1.54; 95% CI 1.02-2.33), while VTE recurrence was lower (HR 0.34; 95% CI 0.13-0.94). These results were consistent after propensity score matching. COVID-19-associated VTE is linked to worse short-term outcomes, including early mortality and bleeding, and to a persistently elevated bleeding risk at one year. Lower recurrence rates support the consideration of COVID-19 as a transient provoking factor.

Comparative Prognostic Utility of Updated Model for End-Stage Liver Disease Scores for Prediction of Early Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation.

To compare the performance of updated model for end-stage liver disease (MELD) systems with that of the original MELD score for predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. In this single-center retrospective study, 6 MELD variations were quantified in 553 patients (n = 332; 60% male; mean age, 55 years) who underwent TIPS creation between 1998 and 2023. Scoring systems included original MELD, MELD-sodium (MELD-Na), MELD 3.0, MELD-lactate, MELD-glomerular filtration rate assessment in patients with liver disease-sodium (MELD-GRAIL-Na), and MELD-plus. Association of MELD schemes with 30-day, 6-week, and 90-day mortality was assessed using DeLong test, and the predictive capacity of MELD systems was evaluated by comparing area under receiver operating characteristic (AUROC) curves. TIPS were created for ascites (n = 263, 47%), variceal hemorrhage (n = 247, 45%), or other indications (n = 43, 8%). All MELD systems statistically associated with mortality at each time point (P < .001). Based on 30-day, 6-week, and 90-day AUROC curves, none of the updated MELD systems showed superior predictive capacity for early mortality compared with original MELD-MELD: 0.847, 0.841, and 0.818; MELD-Na : 0.847, 0.846, and 0.829; MELD 3.0: 0.848, 0.850, and 0.842; MELD-lactate: 0.915, 0.881, and 0.866; MELD-GRAIL-Na: 0.851, 0.847, and 0.831; and MELD-Plus: 0.843-0.898, 0.853-0.910, and 0.814-0.829, respectively (P > .05). Findings were principally confirmed on subset analyses stratified by sex, TIPS indication, TIPS urgency, stent type, and TIPS date. Updated MELD systems have prognostic value for early mortality after TIPS creation. However, in this study, these newer schemes did not offer additional predictive power beyond the original MELD, which still effectively estimates early post-TIPS survival.

Obesity hypoventilation syndrome: Current status and future directions for optimizing care of a complex and diverse condition (a narrative review).

Obesity hypoventilation syndrome: Current status and future directions for optimizing care of a complex and diverse condition (a narrative review).

Outcomes of Newly Diagnosed Multiple Myeloma Patients Requiring Dialysis.

Outcomes of Newly Diagnosed Multiple Myeloma Patients Requiring Dialysis.

Adverse Outcomes after Cemented and Cementless Primary Elective Total Hip Arthroplasty in 60,064 Matched Patients: A Study of Data from the Swedish Arthroplasty Register.

The choice between cemented and cementless fixation in primary elective total hip arthroplasty (THA) remains a subject of ongoing debate. However, comparisons between the two are subject to limited adjustments for patient characteristics, diagnoses, and surgical factors, as well as by limited outcome time endpoints. Our study aimed to compare the effect of femoral fixation on safety and implant survival outcomes in matched patients. Using propensity score techniques, we matched patients undergoing cemented (n = 101,523) and cementless (n = 52,996) primary elective THA in the Swedish Arthroplasty Register based on age, sex, American Society of Anesthesiologists grade, body mass index, hospital type, and preoperative diagnosis between 2008 and 2018. We used both regression and survival models for 30, 60, and 90 days, as well as one and two years, to compare outcomes, including mortality, revision, and periprosthetic femoral fracture necessitating revision surgery. There were 30,032 cementless femoral fixations one-to-one matched with cemented ones using the Gradient Boosting Machine modeling to estimate the propensity score. Regression analyses showed that cementless fixation had lower mortality outcomes (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.69 to 0.78, P < 0.001), but significantly worse revision (OR 1.51, 95% CI 1.38 to 1.65, P < 0.001) and periprosthetic femoral fracture (OR 2.40, 95% CI 1.92 to 2.99, P < 0.001). Kaplan-Meier survival models showed statistically significant lower mortality risks for uncemented fixation at the 2-year interval (hazard ratio 0.82, 95% CI 0.71 to 0.94, P = 0.006), but not at earlier endpoints. Revision and periprosthetic femoral fractures were both higher for cementless rather than cemented fixation. This study found no significant differences in early mortality between cemented and cementless femoral implants. However, cementless fixation was associated with increased risks of revision and periprosthetic femoral fractures. These findings emphasize the importance of considering implant choice in the context of individual patient characteristics and surgical priorities to optimize outcomes in THA.

Resistance Training Protects against Cardiac Damage in Doxorubicin-Induced Cardiotoxicity in Rats.

Doxorubicin (DOX) is an effective chemotherapeutic agent that leads to a dose-dependent cardiotoxicity that may ultimately result in heart failure. This study explores whether resistance training (RT) may mitigate DOX-induced cardiac damage and examines the expression of proteins involved in muscle anabolism, catabolism, and mitochondrial dynamics in the left ventricle. Male Sprague Dawley rats (3 months old) were divided into control (saline/sedentary, n = 10), Dox/Sed (DOX/sedentary; initial n = 16), and Dox/Tr (DOX/RT; initial n = 16) groups. DOX or saline was administered for ten consecutive days (1 mg/kg/d; i.p.), starting concomitantly with RT, that consisted of ladder climbing with tail-attached weights (15 reps/day; 5 d/wk; 20-60% of maximal load; for eight weeks). 72 h after the last RT session, rats were euthanized and left ventricle fragments were dissected and processed for microscopy and Western blot. RT reduced the early and high mortality observed in Dox/Sed group and prevented DOX-induced cardiac fiber atrophy and fibrosis. Cardiomyocytes ultrastructural damage, including misaligned sarcomeres, myofibril rupture, autophagosome presence, and mitochondrial damage, was mitigated by RT. While Akt, p-Akt, MuRF1, and Atrogin-1 levels in left ventricle were similar among groups, both DOX groups displayed reduced mTOR, ERK, and p-ERK expression compared to control group. Regarding proteins related to mitochondrial dynamics, OPA1 expression did not differ among groups, Mfn2 was significantly lower in both DOX groups compared to control, and FIS1 levels were lower only in Dox/Tr group. In addition, Dox/Tr presented higher levels of PGC1α expression in comparison with control and Dox/Sed groups. RT may be valuable to protect the heart against the structural damage induced by DOX via the modulation of proteins involved in mitochondrial dynamics.

Role of Pulmonary Function Tests to Predict Complications After Chimeric Antigen Receptor T-Cell Therapy.

Role of Pulmonary Function Tests to Predict Complications After Chimeric Antigen Receptor T-Cell Therapy.

Celiac ganglion resection as an intraoperative factor associated with delayed gastric emptying in retroperitoneal sarcoma surgery: A multicentric prospective cohort study.

Celiac ganglion resection as an intraoperative factor associated with delayed gastric emptying in retroperitoneal sarcoma surgery: A multicentric prospective cohort study.

Chiari III Malformation: Quantification of Long-term Outcome After Early Surgery.

Chiari III Malformation: Quantification of Long-term Outcome After Early Surgery.

A Real-World Evaluation of Frontline Treatment for Acute Myeloid Leukemia With Azacitidine Plus Venetoclax.

A Real-World Evaluation of Frontline Treatment for Acute Myeloid Leukemia With Azacitidine Plus Venetoclax.

SUDEP in inherited metabolic epilepsies.

SUDEP in inherited metabolic epilepsies.

Surgeon Frequency of Aortic Root Enlargement and Long-Term Survival in Medicare Beneficiaries Undergoing Surgical Aortic Valve Replacement.

Surgeon Frequency of Aortic Root Enlargement and Long-Term Survival in Medicare Beneficiaries Undergoing Surgical Aortic Valve Replacement.

Sutureless and Trans-catheter Valve Use in Aortic Valve Endocarditis: A Review

New approaches have been developed to treat aortic valve disease, including sutureless and trans-catheter aortic valve replacement (TAVR). Few groups have reported their experience using sutureless and trans-catheter valves for aortic valve endocarditis. We aim to review the current available data on the application of these two approaches in managing aortic valve endocarditis. A literature search was conducted on PubMed, EBSCOhost, and Google scholar databases using the following search terms: “Perceval endocarditis”; “sutureless valve endocarditis”; “Intuity valve endocarditis”; “TAVR endocarditis”; “percutaneous aortic valve endocarditis”; “Trans-catheter valve endocarditis”. After filtering, we found 26 articles appropriate for our review including 20 articles about sutureless valves for endocarditis (16 Perceval, 4 Intuity), and 6 articles on trans-catheter aortic valve implantation for endocarditis. The observed early mortality rate of sutureless valve implantation in aortic valve endocarditis ranged between 14–23%, while early mortality rates in a recent national sample of the standard surgical approach were between 8–10%. Additionally, there was an observed increased incidence of peri-valvular aortic regurgitation after sutureless valve implantation for endocarditis. We observed an increased risk of stroke for trans-catheter implantation in aortic valve endocarditis with large vegetations. The current evidence suggests caution for the implantation of trans-catheter and sutureless valves in patients with aortic valve endocarditis. High risk patients for the standard surgical approach or complex endocarditis cases should be evaluated through a multidisciplinary endocarditis team at specialized centers.

Beyond surgical radicality in intramedullary spinal cord metastases: neurological function and systemic disease burden drive patient outcomes.

Intramedullary spinal cord metastases (ISCM) are rare, clinically challenging lesions with limited evidence-based guidance. Optimal surgical management remains controversial, particularly regarding the ideal extent of resection (EOR) and associated prognostic factors. This study systematically evaluates perioperative outcomes, neurological function, and short-term survival according to biopsy-only, subtotal, or gross total resection (GTR) approaches. This retrospective single-center study included 16 patients treated surgically for histologically confirmed ISCM between 2015 and 2024. Patients were stratified by surgical extent (biopsy, subtotal, or total resection). Outcomes included perioperative complications, neurological function, and 90-day survival. A literature review of surgical ISCM series (≥ 5 cases) was also performed. Sixteen patients with a median age of 59 years (56% male) were included. Thoracic lesions predominated (56%). Surgical complications were seen in 19% of the cases, however no irreversible neurological injury and no intraoperative mortality or transfusion occured. Early mortality was lowest following GTR (13%) compared to subtotal (60%) or biopsy-only (33%) approaches (p = 0.015). However, multivariable regression showed that EOR alone was not independently predictive of short-term survival (p = 0.834), indicating patient selection bias. Neurological function remained stable or improved in all of cases, irrespective of resection extent. Surgical management of ISCM can be performed safely with minimal neurological morbidity, achieving symptom stabilization or improvement. Although GTR was associated with favorable short-term survival, systemic disease burden and postoperative neurological function are stronger prognostic factors. Therefore, surgical decisions should prioritize functional preservation and patient selection based on disease extent and overall health.

Haematological Abnormalities in Late-Presenting Cyanotic Congenital Heart Disease: A Cross-Sectional Study

Every year, a substantial number of children are born with congenital heart disease (CHD), a condition associated with high early mortality rates, particularly in low- and middle-income countries. Timely diagnosis and referral to centers of excellence for either surgical or percutaneous interventions can significantly improve outcomes for these children. However, in our setting, multiple systemic barriers—such as limited access to specialized pediatric cardiac surgery, a lack of awareness, poverty, illiteracy, and delayed referrals—contribute to a persistent gap between the burden of cyanotic congenital heart disease (CCHD) and the availability of adequate diagnostic and therapeutic services. In many regions, pediatric cardiac surgical facilities are entirely absent, and corrective surgeries are often delayed for years or even decades, leading to suboptimal prognoses [1-3]. The present article underscores several underrecognized, yet clinically significant, haematological abnormalities in late-presenting patients with CCHD—factors that can impact surgical outcomes but are frequently overlooked. Traditionally, the poor prognosis in these patients is primarily attributed to the severity of the underlying defect and the delayed presentation. However, this study highlights modifiable and preventable contributors, including coagulation abnormalities and hematologic imbalances, which deserve greater clinical attention [4]. Patients with CCHD are known to be at risk for both thrombotic and hemorrhagic complications. The current study reports prolonged bleeding time, prothrombin time (PT), and activated partial thromboplastin time (APTT), indicating an increased bleeding tendency, particularly during surgery. This finding is of critical importance, as bleeding risks in this population are often overshadowed by the focus on thrombosis. The correction of coagulation abnormalities in the perioperative period must be prioritized to mitigate both thrombotic and hemorrhagic complications. Moreover, platelet deficiencies and defective megakaryocyte maturation—recognized complications in these patients—can further exacerbate bleeding risks, though the study interestingly noted a low incidence of reported bleeding events despite abnormal coagulation profiles [5]. Polycythemia is a hallmark of cyanotic CHD, driven by chronic hypoxia. These patients commonly present with elevated red blood cell counts and hemoglobin levels, which can result in hyperviscosity symptoms and increased thrombotic risk. Of particular note in this study is the observation that, while most patients were polycythemic, a significant subset (12%) were found to have iron deficiency anemia. This finding is clinically relevant, as iron deficiency can exacerbate hypoxia-related symptoms and contribute to adverse perioperative outcomes, especially in surgeries involving significant blood loss. Preoperative identification and correction of iron deficiency may thus serve as an essential component of comprehensive surgical preparation. Ultimately, beyond the need for timely diagnosis and intervention, this study indirectly points toward the importance of primary prevention strategies to reduce the overall burden of CCHD. In this regard, the predictive model recently proposed by Sana Shahid et al., utilizing structural equation modeling to identify at-risk pediatric populations in Pakistan, offers a promising tool for early risk stratification and may potentially lower the incidence of CCHD in resource-limited settings [6]. This article brings to light critical, yet often neglected, aspects of preoperative assessment in children with CCHD. By identifying preventable haematological contributors to poor outcomes, it adds important evidence to the broader discussion on improving care and surgical preparedness for this vulnerable patient population. References Shahid S, Akbar A. Conventional and non-conventional risk factors of cyanotic and acyanotic congenital heart diseases in Children of Southern Punjab, Pakistan. Pakistan Heart J. 2020;53(2):132-6. DOI: 10.47144/phj.v53i2.1698 Ali F, Ladak LA, Usmani AA, Raza HA, Siddiqui MT, Hasan B. Health-related quality of life in postcardiac interventional catheterization patients with congenital heart disease: a mixed-methods study protocol from Pakistan. BMJ Open. 2021;11(12):e052989. DOI: 10.1136/bmjopen-2021-052989 Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019;73(12):1494-563. DOI: 10.1161/CIR.0000000000000602 Younas I, Kazmi T, Saqlain N, Ghous M, Hyder SN, Sadiq M. Hematological Abnormalities in Late-Presenting Cyanotic Congenital Heart Disease: A Cross-Sectional Study. Pak Heart J. 2025;58(02):243-249. DOI: 10.47144/phj.v58i2.2803 Jensen AS, Idorn L, Thomsen C, von der Recke P, Mortensen J, Sørensen KE, et al. Prevalence of cerebral and pulmonary thrombosis in patients with cyanotic congenital heart disease. Heart. 2015;101(19):1540-6. DOI: 10.1136/heartjnl-2015-307657 Shahid S, Khurram H, Shehzad MA, Aslam M. Predictive model for congenital heart disease in children of Pakistan by using structural equation modeling. BMC Med Inform Decis Mak. 2024;24(1):351. DOI: 10.1186/s12911-024-02774-y

Physiological and immunological study of hypertensive patients treated with candesartan

Hypertension is the primary cause of cardiovascular disease and early mortality globally, it is a complex feature Determined by many factors endogenous mechanisms, genetic factors, physiological systems and environmental exposures variances. In recent years, there has been growing scientific interest and research focused on the immunological aspects of antihypertensive medications. Among these, Candesartan has emerged as a prominent subject of study. It has been demonstrated to reduce the inflammatory reactions associated with hypertension. The present study was conducted at Imam Hussein Teaching Hospital in the holy city of Karbala from December 20, 2022 to May 22, 2023. There were three distinct groups in the study which are (G1) healthy people, (G2) those receiving medication other than candesartan for their hypertension and (G3) patients receiving candesartan treatment for hypertension to evaluate various physiological parameters in order to ascertain the impact of candesartan on these samples such as serum sodium, serum potassium, and Adiponectin, as well as the investigation of some immunological markers like Interleukin1( IL-1), Interleukin18( IL-18) and Tumor Necrosis Factor(TNF). The study findings showed statistically significant differences in the mean levels of TNF, Interleukin-1, Interleukin-18, serum sodium, serum potassium, and adiponectin between the study groups. The current study was designed to obtain more clarification of some physiological and Immunological parameters in Iraqi hypertensive patients treated with candesartan, and determine the essential role of some physiological parameters such as, (serum sodium, serum potassium, and adiponectin), and Immunological parameters such as, [pro- inflammatory cytokines like, Interleukin-1(IL-1), Interleukin-18, and Tumor Necrosis Factor alpha (TNF-α)]. The result of physiological parameters showed a high significant increasing (P&lt;0.05) in the concentration of serum potassium level in group of hypertension patients treated with candesartan (G3) while the concentration of serum sodium and adiponectin showed a significant decreasing (P&lt;0.05) in the same group (G3) compared with control healthy group(G1), and positive control group (G2). The results of Immunological parameters including Interleukin-1, Interleukin 18 and Tumor necrosis factor- alpha showed that there was a high significant increasing (P&lt;0.05) in the concentration of control healthy group(G1), and positive control group (G2) compared with hypertension patients treated with candesartan (G3).

The role of leukapheresis in managing complications of hyperleukocytosis in pediatric acute leukemia.

Hyperleukocytosis is defined as a white blood cell (WBC) count ≥ 100,000/mm3 and frequently observed in pediatric acute leukemia patients. It has prognostic significance due to an increased risk of early mortality. This study aimed to evaluate the potential role of leukapheresis in the management of hyperleukocytosis-related complications, including tumor lysis syndrome (TLS), in pediatric acute leukemia patients. This retrospective study included 40 pediatric patients (< 18years) with acute leukemia and hyperleukocytosis at presentation. Patients were monitored for TLS development, and groups that received and did not receive leukapheresis were compared. Statistical analyses were performed using IBM SPSS 22. Of 40 patients, 32.5% (n = 13) underwent leukapheresis. TLS occurred in 47.5% (n = 19) of patients, with no statistically significant difference between groups (p = 0.44). No leukapheresis patients required hemodialysis, while four non-leukapheresis patients did. Time from presentation to chemotherapy initiation was not significantly different between groups (p = 0.10). While leukapheresis did not significantly affect the incidence of TLS, clinical improvements were observed in some patients, particularly in hyperleukocytosis-related symptoms, such as respiratory distress and neurological manifestations. These findings suggest that leukapheresis may play a supportive role in managing leukostasis-associated complications in pediatric acute leukemia patients presenting with hyperleukocytosis.

Dietary Creatine Intake and All-Cause Mortality among U.S. Adults: A Linked Mortality Analysis from the NHANES Study

Evidence linking dietary creatine intake with mortality remains scarce and inconclusive. This study aimed to investigate the relationship between creatine consumption and all-cause mortality, as well as to evaluate the potential impact of meeting the recommended dietary creatine intake of ≥ 1 gram per day in a nationally representative sample of U.S. adults. We evaluated creatine intake, estimated from a single 24-hour dietary recall in the 1999-2000 National Health and Nutrition Examination Survey, with mortality follow-up extending through 2019. Of the 4,041 participants enrolled at baseline, 858 deaths were recorded over a median follow-up period of 19.8 years. Creatine as a continuous variable (grams per day) had inverse association with all-cause mortality (B=-0.094; P=0.04). The hazard ratio for all-cause mortality was 0.85 (95%CI: 0.72–1.00) for participants consuming at least 1 gram of creatine per day, compared to those consuming less than 1 g/day (P=0.05), suggesting that individuals meeting the recommended creatine intake had a significantly lower risk of early mortality compared to those with suboptimal intake. Proportional hazards regression analysis indicated that this association remained robust after adjusting for certain covariates, such as dietary macronutreints (B=-0.234; P=0.01) and physical examination measures (B=-0.206; P=0.02); however, it weakened when demographic and lifestyle factors were included in the model. In this sample of U.S. adults, higher creatine intake was inversely associated with all-cause mortality; however, this relationship may be influenced by other contributing factors. These findings underscore the need for further research on the relationship between dietary creatine intake and mortality outcomes.