Effect of Gut Microbiota from Patients with Uremia on Body Weight and Microinflammation in Rats.

Association of the neutrophil percentage-to-albumin ratio with sarcopenia in U.S. adults: Evidence from NHANES 2011-2018 and machine learning-based analyses.

Association of adipose tissue activity in cervical regions with weight loss and prognostic survival in gastric cancer patients.

ObjectiveThis study aimed to investigate the prognostic value of the postoperative neutrophil-to-albumin ratio (NAR) in patients with bladder cancer undergoing radical cystectomy.Patients and MethodsA total of 368 patients with histologically confirmed bladder cancer who underwent radical cystectomy between January 2018 and December 2021 were retrospectively analyzed. Postoperative NAR was calculated using neutrophil count (%) and serum albumin concentration (g/L) measured approximately three months after surgery. Receiver operating characteristic analysis identified the optimal NAR cutoff value for predicting 5-year overall survival. Kaplan–Meier and Cox regression models were used to assess associations between NAR and overall survival or recurrence-free survival.ResultsThe optimal NAR cutoff value was 2.6 with an AUC value of 0.76. Elevated NAR was significantly correlated with bladder cancer of invasive pathological types (p = 0.005), advanced tumor stage (p < 0.0001), lymph-node metastasis (p = 0.002), and receipt of neoadjuvant chemotherapy (p = 0.014). Patients with elevated NAR had significantly shorter overall survival (HR=3.14; 95% CI, 1.27–6.24; p = 0.002) and recurrence-free survival (HR=3.27; 95% CI, 1.52–5.87; p = 0.001) compared with those with low NAR. In multivariate analysis, postoperative NAR (p = 0.001), tumor stage (p = 0.002), and pathological type (p = 0.013) were independent predictors of overall survival, while NAR (p = 0.002), tumor stage (p = 0.003), and lymph-node metastasis (p = 0.014) independently predicted recurrence-free survival.ConclusionAn increased postoperative NAR independently predicts poorer overall and recurrence-free survival of bladder cancer patients following radical cystectomy. As an inexpensive and readily available biomarker reflecting systemic inflammation and nutritional status, NAR may serve as a practical tool for postoperative risk stratification and individualized patient management.

Abstract The aim of this study was to investigate the effects of dietary supplementation with tannic acid (TA) on the growth performance, nutrient apparent digestibility, nitrogen metabolism, rumen fermentation and blood indices in Liaoning cashmere goats. Twenty-four Liaoning cashmere goats with an initial body weight of 23.78±1.25 kg were equally divided into four dietary treatment groups: TA0 (Con group), 0 g/kg dry matter (DM) TA; TA2, 2 g/kg DM TA; TA4, 4 g/kg DM TA; TA8, 8 g/kg DM TA. The results showed that dietary TA supplementation had no effect on growth performance of goats (P&gt;0.05), but increased the apparent digestibility of crude protein (P&lt;0.05). The addition of 4 g/kg DM TA increased the content of total protein, albumin and creatinine in serum (P&lt;0.05). Moreover, the concentrations of propionic acid, butyric acid, valeric acid and microbial crude proteins in rumen were significantly higher in the 4 g/kg DM TA group compared to the Con group (P&lt;0.05). Furthermore, dietary 4 g/kg DM TA reduced urinary urea nitrogen and nitrogen excretion but increased nitrogen deposition and nitrogen deposition rate significantly (P&lt;0.05). Thus, adding 4 g/kg DM of TA to the basal diet modulates nitrogen metabolism, improving the crude protein apparent digestibility and protein utilization without affecting the growth performance of goats.

Risk factors for sputum smear-positive in COPD patients first diagnosed with active tuberculosis.

BackgroundThe Prognostic Nutritional Index (PNI) is a numerical score used to assess the nutritional and immunological status, derived from serum albumin concentration and lymphocyte count. While malnutrition and systemic inflammation are known to influence surgical outcomes and cancer prognosis, the predictive value of PNI in colorectal cancer (CRC) is underexplored. This study aimed to evaluate whether preoperative PNI predicts postoperative complications and long-term survival in patients with CRC undergoing curative-intent surgery.MethodsThe records of 2,026 patients who underwent curative-intent surgery for CRC between 2011 and 2023 at a tertiary center in Taiwan were retrospectively reviewed. Propensity score matching (PSM) was used and patients were stratified into high and low PNI groups based on the median value. Outcomes included in-hospital complications, 5-year overall survival (OS), and disease-free survival (DFS) in the subgroup of patients with stage I–III disease. Multivariable logistic regression and Cox proportional hazards models were used as well as restricted cubic spline (RCS) analysis.ResultsHigh PNI was independently associated with lower rates of overall complications (adjusted odds ratio [aOR] = 0.22, 95% confidence interval [CI]: 0.17–0.28), ileus (aOR = 0.23), anastomotic leakage (aOR = 0.16), and lung-related complications (aOR = 0.38). High PNI was also significantly associated with improved 5-year OS (aHR = 0.45, 95% CI: 0.38–0.55), but not DFS. In additional competing-risk and comorbidity-stratified analyses, high PNI remained protective for both cancer-related (p = 0.0005) and non–cancer-related mortality (p < 0.0001), with consistent effects across CCI strata and attenuation for cancer-related death in CCI ≥ 3 (p = 0.1024). Additionally, PNI demonstrated superior predictive performance over the neutrophil-to-lymphocyte ratio (NLR) for all complication types based on receiver operating characteristic (ROC) analysis.ConclusionPreoperative PNI was independently associated with postoperative complications and OS in patients with CRC undergoing curative surgery. Routine assessment of PNI may help refine risk stratification and guide perioperative management to improve surgical outcomes.

Human serum albumin (HSA) possesses oncotic, antioxidant, and immunomodulatory properties. Although recent studies suggest that albumin may promote resolution of acute-on-chronic liver failure (ACLF) and reduce the incidence of infection, its impact on overall prognosis with daily administration remains unestablished. Patients meeting the Asian Pacific Association for the Study of the Liver (APASL) criteria for ACLF were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV 2.2) database. The primary outcome was 30-day mortality. To balance baseline characteristics between the albumin and non-albumin groups, we applied stabilized inverse probability of treatment weighting (SIPTW). The association between daily albumin infusion and 30-day mortality was subsequently assessed using Cox regression analyses. A total of 505 patients were enrolled in the study, of whom 325 received albumin therapy within the first 24h of ICU admission. After applying SIPTW, the cohort comprised 169 patients in the non-albumin group and 319 in the albumin group. Overall, albumin administration was not significantly associated with 30-day mortality in patients with ACLF. However, subgroup analyses revealed that albumin infusion conferred the most substantial survival benefit in specific patient populations. These included individuals with spontaneous bacterial peritonitis, a Model for End-Stage Liver Disease score of ≥ 30.1, a mean arterial pressure below 73 mmHg, a daily albumin dosage of ≤ 1.0g/kg, or those receiving a combination of 5% and 25% albumin concentrations. Conversely, a dosage exceeding 1.0g/kg/day was associated with inferior 30-day survival. Albumin administration is associated with reduced mortality in specific subpopulations of patients with ACLF. Key clinical parameters-including serum albumin concentration, SBP, MELD score, and MAP-were identified as significant modifiers of treatment efficacy and should be incorporated into clinical decision-making when initiating albumin therapy.

Antibiotic contamination in food matrices and environmental waters typically occurs at low residue levels, necessitating sensitive detection methods. We developed a magnetic immunoassay utilizing horseradish peroxidase (HRP)-conjugated tetracycline (TC) immobilized on gold nanoparticle (AuNP)-decorated poly(amidoamine) (PAMAM) dendrimers. The immunomagnetic beads were functionalized with an anti-TC antibody using bovine serum albumin (BSA) for oriented immobilization. Fourth-generation (G4) PAMAM dendrimers served as a substrate for AuNP attachment, enabling covalent conjugation of HRP-TC to form HRP-TC/AuNPs/PAMAM nanoparticles. Structural analysis and microscopic observations confirmed successful synthesis of HRP-TC/AuNPs/PAMAM. One-factor optimization was used to determine optimal experimental parameters (buffer pH, NaCl concentration, and bovine serum albumin (BSA) content), with values of 7.4%, 2%, and 0%, respectively. The developed immunoassay exhibited a linear detection range of 0.29–1.07 ng/mL and a limit of detection (LOD) of 0.018 ng/mL. The HRP-TC/AuNPs/PAMAM-based magnetic immunoassay demonstrated high specificity for TC. It was successfully applied to analyze wastewater samples, yielding excellent recovery rates and strong correlation with ultra-high-performance liquid chromatography/mass spectrometry (UHPLC/MS) results. These findings suggest that the proposed HRP-TC/AuNPs/PAMAM immunoassay offers superior sensitivity, reproducibility, and applicability for detecting trace levels of chemicals in complex matrices.

Purpose To quantify functional liver volume (FLV) loss relative to minimal ablative margins (MAMs) achieved during percutaneous thermal ablation (TA) of liver tumors in COVER-ALL randomized controlled trial (RCT) participants. Materials and Methods In the COVER-ALL single-center RCT (June 2020 through October 2023), software-based ablation confirmation (AC) (experimental) and visual margin (control) assessment were compared among participants with histology-agnostic liver tumors. In this post hoc analysis, the authors compared CT-derived volumes, MAMs, and changes in laboratory-based hepatic function using Wilcoxon rank sum and Spearman correlation tests. Results Among 100 participants (mean age ± SD, 57.8 years ± 13.2; 61 male; experimental group, n = 74, 98 tumors ablated, median diameter = 1.5 cm; control group, n = 26, 41 tumors ablated, median diameter = 1.3 cm), the experimental and control group baseline median FLVs (1707 cm3 [IQR, 1467-1964 cm3] vs 1722 cm3 [IQR, 1338-1916 cm3]; P = .84) were comparable. The median MAM was larger in the experimental versus the control group (6 mm [IQR, 4.5-7.9 mm] vs 1 mm [IQR, 0-4 mm]; P < .001). The median percentage FLV loss was larger in the experimental versus the control group (2.9% [IQR, 1.8%-4.4%] vs 1.7% [IQR, 1.2%-3.4%]; P = .03). The median postablation FLV was comparable between the experimental and control groups (1643 cm3 [IQR, 1403-1886 cm3] and 1696 cm3 [IQR, 1315-1843 cm3]; P = .87). We observed no association between percentage FLV loss and changes in serum albumin (ρ = -0.153, P = .16) or total bilirubin concentrations (ρ = -0.128, P = .25). Conclusion Liver tumor TA resulted in minimal percentage FLV loss. Software-based AC use increased the MAM at the expense of a negligible increase in percentage FLV loss. Keywords: Ablation Techniques, Segmentation, Liver, Volume Analysis ClinicalTrials.gov: NCT04083378 Supplemental material is available online. © RSNA, 2026.

Replacing hexane with 2-methyloxolane (MeOx) for defatting soybean meal (SBM) requires adaptations of the SBM production process. These modifications may increase the concentration of Maillard reaction products and reduce the residual oil content in MeOx-defatted SBM compared with hexane-defatted SBM. In addition, despite desolventization, solvent residues may still be present in the SBM when fed to livestock. This study aims to ensure that the replacement of hexane with MeOx for defatting SBM does not affect the ruminal and milk fatty acid profiles nor the liver activity, liver functionality, and inflammatory status in dairy cows. A 4 × 4 Latin square design experiment was conducted with 16 primiparous dairy cows that received 4 dietary treatments: 100% hexane-defatted SBM (control diet, HEX), 67% hexane-defatted SBM plus 33% MeOx-defatted SBM (33MeOx), 33% hexane-defatted SBM plus 67% MeOx-defatted SBM (67MeOx), and 100% MeOx-defatted SBM (100MeOx). Diets contained 16% SBM on a DM basis and were iso-CP and iso-net energy. We collected feed, ruminal content, blood, and milk samples. We measured traits related to lipid digestion in the rumen and secretion in milk (feed, ruminal, and milk fatty acid profiles), energy metabolism (plasma acetate, BHB, nonesterified fatty acids, and glucose concentrations, as well as C isotopic discrimination between plasma and diet), liver integrity and functionality (plasma enzyme activities and serum albumin and plasma total bilirubin concentrations), and inflammatory status (blood cell counts and plasma cytokine concentrations). We used difference and equivalence tests for statistical analyses. Replacing HEX with 100MeOx resulted in likely equivalent milk fat content, fat yield, and major fatty acid profile. Stearyl-CoA desaturase activity in the mammary gland, indicated by the C14:1 cis-9-to-C14:0 ratio, was negatively linearly related to the proportion of MeOx-defatted SBM in the diet. We did not find evidence of strict equivalence between 100MeOx and HEX in ruminal fatty acid profile. However, only minor differences were observed. Plasma γ-glutamyltransferase, aspartate aminotransferase, and alanine aminotransferase activities, as well as total bilirubin concentration, were unlikely equivalent toward greater values with 100MeOx compared with HEX, suggesting slight changes in liver integrity and functionality with 100MeOx. The overall inflammatory status of dairy cows was unlikely equivalent between 100MeOx and HEX. However, significant differences were limited to blood basophil count and plasma chemokine C-C motif ligand 4 concentration that were negatively linearly related to the proportion of MeOx-defatted SBM in the diet, and plasma chemokine C-X-C motif ligand 8 concentration that was quadratically related to the proportion of MeOx-defatted SBM in the diet. Altogether, these results indicate that the replacement of hexane-defatted SBM with MeOx-defatted SBM in the diet of dairy cows resulted in likely equivalent lipid secretion in milk despite a slight reduction in stearyl-CoA desaturase activity in the mammary gland with MeOx-defatted SBM. In the context of this study (i.e., short-term exposure, high level of MeOx, low level of hexane), neither hexane-defatted SBM nor MeOx-defatted SBM impaired health, but slight changes in some indicators of liver integrity, liver functionality, and inflammatory profile may warrant further investigation (e.g., long-term exposure).

Modulation of islet amyloid polypeptide induced β-cell toxicity and amyloid formation by serum albumin proteins.

Strategies for the prevention of hyperketonemia, or subclinical ketosis, based on providing additional glucose or glucose precursors provide discordant results suggesting that other poorly understood metabolic factors may potentially contribute to the onset of this affliction. The aim of this study was to compare the efficacy of hepatic-protectors (acetyl-Met, Ala, Arg, Thr, Gln, cyanocobalamin, inositol, and α-lipoic acid) or monensin to reduce postpartum hyperketonemia. A total of 594 Holstein Friesian dairy cows from a single herd were enrolled in a longitudinal study. Animals were blocked by parity and randomly distributed into 4 groups at dry-off: control group (CTR; n = 148); complete preventive protocol based on hepato-protectors (CPP; n = 149); simplified preventive protocol based on hepato-protectors (SPP; n = 149); and monensin (MON; n = 148). Cows in CPP received an i.m. injection of 2 mL/kg of BW of a solution containing acetyl-Met, Ala, Arg, Thr, Gln, inositol, and cyanocobalamin at 15 and 12 d before the expected calving date, and an i.m. injection of 20 mL/kg of BW of a solution containing acetyl-Met, α-lipoic acid, and cyanocobalamin at calving, and 2, 4, 6, 8, 10, and 12 d postpartum. The SPP group received both drugs i.m. (2 mL/10 kg of BW and 70 mL/animal, respectively) at 12 d before the expected calving and 6 d postpartum. The MON group received one intraruminal bolus of monensin (32.4 g/animal) 21 d before the expected calving date. Blood samples were collected at 21 and 7 d before expected calving, the day of calving, and 7, 14, 28, and 55 d postpartum. Blood nonesterified fatty acids (NEFA) and BHB were determined in all animals, whereas blood biochemical profiles were evaluated in 180 cows (30.3%) randomly selected. Cows in CPP and SPP had lower serum NEFA, BHB, aspartate amino-transferase, γ-glutamyl transferase, and urea concentrations than CTR and MON cows. Furthermore, SPP cows had the greatest serum albumin concentrations during the postpartum period. Postpartum hyperketonemia prevalence was lower in CPP and SPP than in CTR cows at 14 and 28 d, and lower than MON cows at 55 d. In addition, hyperketonemia prevalence was lower in SPP than in CTR cows at 55 d postpartum. Hepato-protectors influenced energy and protein metabolism, and liver metabolism of cows, and they may represent a valuable strategy to reduce hyperketonemia in dairy cattle.

This study aims to further validate the association of serum albumin and obesity in a larger population and explore potential underlying mediating factors. Our study utilized data from 5881 participants in the National Health and Nutrition Examination Survey (NHANES 1999-2004). Multivariable weighted logistic regression analyses were conducted to assess the association between serum albumin and obesity, while evaluating the potential mediating effects of extracellular fluid (ECF), percentage body fat (PFAT), and C-reactive protein (CRP). Secondary analyses encompassed restricted cubic splines (RCS) and subgroup analyses. Every 1 g/L increase in serum albumin concentration was associated with a 17% reduction in obesity prevalence (adjusted odds ratio = 0.83; 95% confidence interval (CI): 0.79-0.87; P < .001), after adjusting for age, sex, race/ethnicity, smoking status, drinking status, physical activity, hypertension, diabetes, calorie consumption, protein consumption, insulin, glycohemoglobin, TG, creatinine, ALT, and NHANES cycle. RCS analysis revealed no evidence of a nonlinear relationship (P for nonlinearity = .983). ECF mediated 66.3% (95% CI: 53.1-81.6), PFAT 31.7% (95% CI: 23.4-41.3), and CRP 11.1% (95% CI: 7.1-17.4) of the relationship (all P < .001). Sensitivity analyses revealed robust findings. Serum albumin levels demonstrated an inverse association with obesity odds. Mediation analyses confirmed mediating effects of ECF, PFAT and CRP, suggesting serum albumin may be associated with obesity through these mediators.

Abstracts. Introduction. Secondary peritonitis is an egalitarian disease because it remains a potential health threat to all people of all ages, races, and socioeconomic status, regardless of their health status. Antibiotic resistance of microorganisms can be overcome by the use of probiotic disinfectants, which can also have a positive effect on the treatment of peritonitis. The diverse spectrum of properties of probiotics can solve many modern problems not only in surgery, but also in medicine in general. B. subtilis is a commercially important probiotic that is known to produce secondary metabolites with antibacterial, antifungal, antiviral, and anti-inflammatory effects. This study is a new direction in the complex treatment of peritonitis, which can significantly improve its outcomes. Therefore, this study is relevant in the era of antibiotic resistance of microorganisms and peritonitis. The aim of the study was to determine the effectiveness of various methods of abdominal sanitation in the treatment of disseminated peritonitis. Matherials and methods. The study included 98 patients with disseminated peritonitis who underwent treatment in 2023-2024. Patients were divided into 3 groups. Group I (main) consisted of 31 (31.6%) patients, whose abdominal cavity was cleaned with a 5% solution of probiotic antiseptic, then a probiotic antiseptic spray was applied to the surgical wound, then a gel with probiotics after its suturing. Group II (main) consisted of 32 (32.7%) patients, in whom sorbent solution was used for cleaning the abdominal cavity. Group III (comparison group) consisted of 35 (35.7%) patients, in whom the abdominal cavity was cleaned with 0.9% NaCl solution. To determine the level of endotoxicosis, we determined the cytolytic activity of autologous blood serum, the albumin fraction of blood serum, the toxin-binding capacity of albumin, and the effective concentration of serum albumin. Results. The use of the developed treatment tactics in patients of group I caused a decrease in the manifestations of endotoxicosis already on the 3rd day of the study - the toxin-binding ability of peripheral blood proteins was restored and the effective concentration of albumin increased. This caused a decrease in the cytolytic activity of blood plasma and its albumin fraction. On the 7th day of the study, significant positive dynamics of the studied indicators were determined. In patients of group II, slower positive dynamics of the studied indicators were observed, and its activity was significant on the 7th day of the study. At the same time, in patients of group III, changes in the studied indicators did not have a clearly expressed positive dynamics throughout the study. Conclusions. It has been clinically proven that the use of probiotic antiseptics for the sanitation of the abdominal cavity in disseminated peritonitis is an effective method and allows to improve the treatment outcomes of such patients.

This study investigated the effects of supplementing a commercial milk replacer with Boswellia serrata resin (BSR), a natural frankincense extract rich in boswellic acids that possess anti-inflammatory and antioxidant properties, on the growth performance, serum biochemical parameters, and meat quality of suckling lambs. Twenty-four Assaf lambs were randomly assigned to three groups (n = 8 per group): natural suckling (NS), milk replacer (MR), and MR supplemented with BSR (MR+BSR). The experimental period lasted 60 days, during which growth performance and blood indices were evaluated, followed by meat quality assessment at the end of the trial. Lambs reared artificially (MR and MR+BSR) showed greater growth performance than naturally suckled lambs, as evidenced by significantly higher final body weight (p = 0.003) and average daily gain (p = 0.002), while initial body weight did not differ among treatments (p = 0.881). Within the artificially reared groups, however, BSR supplementation did not further increase growth relative to milk replacer alone. Supplementation with BSR improved the health and metabolic profile of lambs, resulting in higher serum total protein (p < 0.001), albumin (p < 0.001), and globulin (p < 0.001) concentrations. Moreover, BSR supplementation reduced the increase in aspartate aminotransferase (p < 0.001) and alanine aminotransferase (p < 0.001) activities observed in the MR group. No significant differences were detected in meat proximate composition (p > 0.05). However, meat from the NS group was significantly harder (p = 0.002) and more cohesive (p = 0.003) than meat from lambs fed MR or MR+BSR. In addition, the MR+BSR group produced meat with a higher redness (a*) value (p = 0.041), indicating an improved color quality. In conclusion, supplementing milk replacers with BSR enhanced the physiological and biochemical health of suckling lambs and enhanced specific meat quality traits, suggesting its potential as a natural functional additive in artificial rearing systems.

We aimed to evaluate the real-world effectiveness and safety of direct-acting antiviral agents (DAAs) in patients with chronic hepatitis C (CHC) and to describe genotype distribution. Patients diagnosed with CHC and treated with DAAs between June 2016 and January 2023 were included in this single-center, retrospective observational cohort study. Among the 402 patients initially evaluated, 233 patients with available sustained virological response at 12 weeks (SVR12) data were included in the final analysis. The median age was 53 years (range, 18–92), and 50.2% of patients were female; 208 patients (89.3%) were treatment-naïve. Among patients with a single HCV genotype, genotype 1b was the most prevalent. Genotype 3 infection was more frequently observed among individuals with a history of incarceration, alcohol use disorder, and intravenous drug use, whereas genotype 4 was more common among Syrian patients. Overall rates of rapid virological response, end-of-treatment virological response, and SVR12 were 95.6% (n = 195/204), 99.5% (n = 221/222), and 99.6% (n = 232/233), respectively. Compared with baseline, serum albumin concentrations (p = 0.030), WBC counts (p = 0.021), and PLT counts (p < 0.001) increased significantly, while serum AST (p < 0.001), ALT (p < 0.001), ALP (p = 0.011), and GGT (p < 0.001) enzyme activity levels showed significant decreases. Total bilirubin and AFP concentrations also declined significantly (both p < 0.001). Adverse events were infrequent and mild, with fatigue and pruritus (each n = 7, 3.0%) being the most commonly reported. No treatment discontinuation or treatment-related mortality was observed during follow-up. In this real-world cohort, DAA therapy was highly effective and well tolerated, including among vulnerable populations. The observed genotype distribution was consistent with previously reported national data and local population characteristics. These findings likely reflect migration-related epidemiological patterns and changing population dynamics rather than causal relationships. Targeted screening strategies and equitable access to DAAs remain essential for effective HCV control and reduction of its public health burden.

Background:Warfarin is a widely used oral anticoagulant with a narrow therapeutic index and extensive plasma protein binding, primarily to serum albumin. Hypoalbuminemia is prevalent among elderly individuals and may contribute to anticoagulation instability and increased bleeding risk.Objective: This study evaluated the effect of hybrid cross-linked soy–whey protein supplementation on serum albumin concentration and anticoagulation stability in elderly patients with hypoalbuminemia receiving long-term warfarin therapy. Methods: A 12-month prospective randomized clinical study was conducted involving 150 elderly patients receiving chronic warfarin therapy. Participants were divided into three groups: control (low protein intake), standard protein intake, and hybrid protein supplementation. Outcomes included serum albumin concentration, INR variability, Time in Therapeutic Range (TTR), and warfarin dose adjustment frequency. Data were analyzed using descriptive statistics and comparative group analysis. Results: Hybrid soy–whey protein supplementation was associated with a greater increase in serum albumin levels compared with control groups. Patients receiving hybrid protein supplementation demonstrated improved anticoagulation stability, reflected by higher TTR values and reduced INR variability. Conclusion: Hybrid cross-linked soy–whey protein supplementation may contribute to improved serum albumin levels and modest stabilization of warfarin anticoagulation in elderly patients with hypoalbuminemia. Nutritional optimization should be considered as a supportive strategy alongside standard anticoagulation monitoring.

Serum albumin plays an important role in maintaining colloid osmotic pressure and fluid balance. Hypoalbuminemia has been identified as a predictor of postoperative mortality and morbidity. However, the impact of preoperative hypoalbuminemia on intraoperative red blood cell (RBC) transfusion has seldom been investigated. This was a single-center retrospective cohort study conducted at a general tertiary teaching hospital in Beijing. The study included adult patients who underwent representative elective major surgeries between 2018 and 2022. The exposure was preoperative hypoalbuminemia, defined as a serum albumin concentration of less than 35g/l. The primary outcome was the transfusion of allogeneic RBCs during surgery or within three days postoperatively. Twenty confounders related to demographic characteristics, comorbidities, and procedural complexity were adjusted for using multivariable logistic regression and inverse probability of treatment weighting (IPTW). Dose-response analysis, subgroup analysis based on preoperative hemoglobin levels, and mediation analysis of intraoperative blood loss were also performed. A total of 15336 patients were included, of whom 678 (4.4%) had preoperative hypoalbuminemia. Perioperative RBC transfusions were administered to 1804 patients (11.8%). A significant association between preoperative hypoalbuminemia and the risk of perioperative RBC transfusion was observed when adjusting for confounders using logistic regression [odds ratio (OR): 2.04, 95% confidence interval (CI): 1.65-2.54, P <0.001] or IPTW (OR: 1.89, 95% CI: 1.47-2.44, P <0.001). This association became stronger as albumin level decreased (P for trend <0.001), remained significant across preoperative hemoglobin levels, and was mediated by increased intraoperative blood loss (proportion of mediation 22.7%, 95% CI: 10.5-37.4%, P <0.001). Preoperative hypoalbuminemia was associated with an increased risk of perioperative RBC transfusion. These findings highlighted the importance of preparing for RBC transfusion and implementing blood conservation strategies in patients with hypoalbuminemia.

PurposeThis study aimed to evaluate the diagnostic value of red blood cell distribution width-to-albumin ratio (RAR), a biomarker integrating hematological and metabolic information, for COVID-19 pneumonia.MethodsThis retrospective study analyzed clinical data from 2,205 patients with COVID-19. RAR values were calculated as the ratio of red blood cell distribution width (RDW) to serum albumin concentration. Diagnostic performance of RAR in COVID-19 pneumonia was assessed using receiver operating characteristic (ROC) curve analysis, and the optimal cut-off was determined. Mediation analysis was conducted to examine the role of chronological age in the association between RAR and COVID-19 pneumonia risk.ResultsAmong COVID-19 patients, RAR demonstrated strong diagnostic performance for COVID-19 pneumonia, with area under the curve (AUC) of 0.769 [95% confidence interval (CI): 0.747–0.791], sensitivity of 76.8%, and specificity of 65.3% at the optimal cut-off value of 0.154. Its diagnostic utility likely stems from simultaneously reflecting hematopoietic dysfunction (elevated RDW) and systemic metabolic imbalance (hypoalbuminemia). Mediation analysis indicated that chronological age accounted for 14.16% of the association between elevated RAR and COVID-19 pneumonia risk (β = 0.1139, 95%CI: 0.0802–0.1524).ConclusionRAR represents a promising biomarker for the early detection and risk stratification of COVID-19 pneumonia. By simultaneously capturing hematologic and metabolic disturbances, RAR provides a more comprehensive reflection of disease severity. The observed age-mediation effect suggests that elderly individuals with elevated RAR may face heightened risk, warranting enhanced clinical monitoring or prioritized intervention.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12985-026-03100-w.