Competing risk analysis of sociodemographic risk factors for child maltreatment among children in the legal custody of state of Illinois' child welfare system.

Primary care diagnosed multimorbidity and risk of venous thromboembolism in Sweden.

Sex differences in cardiovascular-kidney-metabolic syndrome and new onset cardiovascular outcomes.

To validate International Bladder Cancer Group (IBCG) definitions of Bacillus Calmette-Guérin (BCG)-unresponsive and BCG-exposed non-muscle-invasive bladder cancer (NMIBC) and assess prognostic heterogeneity across various BCG-failure types. From a multicentre international cohort of 3806 BCG-treated patients, 591 who developed high-grade NMIBC recurrence following BCG between 2003 and 2024 were included. Progression-free survival (PFS) was the primary endpoint; cancer-specific (CSM) and overall mortality (OM) were secondary endpoints. Cumulative incidence functions, competing-risk models and multivariable Cox regression were used. Patients with BCG-unresponsive and BCG-exposed disease showed similar PFS, CSM, and OM (all P > 0.05). When stratified into five subgroups, prognosis varied: 5-year progression rates were 29% for BCG-unresponsive, 32.5% for late relapse (between 6 and 24 months) after adequate BCG, 30% for BCG-exposed with inadequate BCG (<24 months from induction), 6.2% for BCG-resistant, and 14% for very late relapse (>24 months since last BCG) (P < 0.01). In multivariable analysis, BCG-exposed after inadequate BCG (subdistribution hazard ratio [sHR] 3.42, 95% confidence interval [CI] 1.33-8.84), late relapse (sHR 3.74, 95% CI 1.59-8.78), and BCG-unresponsive (sHR 2.34, 95% CI 1.00-5.44) were associated with higher progression risks compared to very late relapse. Limitations include retrospective design and treatment heterogeneity. Under IBCG definitions, BCG-unresponsive and BCG-exposed NMIBC have similarly poor outcomes. A refined classification reveals prognostic heterogeneity, with late relapses after adequate BCG demonstrating outcomes comparable to BCG-unresponsive, and very late relapses conferring better prognosis.

Multi-trajectories of intrinsic capacity and their impact on incident disability in community-dwelling older adults in Japan.

We evaluated the association between hepatitis C virus (HCV) infection and the risk of intrahepatic and extrahepatic cancers. Specifically, we compared "1st" versus "1st or 2nd" primary cancers to capture the true disease burden, which is often underestimated in conventional analyses. Additionally, we evaluated the chemopreventive effect of direct-acting antiviral (DAA) therapy on these risks. Using the Korean National Health Insurance database (2005-2023), we compared 119 565 HCV-infected individuals with 2 267 700 controls. Adjusted subdistribution hazard ratios (aHRs) were calculated using competing risk models. Direct-acting antivirals (DAA) effectiveness was evaluated in a sub-cohort of 23 147 patients (2016-2020) using time-dependent Cox models to account for immortal time bias. In the analysis of 1st or 2nd cancers, HCV infection significantly increased the risk of intrahepatic (aHR 16.35; 95% CI, 15.81-16.90) and extrahepatic cancers (aHR 1.14; 95% CI, 1.12-1.16). Notably, expanding the endpoint to include 2nd cancers increased the aHR for extrahepatic cancer from 1.09 to 1.14, indicating that traditional analyses underestimate the true burden. Significant risk elevations were observed for haematological, biliary, pancreatic, and renal cancers. In the DAA sub-cohort analysis using the time-dependent model, DAA treatment significantly reduced the risk of intrahepatic cancer (aHR 0.54-0.61) and extrahepatic cancers (aHR 0.77) after adjusting for competing risks. HCV infection significantly increases both intrahepatic and extrahepatic cancer risks. Excluding 2nd cancer underestimates this burden. Given that DAA therapy significantly reduces the risk of both intrahepatic and extrahepatic cancers, accelerating HCV elimination policies is imperative.

Vertebral compression fractures (VCFs) are potential complications following spine stereotactic body radiation therapy (SBRT). However, limited data exist on prognostic factors underlying VCF development following SBRT. The objective of this clinical cohort investigation was to evaluate risk factors for VCF development, VCF type (de novo or progressive), and VCF severity, following SBRT for spinal metastases. A retrospective analysis was performed on a prospectively maintained database of 600 SBRT treatments (779 vertebral segments) for spinal metastases from 2002 to 2024. Exclusion criteria consisted of benign tumors, prior lesion-specific surgical intervention, and <1 month of follow-up. Logistic regression and Fine-Gray subdistribution hazard modeling was performed to evaluate predictors of VCF development. The median follow-up was 8 months (range, 1-251 months). Fifty-seven (10%) VCFs were identified following SBRT: 29 (5%) de novo VCFs and 28 (5%) progressive VCFs. The median time-to-VCF was 6 months (range, 1-83 months). The 1- and 3-year cumulative incidence of VCF was 11% (95% CI, 8.1%-15%) and 21% (95% CI, 15%-27%), respectively. On multivariable analysis, female sex (odds ratio [OR], 1.06; 95% CI, 1.02-1.11; P = .007), lumbar lesions (OR, 1.05; 95% CI, 1.00-1.11; P = .049), and pre-existing VCF (OR, 1.01; 95% CI, 1.00-1.02; P = .009) were significantly associated with any VCF development, whereas a greater Spinal Instability Neoplastic Scores (SINS) at SBRT trended toward significance (OR, 1.07; 95% CI, 1.00-1.14; P = .060). Osteolytic disease (OR, 1.04; 95% CI, 1.00-1.07; P = .042) and epidural tumor extension (OR, 1.04; 95% CI, 1.01-1.07; P = .022) were associated with de novo VCF development, whereas only pre-existing VCF (OR, 1.08; 95% CI, 1.04-1.12; P < .001) was significantly associated with progressive VCF development. Thirty-three (58%) VCFs required subsequent surgical stabilization. On multivariable analysis, lumbar lesions (OR, 1.07; 95% CI, 1.02-1.12; P = .004), pre-existing VCF (OR, 1.07; 95% CI, 1.01-1.13; P = .026), and a greater SINS at SBRT (OR, 1.02; 95% CI, 1.01-1.02; P = .002) were significantly associated with VCFs requiring stabilization. This large clinical cohort investigation successfully identified patient subgroups with increased risks of developing VCFs following spine SBRT for metastatic disease. Identifying these at-risk subpopulations may guide additional follow-up surveillance and consideration of individualized discussions regarding potential conservative or stabilization management approaches, particularly for those patients with multiple underlying risk factors.

Total body irradiation and smoking interact to increase lung cancer risk after blood or marrow transplantation.

Venetoclax, a potent B-cell leukemia/lymphoma-2 inhibitor, is an antineoplastic agent used in various hematologic malignancies, including acute myeloid leukemia (AML). The aim of the study is to evaluate the incidence, risk factors, and outcomes of major adverse cardiac events (MACEs) among patients with newly diagnosed AML receiving venetoclax-based therapy. We conducted a retrospective, single-center cohort study of 214 patients with newly diagnosed AML treated with venetoclax. MACE was defined as a composite of new-onset heart failure, heart failure exacerbation requiring hospitalization, myocardial infarction/coronary revascularization, or stroke/transient ischemic attack during active venetoclax-based therapy. The Fine-Gray subdistribution hazard model determined the association between baseline clinical characteristics and MACEs, with noncardiovascular death as a competing risk. A Cox proportional hazard model determined the association between time-dependent MACEs and overall survival. Among 214 patients (mean age, 71.5 years; 41% women), MACEs occurred in 14 (6.5%) patients. Patients with non-de novo (secondary /treatment-related) AML had a higher incidence of MACEs compared with de novo AML (85.7% versus 14.3%; subdistribution hazard ratio [HR], 7.1 [95% CI, 1.5-33]; P<0.01). Time-dependent MACE was independently associated with inferior overall survival (adjusted HR, 2.75 [95% CI, 1.41-5.35]). In conclusion, MACE is a clinically significant event that occurs in 6.5% of patients with AML treated with venetoclax and is a higher-risk event for patients with secondary AML or treatment-related AML.

Frailty and readmission to the ICU are common, and both are associated with worse outcomes. However, there is limited literature that assesses how frailty impacts those patients who require readmission to the ICU during a hospitalization. Therefore, we sought to assess whether the association between ICU readmission and death differ by frailty state. A registry-based study used the Australian and New Zealand Intensive Care Society Adult Patient Database. All adult patients (age ≥ 18 yr) admitted to 203 ICUs in Australia and New Zealand between January 2017 and December 2022 with a documented Clinical Frailty Scale (frailty defined as a score ≥ 5) were included. None. The primary outcome was 60-day mortality. A Cox proportional hazards model, treating time to readmission as a time-dependent covariate and including an interaction term between frailty state and readmission, was used. Regression standardization was used to estimate absolute risk and risk differences, with 95% CIs calculated using a nonparametric bootstrap. A competing risk analysis was conducted, treating in-hospital death without ICU readmission as a competing risk. Secondary outcomes included length of hospital stay and discharge location. Six hundred fifteen thousand seven hundred nineteen ICU admission episodes were analyzed. Of the entire cohort, 19% (115,453) were frail, and 4.1% (25,329) were readmitted to the ICU. By day 60, 2.7% patients had died (16,353) in the hospital. Patients with frailty were at increased risk of both ICU readmission (subdistribution hazard ratio [SHR], 1.10; 95% CI, 1.07-1.14) and death without readmission (SHR, 2.83; 95% CI, 2.72-2.94). Observed 60-day mortality was greatest in frail, readmitted patients (22.7%). The standardized risk increase in 60-day mortality associated with ICU readmission was similar between patients with and without frailty (14.6% [95% CI, 13.7-15.6%] vs. 14.9% [95% CI, 13.4-16.6%]), respectively. This large, multicenter, retrospective study found that ICU readmission was associated with increased 60-day mortality in patients with and without frailty. Readmitted patients with frailty had the greatest risk of 60-day mortality; however, frailty state did not modify the incremental absolute risk of death relative to nonreadmitted patients.

Healthcare-associated infections and their complications represent a predominant cause of morbidity and mortality in intensive care units (ICUs) globally. Several studies have reported that the systemic immune-inflammation index (SII) is associated with an increased risk of infection; however, its association with ICU-acquired infection (ICU-AI) remains unclear. We aimed to examine the association between SII and the subsequent risk of ICU-AI. We conducted a retrospective cohort study using the MIMIC-IV database, including adult ICU patients without suspected infection at baseline. SII was calculated as platelet × neutrophil / lymphocyte count, based on values from the first 24h of ICU admission. The primary outcome was ICU-AI, defined as suspected infection occurring after 48h of ICU admission. Two competing risk regression models were employed to evaluate the association between SII and ICU-AI. Among the 5,459 patients included, 627 (11.5%) developed ICU-AI. Higher SII (per 1,000-unit) was independently associated with an increased risk of ICU-AI in both models: adjusted cause-specific hazard ratio (CSHR), 1.06 (95% CI, 1.03-1.08; p < 0.001) and subdistribution hazard ratio (SHR), 1.05 (95% CI, 1.03-1.07; p < 0.001). When analyzed by quartiles, a significant dose-response relationship was observed (p for trend < 0.001). Compared with patients in the lowest quartile (Q1, SII ≤ 594 × 10⁹/L), those in Q3 (SII 1125-2201 × 10⁹/L) and Q4 (SII ≥ 2202 × 10⁹/L) showed progressively higher risks of infection, with adjusted CSHR of 1.44 (95% CI 1.11-1.86) and 1.76 (95% CI 1.37-2.26), and adjusted SHR of 1.51 (95% CI 1.17-1.93) and 1.96 (95% CI 1.54-2.49), respectively. Time-to-event curves showed distinct and consistent cumulative risk trajectories across SII quartiles. Elevated SII at ICU admission was independently associated with an increased risk of developing suspected secondary infection in infection-naïve critically ill patients.

Association between antihypertensive medications and hepatocellular carcinoma risk in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) without cirrhosis.

Clinical outcomes and recurrence after treatment of asymptomatic pulmonary tuberculosis: a nationwide cohort study.

The objective of this study was to quantify incremental diagnostic yield and prognostic value of continuous electroencephalography (cEEG; ≥12 hours) versus a 60-minute short electroencephalography (sEEG) in predicting post-stroke epilepsy (PSE) in patients without acute symptomatic seizures. We retrospectively included 283 adults who underwent cEEG within 7 days; sEEG comprised the first 60 minutes of the same recording. EEGs were interpreted using American Clinical Neurophysiology Society (ACNS) terminology by neurophysiologists blinded to outcomes. Within-patient yield was quantified using odds ratios (ORs) with 95% confidence intervals (CIs). PSE were modeled using Fine-Gray competing-risks regression (death as competing event) and reported as subdistribution hazard ratios (sHR). SeLECT-EEG derived from sEEG and cEEG was compared using C-index and net reclassification improvement (NRI). Over a median follow-up of 41 months (interquartile range [IQR] = 22-64), 41 of 283 patients (14.5%) developed PSE. Compared to sEEG, cEEG increased detection of interictal epileptiform discharges (11 vs 3%, OR = 3.75, 95% CI = 1.75-8.02, p < 0.001) and electrographic seizures (4 vs 0.7%, OR = 6.22, 95% CI = 1.38-28.06, p = 0.01). Lateralized periodic discharges (sHR = 4.50, 95% CI = 2.13-9.51) and electrographic seizures (sHR = 3.63, 95% CI = 1.52-8.63) were the strongest predictors of PSE. The cEEG-derived SeLECT-EEG improved discrimination versus sEEG-derived scoring (ΔC-index 0.055, 95% CI = 0.012-0.101, p = 0.014) and reclassification (NRI = 0.25, 95% CI = 0.07-0.42). Epileptiform activity emerging after the first hour conferred higher 5-year PSE risk than never detected (28 vs 11%, Gray p = 0.006). The cEEG identifies additional epileptiform abnormalities with prognostic value beyond routine-duration EEG, supporting extension of monitoring in selected cases based on baseline risk and early EEG findings. ANN NEUROL 2026.

Background.Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, but there are little data in solid organ transplant populations. We aimed to assess the effect of GLP-1 RA or SGLT2i on the incidence of post-transplant major adverse cardiovascular events (MACE), graft failure, renal outcomes, and mortality in liver or simultaneous liver-kidney transplant populations.Methods.A retrospective chart review of adults with diabetes mellitus and either solitary liver or simultaneous liver-kidney transplantation from January 2012 to March 2022 was completed. The multivariate Cox regression and Fine and Gray competing risk regression analyses were used.Results.Among 457 patients, 33 received a GLP-1 RA or SGLT2i. The GLP-1 RA/SGLT2i group had a lower incidence of graft failure (P = 0.038), new-onset end-stage renal disease requiring dialysis (P = 0.012), and new-onset post–liver transplant MACE at 5 y (adjusted subdistribution hazard ratio, 0.24; P = 0.049; 95% confidence interval, 0.059-0.99).Conclusions.After propensity score matching, the incidence of 5-y post–liver transplant MACE-free survival was significantly higher, and mortality was significantly lower in the GLP-1 RA/SGLT2i group. The use of a GLP-1 RA/SGLT2i post–liver transplant was associated with a lower incidence of new-onset MACE, graft failure, and new-onset end-stage renal disease requiring dialysis. There was an improvement in survival after propensity score matching.

Patients with rheumatoid arthritis (RA) are at an increased risk of developing heart failure (HF); however, the risk of readmission due to HF in patients with RA remains unclear. This retrospective cohort study aimed to identify the risk of HF readmission among patients with RA. We included patients with RA aged ≥18 years who were hospitalized for the first time with HF and discharged between January 2012 and December 2019. The incidence of 90-day HF readmission was assessed. We reported the risk factors for HF readmission using the Fine-Gray model as adjusted subdistribution hazard ratios (aSHRs) and 95% confidence intervals (CIs). The analysis included 1,274 patients (mean age, 76.4 years; 61.5% female; mean Charlson Comorbidity Index [CCI], 4.6). There were 146 (11.5%) cases of 90-day HF readmission in patients with RA who experienced HF complications, associated with the CCI (aSHR: 1.08, 95% CI: 1.01-1.15), diuretic use (aSHR: 1.48, 95% CI: 1.03-2.13), and opioid use (aSHR: 1.76, 95% CI: 1.11-2.77). Patients with RA appeared to have a higher incidence of 90-day HF readmission than the general HF registry population. HF readmission was associated with high CCI scores and the use of diuretics and opioids.

Dynamic Changes and Prognostic Value of Angio-derived Index of Microcirculatory Resistance in Acute Myocardial Infarction: A Cohort Study.

To evaluate the diagnostic performance of preoperative CT-based Node-RADS for regional lymph node (LN) metastasis and its prognostic value for postoperative recurrence in pancreatic ductal adenocarcinoma (PDAC). This single-center retrospective study included patients with PDAC undergoing contrast-enhanced CT and surgical resection between January 2017 and July 2023. Node-RADS scores were independently assigned for each resected LN station, with histopathology as the reference standard. Diagnostic performance was evaluated at the patient, LN group, and station levels using sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Fine-Gray analysis was performed to assess the prognostic association of Node-RADS on time to recurrence (TTR) after adjustment for clinicopathologic variables. A total of 216 patients (mean age, 66.6 ± 9.1 years; 122 men) were included, with LN metastases in 154 (71.3%). Using a cutoff of Node-RADS ≥ 3, the sensitivity and specificity for detecting LN metastasis were 77.3% (119 of 154) and 83.9% (52 of 62) at the patient level, 74.8% (104 of 139) and 81.8% (63 of 77) for group 1, and 77.3% (34 of 44) and 82.6% (142 of 172) for group 2, with AUCs corresponding of 0.815, 0.791, and 0.814. Per-station analysis showed sensitivity ranging from 60.0% to 84.6% and specificity from 79.1% to 97.7%. Multivariable Fine-Gray analyses confirmed that Node-RADS ≥ 3 independently predicted shorter TTR (subdistribution hazard ratio, 1.68; 95% CI: 1.19-2.36; p = 0.003). Preoperative CT-based Node-RADS enabled promising assessment of regional LN metastasis and prediction of postoperative recurrence in PDAC. Question Accurate preoperative identification of regional LN metastasis in PDAC remains challenging, limiting prognosis assessment and individualized treatment allocation. Findings Node-RADS ≥ 3 on preoperative CT demonstrates robust diagnostic performance across patient, group, and station levels and independently predicts shorter recurrence-free survival in PDAC. Clinical relevance CT-based Node-RADS provides promising preoperative assessment of regional nodal involvement and recurrence prediction in PDAC, facilitating personalized surgical planning and decision-making regarding neoadjuvant therapy.

Anti-synthetase syndrome-associated interstitial lung disease (ASyS-ILD) frequently recurs, and its recurrence is associated with poor long-term outcomes. Although anti-Ro52 antibodies have been linked to rapidly progressing ILD, their role in ASyS-ILD recurrence remains unclear. This study aimed to investigate the association between anti-Ro52 antibody positivity and ASyS-ILD recurrence. This single-center retrospective study included 96 patients with ASyS-ILD who received induction therapy with corticosteroids and immunosuppressants between January 2010 and August 2023. Patients were classified by anti-Ro52 antibody status. The primary analysis was performed using a Fine and Gray competing risks model to assess recurrence or ILD-related death, with non-ILD-related death as a competing event. We performed a multivariable competing risks regression analysis using the Fine-Gray sub-distribution hazards model to evaluate the effect of variables on the cumulative incidence of the main outcome. Forty-four patients were anti-Ro52 positive, and 52 were negative. There were no significant differences in initial treatment regimens. The anti-Ro52 group had a significantly higher incidence of recurrence or ILD-related death in the Fine and Gray model (HR: 2.11, 95% CI: 1.21-3.69, P = 0.008). Multivariable competing risks regression analysis also identified anti-Ro52 positivity as a risk factor for recurrence (HR: 1.77, 95% CI: 1.00-3.11, P = 0.049). Anti-Ro52 antibody positivity is associated with increased risk of recurrence in ASyS-ILD. These findings suggest that anti-Ro52 status may serve as a useful biomarker to identify patients who require close monitoring and long-term management.

Advanced heart failure is characterized by progressive myocardial remodeling, with fibrosis representing a final common pathway of chronic injury. We investigated whether quantitatively assessed apical myocardial fibrosis burden at the time of left ventricular assist device (LVAD) implantation is associated with overall and cause-specific mortality. This single-centre retrospective cohort study included 47 consecutive patients undergoing durable LVAD implantation between 2019 and 2025. Median age was 63 years and 14.9% were female. Myocardial tissue obtained from the left ventricular apical core at implantation was analysed using structured histopathologic scoring (THS-10) and quantitative digital morphometry (QuPath). Fibrosis burden was quantified as collagen-positive area relative to total myocardial area. Overall survival was assessed using Kaplan-Meier analysis and Cox regression. Cardiac mortality was evaluated using Fine-Gray competing-risk models, with non-cardiac death treated as a competing event. Median follow-up was 1513 days. During follow-up, 27 deaths occurred (57.4%), including 16 cardiovascular and 11 non-cardiac deaths. Quantitative fibrosis burden showed a strong unadjusted association with overall survival (log-rank p=0.00042). ROC analysis identified a cohort-derived fibrosis threshold of 33.7% for overall mortality risk stratification (AUC 0.739, 95% CI 0.566-0.912). In univariable Cox analysis, fibrosis burden and THS-10 score were associated with mortality (HR 39.39, 95% CI 2.61-594.56, p=0.008; and HR 1.51, 95% CI 1.14-2.01, p=0.005, respectively). After multivariable adjustment for clinical severity, including INTERMACS profile and key laboratory parameters, the association with all-cause mortality was attenuated. In competing-risk analysis, high fibrosis burden independently predicted cardiac mortality (subdistribution hazard ratio approximately 4.1, p=0.02). Additional exploratory ROC analysis for cardiovascular death showed an AUC of 0.752, with a cohort-derived threshold of 39.6%. Quantitatively assessed apical myocardial fibrosis burden identifies a biologically high-risk myocardial phenotype in LVAD recipients. While the association with all-cause mortality is attenuated after adjustment, fibrosis burden shows a specific relationship with cardiac mortality when competing non-cardiac risk is taken into account. These findings support the prognostic relevance of myocardial substrate and warrant external validation in larger prospective cohorts.