European Journal of Clinical Investigation最新文献

{"title":"Circulating Human Epididymis Protein 4 Predicts 10-Year Mortality and Major Adverse Cardiovascular Events in Patients With Peripheral Artery Disease","authors":"Axel Muendlein,&nbsp;Christine Heinzle,&nbsp;Kathrin Geiger,&nbsp;Eva Maria Brandtner,&nbsp;Laura Schnetzer,&nbsp;Jörn F. Dopheide,&nbsp;Rainer Mathies,&nbsp;Christoph H. Saely,&nbsp;Heinz Drexel,&nbsp;Andreas Leiherer","doi":"10.1111/eci.70236","DOIUrl":"10.1111/eci.70236","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Human epididymis protein 4 (HE4) has emerged as a biomarker linked to fibrosis and cardiovascular disease. However, its prognostic relevance in peripheral artery disease (PAD) remains unclear. We therefore investigated the association of circulating HE4 with long-term outcomes in patients with PAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, 291 patients with symptomatic PAD were enrolled and followed for 10 years. Serum HE4 concentrations were measured by ELISA at baseline. Primary endpoints were all-cause mortality and major adverse cardiovascular events (MACE); secondary endpoints were cardiovascular and non-cardiovascular mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During follow-up, 44.7% of patients died and 41.2% experienced MACE. In univariable models, higher HE4 levels were associated with all-cause mortality and MACE. These associations remained significant after adjustment for established cardiovascular risk factors and renal function: HR 1.35 (95% CI 1.14–1.58; <i>p</i> &lt; 0.001) for all-cause mortality and HR 1.24 (95% CI 1.05–1.46; <i>p</i> = 0.010) for MACE per doubling of HE4. In secondary analyses, HE4 was independently associated with both cardiovascular and non-cardiovascular mortality. Addition of HE4 to established risk factors significantly improved risk discrimination and reclassification for all-cause mortality (NRI = 0.412, <i>p</i> &lt; 0.001; IDI = 0.028, <i>p</i> = 0.004), whereas incremental prognostic value for MACE was not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Circulating HE4 is a robust and independent predictor of long-term mortality and MACE in patients with PAD, with incremental prognostic value for mortality, primarily in terms of risk reclassification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Liver Disease, Liver Damage and Liver Failure After Hypoabsorptive Bariatric Surgery: A Dose-Dependent Relationship and Multisystemic Consequences","authors":"Francesco Saverio Papadia,&nbsp;Konrad Wojcieck Karcz,&nbsp;Andrea Pasta,&nbsp;Edoardo Giannini","doi":"10.1111/eci.70234","DOIUrl":"https://doi.org/10.1111/eci.70234","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aims</h3>\u0000 \u0000 <p>Metabolic bariatric surgery remains the most potent weapon we have against severe obesity and its metabolic consequences. Yet, its effects on the liver are far from uniform. Although restrictive and mixed procedures like sleeve gastrectomy and Roux-en-Y gastric bypass consistently improve metabolic dysfunction-associated steatotic liver disease (MASLD), hypoabsorptive operations carry a distinct and troubling risk of progressive liver injury. The available evidence, drawn predominantly from case series, registry data and retrospective analyses, suggests that this risk is not an all-or-nothing phenomenon but instead follows a conceptual gradient, one that correlates with the degree of intestinal malabsorption and, more specifically, with the extent of bile acid malabsorption. This review traces the evidence for this dose-dependent relationship from the historical disaster of the jejunoileal bypass to contemporary procedures like the biliopancreatic diversion and the single-anastomosis duodenal-ileal bypass.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials &amp; Methods</h3>\u0000 \u0000 <p>We explore the pathophysiological triad that drives this process—protein-energy malnutrition, bacterial overgrowth, and bile acid hepatotoxicity—supported by recent experimental evidence directly linking biliary limb length to liver injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review then contextualizes the discussion within associated multisystemic consequences, including de novo inflammatory bowel disease, severe metabolic bone disease, and a distinct discussion of the accelerated alcohol-associated liver disease that follows bariatric surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A synthesis of the available evidence supports the abandonment of a one-size-fits-all approach in favour of meticulous patient selection, precise and individualized surgical technique based on measured bowel length and a commitment to lifelong, intensive, multidisciplinary postoperative surveillance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hypoabsorptive bariatric procedures carry a dose-dependent risk of progressive liver injury mediated by malabsorption, bacterial overgrowth and bile acid hepatotoxicity, necessitating individualized surgical planning and lifelong follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.70234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148103524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Liver Disease, Liver Damage and Liver Failure After Hypoabsorptive Bariatric Surgery: A Dose-Dependent Relationship and Multisystemic Consequences","authors":"Francesco Saverio Papadia,&nbsp;Konrad Wojcieck Karcz,&nbsp;Andrea Pasta,&nbsp;Edoardo Giannini","doi":"10.1111/eci.70234","DOIUrl":"https://doi.org/10.1111/eci.70234","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aims</h3>\u0000 \u0000 <p>Metabolic bariatric surgery remains the most potent weapon we have against severe obesity and its metabolic consequences. Yet, its effects on the liver are far from uniform. Although restrictive and mixed procedures like sleeve gastrectomy and Roux-en-Y gastric bypass consistently improve metabolic dysfunction-associated steatotic liver disease (MASLD), hypoabsorptive operations carry a distinct and troubling risk of progressive liver injury. The available evidence, drawn predominantly from case series, registry data and retrospective analyses, suggests that this risk is not an all-or-nothing phenomenon but instead follows a conceptual gradient, one that correlates with the degree of intestinal malabsorption and, more specifically, with the extent of bile acid malabsorption. This review traces the evidence for this dose-dependent relationship from the historical disaster of the jejunoileal bypass to contemporary procedures like the biliopancreatic diversion and the single-anastomosis duodenal-ileal bypass.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials &amp; Methods</h3>\u0000 \u0000 <p>We explore the pathophysiological triad that drives this process—protein-energy malnutrition, bacterial overgrowth, and bile acid hepatotoxicity—supported by recent experimental evidence directly linking biliary limb length to liver injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review then contextualizes the discussion within associated multisystemic consequences, including de novo inflammatory bowel disease, severe metabolic bone disease, and a distinct discussion of the accelerated alcohol-associated liver disease that follows bariatric surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A synthesis of the available evidence supports the abandonment of a one-size-fits-all approach in favour of meticulous patient selection, precise and individualized surgical technique based on measured bowel length and a commitment to lifelong, intensive, multidisciplinary postoperative surveillance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hypoabsorptive bariatric procedures carry a dose-dependent risk of progressive liver injury mediated by malabsorption, bacterial overgrowth and bile acid hepatotoxicity, necessitating individualized surgical planning and lifelong follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.70234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148103525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148085426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148084125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148081206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148079291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148076132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148077506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"56 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148077505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}