Internal Medicine Journal最新文献

{"title":"Regulatory standardisation to improve the safety of continuous glucose monitoring systems in Australia and New Zealand: joint ADS/ADEA/ADIPS/ANZSPED/NZSSD statement","authors":"Sofianos Andrikopoulos,&nbsp;Lisa M. Raven,&nbsp;Ramzi Ajjan,&nbsp;Kate Lomax,&nbsp;Tara Whelan,&nbsp;Brett Fenton,&nbsp;Amanda Bartlett,&nbsp;Shantha Joseph,&nbsp;Matthew Hare,&nbsp;Mary B. Abraham,&nbsp;Hamish R. Crocket,&nbsp;Tom M. Wilkinson,&nbsp;Joanna McClintock,&nbsp;Benjamin J. Wheeler,&nbsp;Glynis P. Ross","doi":"10.1111/imj.70586","DOIUrl":"10.1111/imj.70586","url":null,"abstract":"<p>Self-monitoring of glycaemia is a cornerstone of diabetes management, particularly for people using insulin. Traditionally, glucose monitoring involved finger-pricking and measuring capillary blood glucose concentration. Continuous glucose monitors (CGMs) have revolutionised self-monitoring of glucose levels. These devices provide continuous interstitial fluid glucose measurements, including trend arrows and alarms to alert the person if glucose levels are outside predetermined ranges. The increased reliance on CGM metrics for clinical decisions to manage diabetes necessitates the consideration and implementation of minimum standards that device manufacturers should meet to demonstrate safety, precision and accuracy. This statement provides recommendations to ensure that CGM devices that are approved for the Australian and New Zealand markets meet/exceed these minimum standards of accuracy, to provide health professionals and people living with diabetes the confidence to manage their glucose levels effectively.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1630-1636"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Pulmonary Fibrosis update, comparing the Australasian Interstitial Lung Disease Registry to the Australian Idiopathic Pulmonary Fibrosis Registry","authors":"Michelle Chee,&nbsp;Yet Hong Khor,&nbsp;Dan Jackson,&nbsp;Wendy Cooper,&nbsp;Jason D’Costa,&nbsp;Sally de Boer,&nbsp;Adrienne Edwards,&nbsp;Samantha Ellis,&nbsp;Eli Gabbay,&nbsp;Henry Gallagher,&nbsp;Ian Glaspole,&nbsp;Nicole Goh,&nbsp;Christopher Grainge,&nbsp;Peter Hopkins,&nbsp;Gregory Keir,&nbsp;Benjamin Kwan,&nbsp;John Mackintosh,&nbsp;Yuben Moodley,&nbsp;Irene Moore,&nbsp;Vidya Navaratnam,&nbsp;Chong Ong,&nbsp;Paul Reynolds,&nbsp;Karen Royals,&nbsp;Alan Teoh,&nbsp;Lauren Troy,&nbsp;Elizabeth Veitch,&nbsp;Margaret Wilsher,&nbsp;Jeremy Wrobel,&nbsp;Chris Zappala,&nbsp;Tamera Corte,&nbsp;Francis Thien,&nbsp;the AILDR Steering Committee","doi":"10.1111/imj.70490","DOIUrl":"10.1111/imj.70490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Real-world evaluation of clinical characteristics and treatment profile of patients with idiopathic pulmonary fibrosis (IPF) is needed to establish areas for improvement according to evidence-based recommendations. This study evaluated the clinical characteristics and treatment profile of patients with IPF from the Australasian ILD Registry (AILDR), comparing them to the Australian IPF Registry (AIPFR) cohort, to identify differences in baseline characteristics among IPF patients treated with antifibrotics and immunosuppressants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with IPF enrolled between May 2016 and December 2023 from the AILDR and data of patients enrolled in the AIPFR between 2012 and 2016 were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 842 and 647 patients with IPF were included from the AILDR and the AIPFR respectively. Both cohorts were male predominant (AILDR: 72.0%; AIPFR: 67.7%) of similar mean body mass index (AILDR: 29.2 ± 4.9 kg/m²; AIPFR: 28.7 ± 4.8 kg/m²). With regard to disease-targeted treatment, 572 (67.9%) and 108 (12.8%) participants of the AILDR cohort were on antifibrotic medications and immunosuppressants respectively. There were a total of 35.6% (<i>n</i> = 300) IPF patients on pirfenidone and 40.4% (<i>n</i> = 340) on nintedanib in AILDR. Only 146 (23%) of the AIPFR cohort were receiving antifibrotics. Of newly registered patients in 2016 (n = 18), 2020 (<i>n</i> = 71) and 2023 (<i>n</i> = 151), 50.0%, 18.3% and 15.2% respectively had received immunosuppressive therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Baseline demographics from the IPF cohorts for both AILDR and AIPFR are largely comparable, with increasing antifibrotic and decreasing use of immunosuppressants since 2016. Immunosuppressive therapy in IPF remains relatively higher than expected despite guideline recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1518-1527"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of clinician perceptions in estimating patient survival in general medicine","authors":"Kerman Singh Kahlon,&nbsp;Geoffrey Shaw,&nbsp;Chris Frampton,&nbsp;Tom J Cawood","doi":"10.1111/imj.70514","DOIUrl":"10.1111/imj.70514","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients and families often rely on clinicians' predictions of life expectancy to make critical treatment and personal decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the accuracy and risk intelligence of clinicians in predicting 1-year survival of general medicine patients after hospital discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Doctors, nurses, allied health professionals and medical students completed 125 questionnaires (70% response rate) distributed in the intensive care unit (ICU) and at a medical grand round at Christchurch Hospital. Survival estimates for four case vignettes were compared to an evidence-based survival score (EBSS) derived from over 120 000 local hospital discharges. Accuracy was defined as estimates within ±10% and ±20% of the EBSS. Confidence was assessed based on the reported range for each estimate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median survival estimates were widely variable and frequently underestimated the EBSS, with 27% and 48% of estimates falling within ±10% and ±20% of the EBSS respectively. Confidence was moderate (median range ±15%), although 52% of estimates were outside ±20% of the EBSS. No significant differences in accuracy were observed between ICU and general medicine respondents, doctors and other healthcare professionals, or senior and junior doctors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Clinician estimates of 1-year survival in vignette-based scenarios varied widely and differed from model-based estimates. These findings highlight variability in prognostic estimation and support the potential role of evidence-based tools to complement clinical judgement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1610-1616"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline concordance of stage IIIA non-small-cell lung cancer treatment in the Australian setting","authors":"Georgia Ross,&nbsp;Matthew Conron,&nbsp;Gavin Wright,&nbsp;Eve Denton","doi":"10.1111/imj.70511","DOIUrl":"10.1111/imj.70511","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stage IIIA non-small-cell lung cancer (NSCLC) is a life-limiting disease, and the level of adherence to evidence-based treatment guidelines in the Australian setting is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the level of adherence to stage IIIA NSCLC treatment guidelines prior to the advent of immunotherapy and highlight factors that may contribute to guideline non-concordance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was performed. All patients diagnosed with stage IIIA NSCLC between May 2012 and January 2016 in a Victorian Tertiary Referral Centre were included. Guideline concordant initial treatment (GCIT) was defined according to contemporaneous National Comprehensive Cancer Network (NCCN) recommendations based on tumour resectability. Curative intent treatment was defined as surgery and/or definitive chemoradiotherapy delivered with the aim of disease eradication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-two patients were included. The mean age of diagnosis was 66 years, and 76.7% had an Eastern Cooperative Oncology Group performance status of 0–1. Curative-intent treatment was delivered in 67.4% of patients, and 62.5% were deemed to have resectable disease of which 58.7% proceeded to surgery. The predominant pre-treatment histological diagnosis was adenocarcinoma (48.3%). Non-operative treatment modalities included platinum-based chemotherapy (64.1%) and radiation (49.4%). One-year survival was 70.5%, while the 5-year survival was significantly lower at 22.2%. Overall, a notable proportion of patients (36.0%) were not treated in accordance with the established guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While most patients received GCIT, a significant proportion of patients received no or less intensive treatment. This deviation primarily arose from factors such as advanced age, comorbidities and respiratory impairment at baseline.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1593-1599"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70511","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypophosphataemia following iron infusion: a narrative review of an increasingly recognised complication","authors":"Brenda Ta,&nbsp;Stephanie Baddock,&nbsp;Jane Ludington,&nbsp;Angela Sheu","doi":"10.1111/imj.70576","DOIUrl":"10.1111/imj.70576","url":null,"abstract":"<p>Parenteral iron is widely prescribed by medical practitioners, with more than 600 000 outpatient prescriptions dispensed in 2025 through the Australian Pharmaceutical Benefits Scheme. While intravenous iron has transformed the management of iron deficiency, hypophosphataemia is now recognised as a common complication, with incidences reported as high as 92% depending on formulation. Although most cases are mild and transient, vulnerable patient groups may develop profound and symptomatic hypophosphataemia, sometimes requiring hospitalisation and intravenous phosphate replacement. The clinical spectrum ranges from subtle biochemical abnormalities to lethargy, weakness and myalgias and, rarely, severe manifestations including muscle weakness, osteomalacia, myopathy, arrhythmias and cardiomyopathy. This narrative review presents five illustrative cases, highlighting the varied presentations of iron-induced hypophosphataemia and potential patient groups at high risk. To address this growing challenge, we present an institutionally endorsed management pathway based on our review of the literature and current practice after multidisciplinary consultation. The algorithm emphasises early recognition of high-risk patients, primary prevention by using formulations of iron associated with the lowest risk of hypophosphataemia, timely identification of symptomatic hypophosphataemia and coordinated correction of concurrent electrolyte disturbances, with the aim of improving patient safety and outcomes.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1500-1509"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70576","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes in Australian oncology: from emerging practice to system-wide care","authors":"Marianne Holly Clausen,&nbsp;Carolyn Mazariego,&nbsp;Julia Lai-Kwon,&nbsp;Ganessan Kichenadasse","doi":"10.1111/imj.70617","DOIUrl":"10.1111/imj.70617","url":null,"abstract":"&lt;p&gt;Translating evidence into routine clinical practice is a persistent challenge in medicine. Patient-reported outcome (PRO) measures are tools that capture symptoms, function and quality of life directly from patients. Their regular collection and actioning has been shown to enhance quality of life, satisfaction with care and survival.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; In cancer care, PROs represent a clear case where the evidence has emerged, but implementation has not kept pace. As cancer survival improves and more patients are managed across primary and specialist care, PROs are increasingly relevant to any clinician involved in the care of people living with cancer.&lt;/p&gt;&lt;p&gt;Despite a broad evidence base, routine PRO use in Australia remains limited and inconsistent. The task ahead is implementation: embedding PROs into routine clinical workflows and providing the infrastructure to support real-time responses that actively inform care. Australia is laying the groundwork, reflected in a series of landmark developments. The Australian Cancer Plan aligns Australia with global calls to improve cancer outcomes and specifically calls for PROs to be embedded into national performance monitoring and reporting.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The PanCancer Initiative is a partnership between Cancer Australia and Movember aiming to integrate patient-reported measures across the cancer sector.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The PROActive consensus meeting engaged consumers, clinicians and policymakers from across Australia to collectively identify priority areas for implementation.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Together, these signal a national commitment to move PROs to the forefront of cancer care.&lt;/p&gt;&lt;p&gt;Clinicians consistently underreport treatment-related symptoms compared to patient self-reports. PROs are instruments that capture information about health outcomes directly from patients, without interpretation by clinicians.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Seminal work in cancer care by Basch &lt;i&gt;et al&lt;/i&gt;. demonstrated the value of PRO collection in clinical care, providing evidence for PRO use in acute cancer care.&lt;span&gt;&lt;sup&gt;8, 9&lt;/sup&gt;&lt;/span&gt; The PROMPT-Care programme in New South Wales (NSW) extended this work to an Australian context, establishing a technology-enabled PRO system within routine cancer care and forming the foundational evidence for the Cancer Institute NSW's statewide implementation.&lt;span&gt;&lt;sup&gt;3, 10&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;PROs are typically used within three environments: registries, clinical trials and at point of clinical care. Registries collect population-level data for benchmarking; trial PROs measure treatment outcomes alongside survival and response rates. The strongest evidence for PRO implementation and use is within clinical practice where they are collected regularly and reviewed by clinicians to inform care.&lt;span&gt;&lt;sup&gt;3, 9&lt;/sup&gt;&lt;/span&gt; The goal of collecting PROs in clinical care is to address outcomes that matter to patients.&lt;/p&gt;&lt;p&gt;Beyond cancer care, PROs","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1483-1487"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70617","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring detects spontaneous reactive and fasting hypoglycaemia in cystic fibrosis adults without diabetes.","authors":"Shanal Kumar, Karen Hay, Felicity Loel, Angela Matson","doi":"10.1111/imj.70626","DOIUrl":"https://doi.org/10.1111/imj.70626","url":null,"abstract":"<p><p>People with cystic fibrosis (pwCF) experience a spectrum of glucose disorders. Spontaneous hypoglycaemia is a unique entity affecting pwCF and can be an incidental finding on biochemistry. Our prospective, single-arm pilot study of eight pwCF without confirmed diabetes and incidental biochemical hypoglycaemia found 62.5% demonstrated fasting or reactive hypoglycaemia on continuous glucose monitoring (CGM). The remaining individuals without hypoglycaemia on CGM demonstrated dysglycaemia consistent with pre-diabetes. Symptomatic spontaneous hypoglycaemia captured on CGM was successfully managed with dietary modifications and dipeptidyl peptidase-4 inhibitor in all participants. Whether spontaneous hypoglycaemia precedes progression to pre-diabetes and overt diabetes in pwCF requires further evaluation.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of changes in N-terminal pro-B-type natriuretic peptide on the outcome of acute kidney injury in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention: a retrospective study.","authors":"Chongrong Qiu, Wei Zhan","doi":"10.1111/imj.70524","DOIUrl":"https://doi.org/10.1111/imj.70524","url":null,"abstract":"<p><strong>Background: </strong>Patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) are at heightened risk of acute kidney injury (AKI). Prior studies have suggested that serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be linked to AKI development, proposing it as a potential predictive biomarker.</p><p><strong>Aim: </strong>This study aimed to evaluate whether changes in NT-proBNP levels are associated with the risk of AKI in STEMI patients.</p><p><strong>Methods: </strong>This retrospective analysis included 107 STEMI patients who underwent PCI. Patients were stratified into three groups based on the percentage change in NT-proBNP levels: a reduction > 30%, a reduction ≤ 30%, or an increase. The primary endpoints were post-PCI AKI incidence and 180-day mortality. Logistic regression was used to assess the association between NT-proBNP dynamics and AKI risk.</p><p><strong>Results: </strong>A reduction in NT-proBNP of >30% was independently associated with a reduced risk of postoperative AKI (OR = 0.41, 95% CI 0.17-0.98, p = 0.045). This group also exhibited the favorable survival profile, with the lowest 180-day mortality rate (11/62, 17.7%) compared to the ≤ 30% reduction group (9/27, 33.3%) and the increase group (13/18, 72.2%; p < 0.001 for trend).</p><p><strong>Conclusion: </strong>Dynamics of NT-proBNP levels are closely associated with the incidence of AKI following PCI in STEMI patients. Specifically, an NT-proBNP reduction of >30% may serve as a robust biomarker for predicting lower post-PCI AKI risk and improved short-term survival.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between serum calcium levels and mortality in critically ill patients with gastrointestinal bleeding: a retrospective cohort study.","authors":"Xiaoyu Zhao, Hong Yang, Zuoan Qin, Qi Liu","doi":"10.1111/imj.70592","DOIUrl":"https://doi.org/10.1111/imj.70592","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of serum total calcium levels in critically ill patients with gastrointestinal bleeding remains unclear. This study aimed to investigate the association between baseline serum total calcium levels and mortality in critically ill patients with gastrointestinal bleeding using the electronic Intensive Care Unit (eICU) database.</p><p><strong>Methods: </strong>This retrospective cohort study was based on data collected from the eICU Collaborative Research Database in 2014 and 2015. Critically ill patients with gastrointestinal bleeding were included in this study. The exposure variable was the baseline serum calcium level. The primary outcome was hospital mortality, and the secondary outcome was intensive care unit (ICU) mortality. The non-linear relationship between serum calcium levels and mortality was determined using a generalised additive model and smooth curve fitting, and we calculated the inflection point.</p><p><strong>Results: </strong>A total of 10 731 eligible patients were included. The hospital mortality and ICU mortality rates were 10.49% and 6.53% respectively. After adjusting for potential confounding factors, a U-shaped relationship was detected between serum calcium levels and mortality. The first inflection point was 8.5 mg/dL, and the second inflection point was 10.3 mg/dL. On the left side of the first inflection point (serum calcium <8.5 mg/dL), serum calcium levels were negatively associated with both hospital mortality (OR = 0.85, 95% CI 0.76-0.95) and ICU mortality (OR = 0.82, 95% CI 0.72-0.93). Conversely, on the right side of the second inflection point (serum calcium >10.3 mg/dL), serum calcium levels were positively associated with both hospital mortality (OR = 1.57, 95% CI 1.05-2.34) and ICU mortality (OR = 1.56, 95% CI 1.02-2.38).</p><p><strong>Conclusions: </strong>A U-shaped relationship between serum total calcium levels and mortality was observed in critically ill patients with gastrointestinal bleeding. Serum total calcium levels were associated with mortality in such patients, and this association has potential reference significance for risk assessment.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract","authors":"","doi":"10.1111/imj.70616","DOIUrl":"https://doi.org/10.1111/imj.70616","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 S4","pages":"4-22"},"PeriodicalIF":1.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}