Irish Journal of Medical Science最新文献

{"title":"Intraosseous route is associated with prolonged epinephrine-to-ROSC interval in out-of-hospital cardiac arrest.","authors":"Michael W Hubble, Stephen Taylor, Melisa Martin, Sara Houston, Ginny R Kaplan, Randy D Kearns","doi":"10.1007/s11845-025-03979-4","DOIUrl":"https://doi.org/10.1007/s11845-025-03979-4","url":null,"abstract":"<p><strong>Background: </strong>Prolonged resuscitation is associated with poor patient outcomes. While the importance of bystander CPR and early defibrillation is well-known, the role of other components affecting resuscitation duration is less well-established. We postulated that first-dose intraosseous (IO) epinephrine would prolong the pressor-to-ROSC interval compared to intravenous (IV) drug administration.</p><p><strong>Aims: </strong>To describe the relationship between first epinephrine administration route and pressor-to-ROSC intervals.</p><p><strong>Methods: </strong>A retrospective analysis of the 2020 ESO Data Collaborative Annual Research dataset was conducted among adults who experienced non-traumatic, bystander-witnessed arrests. A Cox proportional hazard model was used to determine the influence of first epinephrine route on the pressor-to-ROSC interval. End-of-event was defined as ROSC, field termination of resuscitation, or hospital arrival without ROSC, with right censoring of the latter group.</p><p><strong>Results: </strong>Overall, 9351 patients were included for analysis, of which 63.9% were males. The mean age of participants was 65.3(± 15.5) years and presumed cardiac etiology was present in 82.7% of arrests. An initial shockable rhythm was present in 27.1%, while 29.7% received bystander CPR and 39.7% attained ROSC. The mean pressor-to-ROSC interval was 13.21(± 9.65), 14.86 (± 10.89), and 14.42 (± 10.52) minutes for the intravenous, tibial IO, and humeral IO routes, respectively (p < 0.001). First epinephrine administration via the tibial or humeral IO route was associated with a decreased hazard of ROSC compared to the IV route (HR = 0.78, p < 0.001 and HR = 0.86, p = 0.01 per minute, respectively).</p><p><strong>Conclusions: </strong>These data suggest that the tibial and humeral IO routes of first epinephrine administration were associated with marginally prolonged resuscitation duration after drug administration and decreasing hazard of ROSC.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340114","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":"A comprehensive systematic review of prognostic factors, survival outcomes, and the role of targeted therapies in endometrial cancer.","authors":"Ali Raza, Rimsha Abaidullah, Fahad M Alshabrmi, Israr Fatima","doi":"10.1007/s11845-025-03984-7","DOIUrl":"https://doi.org/10.1007/s11845-025-03984-7","url":null,"abstract":"<p><strong>Study background and objectives: </strong>Endometrial cancer, ranking as the 6th most prevalent cancer affecting women globally, is characterized by high mortality rates, recurrence, and poor prognosis. The disease lacks comprehensive understanding and effective treatment options. This meta-analysis focuses on randomized controlled trials to investigate targeted therapies, survival outcomes, and prognostic factors in endometrial cancer.</p><p><strong>Methods: </strong>The study follows the PICOS protocol and PRISMA guidelines, utilizing Review Manager Software (Version 5.4) for meta-analyses. Predetermined outcomes relevant to the topic guide the study search, with the GRADE tool assessing the quality of evidence and Begg's formula and Kendall's Tau evaluating certainty.</p><p><strong>Results: </strong>Results reveal oral anastrozole and vistusertib's efficacy, reducing progression-free survival (PFS) and enhancing protein detection. The meta-analysis indicates that targeted therapies do not significantly improve PFS but reduce adverse effects. Chemotherapy does not considerably improve survival rates, and interventions show no significant difference in prognostic factors.</p><p><strong>Conclusion: </strong>In conclusion, anastrozole and vistusertib emerge as effective targeted therapies for endometrial cancer, supported by clinical trial evidence demonstrating reduced PFS and improved protein detection. Additionally, the carboplatin-paclitaxel combination and radiotherapy in monotherapy show promising clinical outcomes. These findings contribute to a comprehensive understanding of prognostic factors, targeted therapies, and survival outcomes in endometrial cancer, emphasizing the need for further research and clinical trials for optimal disease management.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340112","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":"A new electrocardiographic evaluation in hyperkalemia: frontal QRS-T angle.","authors":"Mustafa Yedigoz, Akkan Avci, Kemal Sener, Begum S Avci, Onder Yesiloglu, Ahmet B Urfalioglu, Erdem Aksay, Yeliz Simsek","doi":"10.1007/s11845-025-03988-3","DOIUrl":"https://doi.org/10.1007/s11845-025-03988-3","url":null,"abstract":"<p><strong>Introduction: </strong>ECG is a frequently used and easily accessible diagnostic tool used to evaluate cardiac involvement in hyperkalemia patients.</p><p><strong>Objective: </strong>The present study aimed to investigate the mortality prediction potential of the frontal QRS-T angle in hyperkalemia patients and the effects of the treatment process on this angle.</p><p><strong>Method: </strong>The study was planned as a prospective study. A total of 121 hyperkalemia patients were included in the study. Conditions that caused high potassium were identified and the PR, QRS, QT, QTc, and frontal QRS-T angle were calculated and recorded from the 12-lead ECG recordings of the patients at the time of admission to the emergency room.</p><p><strong>Results: </strong>The mean age of the patients was 58.5 ± 9.2 years (median: 59), 63 (% 52.1) were female and 58 (% 47.9) were male. The second measurements of the ECG parameters PR, QTc, QRS, T-amplitude, T duration, and frontal QRS-T values were lower than the first measurements (p < 0.001; p = 0.007; p < 0.001; p < 0.001; p < 0.001; p = 0.006, respectively). The ability of the patient's ECG parameters PR, QT, QTc, QRS, T-amplitude, frontal QRS-T angle, and frontal QRS-T (absolute value) to predict the development of mortality In the ROC Curve analysis, it was found that these parameters did not have a statistically significant effect in predicting mortality.</p><p><strong>Conclusion: </strong>As well as known ECG findings, in cases of hyperkalemia, widening of the frontal QRS-T angle and correction of this widened angle in patients with normokalemia detected with treatment can be used as an important follow-up parameter.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340113","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":"Methanol poisoning in the emergency department: methanol blood levels, prognosis, and sequelae outcomes.","authors":"Kürşat Sarıbaş, Ayça Açıkalın Akpınar, Pınar Efeoğlu Özşeker, Ömer Taşkın, Nezihat Rana Dişel, Gül Filiz Devecioğlu","doi":"10.1007/s11845-025-03982-9","DOIUrl":"https://doi.org/10.1007/s11845-025-03982-9","url":null,"abstract":"<p><strong>Background: </strong>Methanol poisoning is a critical condition marked by severe metabolic acidosis, shock, and organ failure, often leading to high morbidity, mortality, and sequelae such as permanent blindness.</p><p><strong>Aims: </strong>This study retrospectively analyzes methanol poisoning cases to provide insights into diagnosis, treatment, outcomes, and sequelae rates.</p><p><strong>Methods: </strong>Patients diagnosed with methanol poisoning in a university-based emergency department between 2015 and 2023 were analyzed. Data on demographics, presenting complaints, diagnostics, treatments, hospitalization, outcomes, and sequelae were collected.</p><p><strong>Results: </strong>Among 116 patients, the mean age was 48.3 ± 13.5 years, and 94.8% (n = 110) were male. Alcohol poisoning accounted for 110 cases, while six involved other substances. Eighty-nine patients were discharged, and 27 died. Ocular findings predominated among survivors, while altered consciousness was the most common complaint in deceased patients. Deceased patients exhibited significantly lower pH and HCO₃ levels and higher base deficit, anion gap, and lactate levels. Blood methanol levels (mean, 64.5 ± 79.9 mg/dL) showed no correlation with mortality. Treatments included hemodialysis (89.7%), hemofiltration (19.8%), ethyl alcohol (77.6%), fomepizole (15%), and NaHCO₃ (78.1%). Visual sequelae developed in 33.7% of patients, while neurologic sequelae occurred in 6.2%.</p><p><strong>Conclusion: </strong>Methanol poisoning remains a severe clinical issue with high morbidity and mortality. Low pH, HCO₃, and high anion/lactate levels are poor prognostic indicators. Early treatment improves outcomes, yet disabling visual sequelae are frequent. Developing rapid diagnostic kits for methanol and formic acid detection is essential for improving early diagnosis and management.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340115","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":"Digital habits and physical health: a study of screen time and BMI among young healthcare profession students and residents.","authors":"Hooria Rahim, Bilal Ahmad, Khoban Rahim, Zainab Fatima, Ayesha Humayun, Hafiza Asma Nazir, Arzoo Rahim, Maryam Shafiq, Eman Azam, Muhammad Usman","doi":"10.1007/s11845-025-03991-8","DOIUrl":"https://doi.org/10.1007/s11845-025-03991-8","url":null,"abstract":"<p><strong>Background: </strong>Average screen time has increased drastically after the COVID-19 pandemic. It has raised concerns about the adverse effects, including the effect on BMI.</p><p><strong>Aim: </strong>The present study is conducted to study the relationship between screen time and BMI among medical students at a medical institute in Lahore, Pakistan.</p><p><strong>Methods: </strong>For this cross-sectional study, a sample of 370 medical students and residents was obtained from a medical institute in Pakistan. An online survey to gather data about screen time activities, device usage, and BMI. Screen time was categorized into low (1-2 h/day), moderate (3-4 h/day), and high (5-6 h/day), while BMI score was calculated and categorized into under-weight, normal, overweight, and obese groups. Descriptive and inferential statistics including Spearman correlation analysis were applied using IBM SPSS 25.0.</p><p><strong>Results: </strong>Most participants fell into the normal BMI category (79%), with a smaller proportion classified as overweight (16%) or obese (5%). Most participants preferred using smartphones (92.1%). About 41% of participants had high screen time. There was a strong positive correlation between low screen time and normal BMI (r = 0.999). However, only 2.9% of the participants had low screen time. The link between higher screen time and obesity is observed especially in males, while females maintain a more stable normal weight, suggesting gender-based lifestyle or metabolic differences.</p><p><strong>Conclusion: </strong>Screen time is significantly associated with BMI with a strong positive correlation as well. There is need to design educational programs to raise awareness about the safe use of devices and the amount of screen time.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325693","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":"Low awareness of lipid disorders amongst individuals despite their high prevalence.","authors":"Aimee Walsh, Ruth Agar, Greg Offiah, Vincent Maher","doi":"10.1007/s11845-025-03973-w","DOIUrl":"https://doi.org/10.1007/s11845-025-03973-w","url":null,"abstract":"<p><strong>Background: </strong>Atherosclerotic cardiovascular disease (ASCVD) usually goes undetected until complications develop. Knowledge and awareness of cardiovascular risk factors, particularly lipid disorders, lead to earlier disease detection and risk factor intervention.</p><p><strong>Aim: </strong>We sought to assess the awareness of lipid disorders in a population randomly screened for lipid abnormalities.</p><p><strong>Methods: </strong>As part of a national awareness campaign, 360 individuals underwent lipid screening and completed a questionnaire regarding their awareness of cardiovascular risk factors.</p><p><strong>Results: </strong>We identified 240 (66%) individuals with a lipid disorder. Lipid disorders were unrelated to gender but increased sharply from 39% in those under 40 years of age to (71%) in those between 40 and 54 years and (75%) in those older than 55 years. They were more prevalent in those reporting diabetes (78%), hypertension (88%) and hypercholesterolaemia (90%) but not in smokers 62% versus non-smokers 68%. Awareness of abnormal lipids was present in only 34% of individuals overall but was higher in those with diabetes (70%) hypertension (64%) or in those with two or more risk factors (50%). Awareness of lipid disorders increased with age, being extremely low (8%) in those under 40 years of age and increasing to (28%), (45%) and (54%) in those aged 40 to 54 years, 55 to 70 years and older than 70 years, respectively. The biggest gap between the presence and awareness of lipid disorders occurred in the 40 to 54 year age group. There were significant correlations between the awareness of lipid disorders and the awareness of hypertension r = 0.27, p < 0.01 or diabetes r = 0.14, p < 0.05 but not of smoking r =  - 0.04 or family history of ASCVD r = 0.11.</p><p><strong>Conclusions: </strong>Given the importance of early detection and intervention to reduce cardiovascular disease risk factors, public education and increased screening are advisable, especially for lipid disorders in the youngerage groups.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325694","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 potential of visual evoked potentials latency and amplitude to be a subclinical predictor of clinical prognosis in multiple sclerosis.","authors":"Elif Banu Soker, Miray Erdem, Derya Ozdogru, Onur Serdar Gencler, Onder Yesiloglu, Halit Fidanci","doi":"10.1007/s11845-025-03980-x","DOIUrl":"https://doi.org/10.1007/s11845-025-03980-x","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by focal demyelinating lesions, axonal dysfunction/degeneration, and gliosis, which can lead to various clinical disabilities. Visual evoked potentials (VEP) is sensitive and repeatable techniques capable of monitoring significant short-term changes in neuroaxonal integrity and alterations in nerve conduction triggered by acute optic neuritis.</p><p><strong>Aim: </strong>This study aims to evaluate whether VEP latency and amplitude could serve as subclinical predictors of clinical outcomes in MS patients over short-term follow-ups.</p><p><strong>Methods: </strong>This study was planned to include MS patients diagnosed according to the McDonald Criteria 18 who did not have any psychiatric, neurological, or ocular disorders that could interfere with the main purpose. The VEP test was performed for routine evaluation of demyelination or axonal damage.</p><p><strong>Results: </strong>A total of 83 patients were included in the study, with a mean age of 33.6 ± 9.3 years. Of all the patients, 54 were female (65.1%) and 29 were male (34.9%). Right pattern reversal visual evoked potential (PVEP) P100 (OR for PVEP1: 0.802, p = 0.001; OR for PVEP2: 0.879, p = 0.002) was statistically significant in showing right VEP abnormality at both baseline and at 6 months. Left VEP abnormalities were associated with left PVEP P100 at PVEP1 (OR: 0.852, p = 0.003) and left PVEP N75 at PVEP2 (OR: 0.935, p = 0.029).</p><p><strong>Conclusion: </strong>VEPs have the potential to predict short-term subclinical stability or progression, making them valuable candidates for early treatment adjustments and evaluating future pharmacotherapy-supported remyelination.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325698","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":"Neutrophil-to-lymphocyte ratio: is it more valuable than CRP in assessing severity of acute diverticulitis at initial presentation? A single-center retrospective cohort study.","authors":"Nurettin Sahin, Ahmet Surek, Turgut Donmez, Ferman Tevfik Ozyalvac, Emine Ayca Sahin, Sina Ferahman, Halil Kirazkaya, Muge Yurdacan, Mahmut Said Degerli, Sezer Bulut, Hamit Ahmet Kabuli, Alpen Yahya Gumusoglu","doi":"10.1007/s11845-025-03983-8","DOIUrl":"https://doi.org/10.1007/s11845-025-03983-8","url":null,"abstract":"<p><strong>Aim: </strong>We aim to evaluate the effectiveness of cheap, easily accessible, and simple biomarkers in determining the severity of diverticulitis according to the modified Hinchey classification.</p><p><strong>Method: </strong>Patients were divided into two groups: complicated and uncomplicated diverticulitis. Laboratory test results of the two groups were compared. The same patients were divided into two groups: operated and non-operated patients. Laboratory test results of these two groups were compared.</p><p><strong>Results: </strong>The study included 335 patients. Two hundred twenty patients (65.7%) were classified as having uncomplicated diverticulitis, and 115 patients (34.3%) were classified as having complicated diverticulitis. For CRP, the sensitivity was 53.9%, and the specificity was 69.1% in distinguishing between complicated and uncomplicated diverticulitis patients [AUC 0.648 (0.587-0.709)]. For NLR, the sensitivity was 80.9%, and the specificity was 58.6% [AUC 0.734 (0.678-0.791)]. Forty-nine patients (14.6%) were classified as having operated diverticulitis, and 286 patients (85.4%) were classified as having non-operated diverticulitis. For NLR, the sensitivity was 84.5%, and the specificity was 65.0% in distinguishing between operated and non-operated diverticulitis patients [AUC 0.789 (0.728-0.850)]. For CLR, the sensitivity was 85.7% and the specificity was 53.5% [AUC 0.735(0.664-0.805)].</p><p><strong>Conclusion: </strong>In patients with acute diverticulitis, the NLR value is more successful than the CRP value in distinguishing between complicated and uncomplicated diverticulitis. Similarly, it can effectively predict whether patients with acute diverticulitis will require surgery. In addition, the CLR value predicts the need for surgery in patients with acute diverticulitis with high sensitivity.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325695","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":"Attitudes towards stress urinary incontinence surgery in Ireland: navigating the pause on mid-urethral sling use.","authors":"Reut Rotem, Muireann Hickey, Daniel Galvin, Suzanne O'Sullivan, Ciaran Brady, Orfhlaith E O'Sullivan","doi":"10.1007/s11845-025-03986-5","DOIUrl":"https://doi.org/10.1007/s11845-025-03986-5","url":null,"abstract":"<p><strong>Background: </strong>Mid-urethral slings (MUS) for the surgical management of stress urinary incontinence (SUI) have been suspended in Ireland since July 2018, significantly impacting treatment options and clinical practice.</p><p><strong>Aims: </strong>This study aimed to explore the attitudes of consultant obstetricians, gynaecologists, and urologists in Ireland toward SUI surgery following the MUS suspension, including their prior practices, current approaches, and views on MUS safety and potential reinstatement.</p><p><strong>Methods: </strong>A descriptive, anonymized questionnaire was electronically distributed in early 2023 to consultant members of the Irish Society of Urology and the Continence Foundation of Ireland. Non-consultants, non-medical professionals, and respondents outside Ireland were excluded. Data were analyzed using SPSS v28.</p><p><strong>Results: </strong>Before the 2018 suspension, 89.5% (17/19) of respondents performed SUI surgeries, with 76.5% (13/17) using MUS-retropubic and 53% (9/17) MUS-transobturator techniques. Post-suspension, 63.2% (12/19) continued performing SUI surgery, primarily urethral bulking (83.3%, 10/12). Regarding safety, 83.3% (15/18) believed MUS led to fewer instances of post-operative voiding dysfunction and 66.7% (12/18) reported fewer complications such as vault prolapse or rectocele. Notably, 44.4% (8/18) had been involved in litigation related to MUS. Despite this, 52.6% (10/19) expressed willingness to resume MUS if the suspension was lifted.</p><p><strong>Conclusions: </strong>MUS was the preferred SUI procedure prior to suspension due to perceived safety and effectiveness. Over half of consultants surveyed would consider resuming its use, highlighting a need for diverse, evidence-based treatment options and calling for a re-evaluation of the current suspension.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325717","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":"Preoperative proteinuria as a novel biomarker for predicting postoperative renal insufficiency after nephrectomy for renal cell carcinoma: a systematic review and meta-analysis.","authors":"Qiankun Xu, Huilan Zheng, Fanchao Zeng, Bin Li, Deliang Huang, Qiang Cai, Zhizhao Yang, Peng Wu","doi":"10.1007/s11845-025-03987-4","DOIUrl":"https://doi.org/10.1007/s11845-025-03987-4","url":null,"abstract":"<p><strong>Background: </strong>Identifying reliable predictors of postoperative renal insufficiency (PRI) following partial or radical nephrectomy for renal cell carcinoma (RCC) is critical for optimizing perioperative management.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Cochrane Library, and Embase up to March 20, 2025, to identify cohort studies that evaluated the association between preoperative proteinuria and PRI. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses were stratified by study design (prospective vs. retrospective) and surgical modality (partial vs. radical nephrectomy).</p><p><strong>Results: </strong>Six cohort studies involving 3124 patients were included. Preoperative proteinuria was significantly associated with an increased risk of PRI (OR = 2.69, 95% CI 1.48-4.89; I² = 67.3%). We found that retrospective studies showed a stronger association between preoperative proteinuria and PRI (OR = 3.35, 95% CI 1.71-6.56) compared to prospective studies (OR = 1.89, 95% CI 0.98-3.66). Subgroup analysis by surgical approach revealed significant risk elevation in both partial nephrectomy (OR = 2.11, 95% CI 1.34-3.33) and radical nephrectomy cohorts (OR = 5.50, 95% CI 4.31-7.02), with a notably higher effect size in the latter.</p><p><strong>Conclusion: </strong>Preoperative proteinuria is significantly associated with an elevated risk of PRI in patients undergoing nephrectomy for renal cell carcinoma. These findings emphasize the need to incorporate proteinuria assessment into preoperative risk evaluations to improve patient counselling and perioperative management. Future high-quality prospective studies, particularly multicenter investigations with standardized protocols, are essential to confirm these associations and explore the pathophysiological mechanisms underlying proteinuria-related renal functional decline.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325696","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}