Romanian Journal of Internal Medicine最新文献

{"title":"Improved ASCVD Screening in Diabetes: a Focus on Scoring Models and Detection Techniques.","authors":"Răzvan-Liviu Zanfirescu, Larisa Anghel, Bogdan-Sorin Tudurachi, Alexandra-Mihaela Clement, Alexandra Zăvoi, Laura-Cătălina Benchea, Manuela Ciocoiu, Radu Andy Sascău, Cristian Stătescu, Rodica Radu","doi":"10.2478/rjim-2025-0009","DOIUrl":"https://doi.org/10.2478/rjim-2025-0009","url":null,"abstract":"<p><p>Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Diabetes accelerates the progression of atherosclerosis through key mechanisms such as insulin resistance, hyperglycemia, dyslipidemia, chronic inflammation, and oxidative stress, significantly increasing the risk of coronary artery disease, stroke, and heart failure. Traditional risk assessment models and treatment strategies often fall short in fully addressing these complexities, leaving a substantial residual cardiovascular risk in diabetic patients. This review focuses on the need for enhanced screening protocols in diabetic populations, examining advanced risk scoring models and detection techniques aimed at improving early identification and management of ASCVD. Also, this study examines the pathophysiological links between diabetes and atherosclerosis, emphasizing the need for enhanced screening protocols. Emerging tools, such as non-invasive imaging techniques (e.g., coronary artery calcium scoring, CCTA) and biomarkers (e.g., polygenic risk scores), offer promise for improved early detection and risk stratification. Additionally, newer therapeutic strategies targeting inflammation and insulin resistance are being explored to mitigate cardiovascular risks in this population. Given the significant cardiovascular risk associated with diabetes, particularly T2DM, these advancements are crucial in reducing morbidity and mortality related to atherosclerotic events.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound-guided Tissue Acquisition of Pancreatic Malignancy: A Retrospective Study at a Tertiary Center.","authors":"Alexandru Constantinescu, Christoper Pavel, Oana-Mihaela Plotogea, Octavian Andronic, Andreea Puscasu, Florentina Gherghiceanu, Madalina Cristina Stan-Ilie, Vasile Șandru","doi":"10.2478/rjim-2025-0008","DOIUrl":"https://doi.org/10.2478/rjim-2025-0008","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound (EUS) is gaining ground in today's diagnostic routine due to its ability to provide dynamic, accurate representations, but mostly because it facilitates tissue sampling amenable to histopathologic studies. Our main objective was to assess the accuracy of sampling pancreatic malignancies through EUS-fine-needle aspiration (FNA) compared to EUS-fine-needle biopsy (FNB) at a tertiary referral center, where rapid on-site evaluation (ROSE) for EUS-FNA is not available.</p><p><strong>Material and methods: </strong>A retrospective, 5-year analysis of all EUS-guided tissue acquisitions of pancreatic masses suggestive of neoplasia was performed. Out of the 484 patients who initially underwent non-invasive imaging studies, 401 subjects were ultimately confirmed as malignant using EUS-FNA/FNB or surgery.</p><p><strong>Results: </strong>Overall, the accuracy of EUS-guided sampling was 91%. There were 36 patients (9%) with false-negative results after EUS, who were further addressed to surgery and confirmed with pancreatic malignancy. Cytological and histological examinations found that FNB was significantly higher than FNA regarding the diagnostic yield (91.3% vs. 84.1%; p-value<0.05). Moreover, FNB required fewer needle punctures than FNA to achieve a definitive diagnosis (1.63 vs. 1.99; p-value<0.05).</p><p><strong>Conclusions: </strong>Diagnostic management of pancreatic malignancies is unequivocally improved by FNB needles, rendering an improved tissue acquisition at a lower number of passes.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latest Insights in Alcohol-Related Liver Disease and Alcoholic Hepatitis.","authors":"Vlad-Teodor Enciu, Priscila Madalina Ologeanu, Alexandru Constantinescu, Carmen Fierbinteanu-Braticevici","doi":"10.2478/rjim-2025-0007","DOIUrl":"https://doi.org/10.2478/rjim-2025-0007","url":null,"abstract":"<p><p>Alcohol-related liver disease (ALD) is still to this date one of the leading causes of chronic liver disease globally. ALD comprises a wide disease spectrum, from the benign liver steatosis, to the life-threatening inflammatory acute phenotype of alcoholic hepatitis (AH) and ultimately, advanced liver fibrosis and cirrhosis. AH represents an acute inflammatory liver condition caused by prolonged high quantities of alcohol intake. Disease outcome varies from mild to severe, with systemic implication and high mortality. Although the pathogenesis has been extensively studied over the years, little progress has been made regarding therapeutic options. In over 50 years, steroid treatment is still the cornerstone therapeutic option, albeit having multiple limitations and a low success rate. On the other hand, important progress has been made regarding disease management and severity stratification with the implementation of different prognostic score. Although highly prevalent, AH still has many unmet needs, with a growing necessity for novel non-invasive diagnosis, prognosis biomarkers and impactful treatment options.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Value of Troponin Levels Adjusted for Renal Function in Heart Failure - A Systematic Review.","authors":"Anca Breha, Caterina Delcea, Andreea Cristina Ivanescu, Gheorghe Andrei Dan","doi":"10.2478/rjim-2025-0006","DOIUrl":"https://doi.org/10.2478/rjim-2025-0006","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure (HF) is a significant global health issue associated with high morbidity and mortality. Accurate biomarkers are crucial for predicting adverse outcomes and informing management. High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are important prognostic indicators in HF, though their predictive value can be affected by comorbidities, particularly renal dysfunction.</p><p><strong>Objectives: </strong>This review evaluates the prognostic significance of troponin adjusted for renal function in patients with HF.</p><p><strong>Methods: </strong>A comprehensive literature search was performed in PubMed, including studies from 2011 to September 2024, using specific MeSH terms related to HF, troponin, and prognosis.</p><p><strong>Results: </strong>Thirty-two studies met the inclusion criteria, all indicating an association between troponin levels adjusted for renal function and cardiovascular mortality in HF patients (HR 1.67-3.22). High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are independent predictors of cardiovascular mortality in acute heart failure (AHF). Increasing hs-cTnI levels, with a baseline threshold of 0.03 ng/mL, significantly correlate with mortality risk (P = .0011). Patients with hs-cTnT > 14 ng/L, > 21.5 ng/L, and > 26.5 ng/L exhibit increased all-cause mortality after adjusting for renal function. Despite these associations, the role of troponin in predicting heart failure readmissions remains inconsistent, indicating that elevated troponin levels do not reliably predict rehospitalization risk, particularly in those with advanced renal impairment.</p><p><strong>Conclusions: </strong>High-sensitivity troponins (hs-cTnT and hs-cTnI) are independent predictors of mortality in heart failure, even after accounting for renal function, while their role in predicting hospitalizations is weaker.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-steroidal anti-inflammatory drugs: what is the actual risk of chronic kidney disease? A systematic review and meta-analysis.","authors":"Saeed Soliman, Rabab Mahmoud Ahmed, Marwa Mostafa Ahmed, Abeer Attia, Amin Roshdy Soliman","doi":"10.2478/rjim-2024-0029","DOIUrl":"10.2478/rjim-2024-0029","url":null,"abstract":"<p><strong>Background: </strong>Non-steroidal anti-inflammatory drugs (NSAIDs) are common cause of acute kidney injury, but chronic kidney disease (CKD) risk of NSAIDs is controversial. Prior systematic reviews are outdated with some methodological flaws. We conducted this systematic review to clarify the association between chronic NSAIDs use and occurrence and/or progression of CKD.</p><p><strong>Methods: </strong>MEDLINE, Cochrane Library, Web of Science and Science direct were searched for observational and interventional studies from inception to May 2023. Qualitative synthesis was performed. The meta-analysis used pooled odds ratios (OR) and hazard ratios (HR) to estimate the association between chronic NSAID use and CKD occurrence or progression.</p><p><strong>Results: </strong>Forty studies with a total of 1757118 participants were included in the systematic review; of them 39 studies were suitable for meta-analysis. 56% of our included studies were recent, published within the last 10 years. The meta-analysis revealed a significant association between chronic NSAIDs use and CKD occurrence and progression. The pooled odds ratio was 1.24 (95% CI: 1.11-1.39, p <0.001, I² = 91.21%), and the pooled hazard ratio was 1.50 (95% CI: 1.31-1.7, p <0.001, I² = 90.77%). The pooled hazard ratio (HR) for individuals with no CKD at baseline was 1.31 (95% CI, 1.26-1.40), while for those with preexisting CKD, the HR was significantly higher at 1.67 (95% CI, 1.38-2.02). The HR for individuals with no specific chronic disease was 1.6 (95% CI, 1.32-1.94). For populations with diabetes mellitus (DM) and/or hypertension (HTN), the HR was 1.35 (95% CI, 1.27-1.43), and for those with rheumatic disease, the HR was 1.36 (95% CI, 0.88-2.10).</p><p><strong>Conclusions: </strong>Long-term NSAID use increases the risk of chronic kidney disease (CKD) occurrence and progression, especially in individuals with pre-existing CKD, who have a 67% risk compared to the general population's 60%. A patient-centered approach for safe and effective pain management is crucial, with special caution for those with pre-existing CKD.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"3-27"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of survival and functioning of arteriovenous fistula in patients on hemodialysis during a one-year follow-up.","authors":"Radojica V Stolic, Marija Milic, Vekoslav Mitrovic, Milica Mirovic, Tatjana Pesic, Kristina Z Dugalic, Jelena Zivic, Andriana Karanovic, Maja V Sipic, Kristina Bulatovic, Suzana Milutinovic","doi":"10.2478/rjim-2024-0033","DOIUrl":"10.2478/rjim-2024-0033","url":null,"abstract":"<p><strong>Introduction: </strong>The mortality rate of hemodialysis patients is extremely high and it is significantly affected by vascular access dysfunction. Our research aimed to determine predictive parameters of arteriovenous fistula functioning and survival in a one-year follow-up period.</p><p><strong>Methods: </strong>The research was organized as a prospective, one-year study, which included 120 dialysis patients who were followed for one year. We recorded the demographic and gender structure, clinical parameters, and laboratory findings significant for the survival and functioning of arteriovenous fistulas. Laboratory findings are presented as the mean values of the analysis at the beginning and the end of the one-year control period.</p><p><strong>Results: </strong>Univariable regression analysis confirmed the predictive significance of anastomosis positioning, type of vascular access, length of hemodialysis treatment, hemoglobin, Kt/V index values, and creatinine concentration for one-year survival, but multivariable regression analysis confirmed predictive significance only for length of treatment. Univariable regression analysis revealed significant predictors of vascular access function for the length of hemodialysis treatment, diastolic blood pressure, leukocytes, platelets, hemoglobin, creation of an arteriovenous fistula by a nephrologist, starting hemodialysis with a fistula and not with a central venous catheter, multivariable regression analysis confirmed predictive significance for the length of dialysis treatment and creation of an arteriovenous fistula by a nephrologist.</p><p><strong>Conclusion: </strong>A prognostically important parameter for the one-year survival of a patient on hemodialysis is the length of dialysis treatment. In contrast, predictive parameters for the functioning of an arteriovenous fistula are the length of dialysis and the creation of a fistula by a nephrologist.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"60-69"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capillaroscopic insights: exploring the connection between microvascular changes and pulmonary manifestations in systemic sclerosis.","authors":"Camelia Palici, Ananu Florentin Vreju, Cristina Elena Biţă, Ștefan Cristian Dinescu, Alesandra Florescu, Anca Emanuela Muşetescu, Andreea Lili Barbulescu, Paulina Lucia Ciurea","doi":"10.2478/rjim-2024-0030","DOIUrl":"10.2478/rjim-2024-0030","url":null,"abstract":"<p><strong>Background: </strong>Systemic sclerosis (SSc) is a complex connective tissue disease characterized by microangiopathy, immune dysregulation, and fibrosis. Early detection of microvascular abnormalities using nailfold videocapillaroscopy (NVC) is crucial in assessing disease progression and associated disease's involvement such as interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH).</p><p><strong>Objective: </strong>This study aims to explore the relationships correlation between NVC patterns, clinical manifestations, and systemic complications in SSc.</p><p><strong>Methods: </strong>We analyzed the data of 63 patients, predominantly female (95%), with a mean age of 49 years and an average disease duration of 42 months. Patients were categorized into early, active, and late patterns based on NVC findings. Clinical features, including digital ulcers (DU), ILD, and PAH, were assessed. Pearson correlation analyses were performed to evaluate the relationships between capillary loss, neoangiogenesis, ILD, and PAH.</p><p><strong>Results: </strong>The early pattern group (mean mRSS 2.36) exhibited minimal microvascular damage and systemic involvement, with no DUs. In the active pattern group (mean mRSS 10.40), 34.38% had diffuse cutaneous SSc (dcSSc), with 15.63% presenting DUs, 65.63% ILD, and 37.5% PAH. The late pattern group (mean mRSS 18.00) showed the most severe disease, with 80% having DUs, 70% dcSSc, 90% ILD, and 70% PAH. Pearson correlation analyses revealed strong correlations between capillary loss and ILD (r = 0.7255) and PAH (r = 0.6369). A moderate correlation was found between neoangiogenesis and PAH (r = 0.5592).</p><p><strong>Conclusion: </strong>The study demonstrates that progressive microvascular damage in SSc, as visualized by NVC, correlates strongly with the severity of systemic complications. Early detection of capillary loss and neoangiogenesis using NVC is critical for timely interventions, which could improve patient outcomes by mitigating the progression of ILD and PAH.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"39-48"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penicillin allergy management strategies relevant for clinical practice - a narrative review.","authors":"Ileana-Maria Ghiordanescu, Nicolas Molinari, Ana-Maria Forsea, Rik Schrijvers, Cyrille Hoarau, Pascal Demoly","doi":"10.2478/rjim-2024-0035","DOIUrl":"10.2478/rjim-2024-0035","url":null,"abstract":"<p><p>Penicillin allergy is the most commonly reported drug allergy, with prevalence rates ranging from 6% to 31% across various populations and geographic areas. The penicillin allergy label is linked to higher mortality and morbidity rates, extended hospital stays, increased readmission rates, and a greater reliance on second-line antibiotics. Research indicates that nearly 99% of those labeled as penicillin-allergic can tolerate the drug. However, alternative antibiotics are often prescribed without confirming the allergy, largely due to legal concerns regarding re-exposure. Even when a negative challenge test is conducted, non-allergist providers may remain hesitant to reintroduce penicillins. To address the considerable gap between reported and actual penicillin allergies, as well as to ensure the prompt use of penicillins by non-allergists, various management strategies have emerged in recent years. Although several comprehensive reviews have examined these strategies, selecting and applying the most suitable for routine practice is difficult. This narrative review focuses on the most relevant data regarding the efficiency of key penicillin allergy risk-assessment tools, particularly those of clinical significance, and discusses their readiness for implementation in non-allergist settings.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"28-38"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of smoking on microRNAs in significant coronary artery disease.","authors":"Shokoufeh Hajsadeghi, Aida Iranpour, Shayan Mirshafiee, Reza Nekouian, Maryam Mollababaei, Hamed Motevalli, Seyyed Amir Yasin Ahmadi, Mohammad Sedigh Dakkali","doi":"10.2478/rjim-2024-0031","DOIUrl":"10.2478/rjim-2024-0031","url":null,"abstract":"<p><strong>Background: </strong>Given the importance of coronary artery disease (CAD) and the range of cardiovascular disease phenotypes in smokers, as well as the potential genetic and epigenetic factors, we were motivated to explore the impact of smoking on some selected microRNAs associated with significant CAD.</p><p><strong>Methods: </strong>A total of 60 individuals were selected in four groups including non-smoker without significant CAD (S-A-), non-smokers with significant CAD (S-A+), smokers without significant CAD (S+A-) and smokers with significant CAD (S+A+). Micro-RNA expression was investigated using real-time PCR. General linear model was used to calculate fold change (FC) considering S-A- as the reference group.</p><p><strong>Results: </strong>For mir-34a, down-regulation was observed in S+A- (FC =0.13, P =0.007) and S+A+ (FC =0.23, P =0.036) groups. For mir-126-3p, down-regulation was observed in S-A+ group (FC =0.05, P =0.024). For mir-199, up-regulation was observed for S+A- group (FC =9.38, P =0.007). The only significant interaction between pack-years of smoking and number of significantly narrowed vessels (≥75% stenosis) was for mir-199 which was in favor of down-regulation (P =0.006), while the main effects were in favor of up-regulation (P <0.05).</p><p><strong>Conclusion: </strong>Mir-34a expression may be affected by smoking, whereas mir-126-3p expression may be affected by atherosclerosis, the most common reason of CAD. The significant down-regulation of mir-199 for the interaction of smoking dose and severity of CAD was a notable finding showing the harmful consequence of this interaction. Further studies are needed for this micro-RNA.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"49-59"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extremely elevated erythrocyte sedimentation rates: Associations with patients' diagnoses and clinical characteristics.","authors":"Esen Nur Holoğlu, Mehmet Uzunlulu, Cundullah Torun","doi":"10.2478/rjim-2024-0034","DOIUrl":"10.2478/rjim-2024-0034","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to assess the etiological distribution of patients with an erythrocyte sedimentation rate (ESR) over 100 mm/hour and to evaluate differences in demographic, comorbidity, laboratory characteristics, and clinical outcomes.</p><p><strong>Methods: </strong>This retrospective observational clinical study included patients aged 18 years and older who were admitted to the internal medicine inpatient clinic between May 1, 2015 and June 1, 2021 and had ESR values above 100 mm/h. Demographic data, comorbidities, laboratory parameters, imaging studies, histopathological findings, microbiological and serological data, along with in-hospital and post-discharge mortality, were collected from the hospital's electronic database. Two independent clinicians evaluated the data to identify diagnoses associated with elevated ESR. Patients were divided into six categories based on the most likely diagnosis.</p><p><strong>Results: </strong>The study included 441 patients, 52.6% of whom were female, and the mean age was 72.6 years. The etiological distribution was as follows: infectious diseases (34%), malignancies (31.5%), undiagnosed cases (15.9%), renal diseases (9.8%), other causes (5%), and rheumatologic diseases (3.8%). Etiological distributions did not differ by gender, age, or ESR ranges. The in-hospital mortality rate was 3.6%, and the overall mortality rate from hospitalization to the data collection date was 64.4%. Mortality was higher in patients with malignancies (81.3%) compared to other etiologies (p<0.001). Patients who died had higher mean age, ferritin levels, having diabetes mellitus, heart failure, or malignancy, and lower hemoglobin and lymphocyte levels compared to survivors (p<0.05 for all).</p><p><strong>Conclusion: </strong>Most patients with an ESR over 100 mm/hour had significant underlying medical conditions, with infectious diseases and malignancies comprising two-thirds of the cases.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"70-78"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}