Romanian Journal of Internal Medicine最新文献

{"title":"The Role of Probiotics, Prebiotics, and Synbiotics for Reducing Chemotherapy-Induced Gastrointestinal Toxicity: A Systematic Review and Meta-Analysis.","authors":"Ermin Rachmawati, Roihatul Mutiah, Syafiq Maulana, Fildzah Ghaisani Alifah, Qanita Adzkia Novindra, Alvi Milliana, Imam Taufik","doi":"10.2478/rjim-2026-0011","DOIUrl":"10.2478/rjim-2026-0011","url":null,"abstract":"<p><strong>Background: </strong>Chemotherapy-induced gastrointestinal toxicity remains a major clinical problem that limits treatment adherence and quality of life in cancer patients. Microbiota-modulating interventions such as probiotics, prebiotics, and synbiotics have been proposed as supportive therapies, yet their comparative effectiveness remains unclear.</p><p><strong>Objective: </strong>This systematic review and meta-analysis evaluated the effectiveness of probiotics, prebiotics, and synbiotics in reducing chemotherapy-induced gastrointestinal toxicity in cancer patients.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov was performed between March and August 2025 to identify randomized controlled trials (RCTs) involving chemotherapy-treated cancer patients with gastrointestinal toxicities. Studies comparing probiotics, prebiotics, or synbiotics with placebo or standard care were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using standardized criteria. Meta-analysis was conducted using RevMan 5.4.</p><p><strong>Results: </strong>Twenty-nine RCTs were included, comprising probiotics (n = 17), prebiotics (n = 6), and synbiotics (n = 6). Probiotic supplementation, predominantly containing <i>Lactobacillus</i> and <i>Bifidobacterium</i> species, significantly reduced the incidence of chemotherapy-induced diarrhea (RR = 0.67; 95% CI 0.47-0.95; p = 0.03). Synbiotics demonstrated an even greater protective effect (RR = 0.51; 95% CI 0.29-0.89; p = 0.02). Evidence supporting prebiotics alone was limited and inconsistent.</p><p><strong>Conclusion: </strong>Probiotics and synbiotics may be effective in reducing chemotherapy-induced gastrointestinal toxicity, with the most consistent evidence for diarrhea.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"157-171"},"PeriodicalIF":1.6,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017108","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":"Accelerated Biological Aging and a Nonlinear Risk Threshold for Sleep Apnea: Evidence from NHANES and Mediation by Oxidative-Metabolic Dysregulation.","authors":"Jia Guo, Xiaona Wang, Ranran Zhao","doi":"10.2478/rjim-2026-0010","DOIUrl":"10.2478/rjim-2026-0010","url":null,"abstract":"<p><strong>Background: </strong>The association between accelerated biological aging and sleep apnea remains unclear. This study aimed to investigate the association of phenotypic aging (PhenoAge) with sleep apnea, identify nonlinear patterns and high-risk subgroups, and explore metabolic-oxidative stress (as measured by uric acid-to-HDL ratio, UHR) as a potential mediator.</p><p><strong>Methods: </strong>In a cross-sectional analysis of 4,901 adults from NHANES 2005-2008, sleep apnea was self-reported. PhenoAge was calculated from clinical biomarkers. Associations were assessed using multivariable logistic regression and restricted cubic splines; potential mediation by UHR was evaluated.</p><p><strong>Results: </strong>Each 1-year increase in PhenoAge was associated with a 3% higher odds of sleep apnea (OR = 1.03, 95% CI: 1.01-1.04). A statistically derived nonlinear inflection point at a PhenoAge of 44.09 years was observed. The association was significant only in adults ≥40 years (<i>P</i>-interaction = 0.001) and was strongest in males and individuals with obesity. UHR accounted for 6.27% of the association, primarily in adults ≥40 years and individuals with obesity.</p><p><strong>Conclusion: </strong>In this cross-sectional study, accelerated biological aging, measured by PhenoAge, was associated with sleep apnea in a dose-dependent and age-delimited manner, with a statistical inflection point at 44.09 years. The modest association via UHR suggests oxidative-metabolic dysregulation as one potential explanatory factor. These exploratory findings provide a framework for hypothesis generation regarding the role of biological aging in sleep apnea.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"183-197"},"PeriodicalIF":1.6,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975105","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":"Contrast-enhanced Ultrasound and the Lerner Histopathological Grade in Gastrointestinal Graft-versus-host Disease: A Prospective Single-centre Study.","authors":"Lavinia-Eugenia Lipan, Iuliana Iordan, Simona Ioanitescu, Alexandra Marcoci, Andra David, Alina Daniela Tanase","doi":"10.2478/rjim-2026-0009","DOIUrl":"10.2478/rjim-2026-0009","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal graft-versus-host disease (GI GVHD) is a major complication of allogeneic haematopoietic stem-cell transplantation (allo-HSCT). Endoscopic biopsy with histopathological grading according to the Lerner system remains the diagnostic standard, although invasive sampling is frequently constrained in this fragile population. We assessed the relationship between a four-parameter contrast-enhanced ultrasound (CEUS) score and the Lerner histopathological grade.</p><p><strong>Methods: </strong>Prospective, single-centre study (October 2018 - December 2025). Adult allo-HSCT recipients with new-onset gastrointestinal symptoms underwent multimodal abdominal ultrasound, including CEUS with sulphur hexafluoride microbubbles, followed by endoscopic biopsy. A composite CEUS-GVHD score (range 0-12) integrated bowel-wall thickness, bowel-loop dilatation, contrast wash-out, and transmural microbubble migration. The cohort comprised 51 episodes (in 41 unique patients) with histopathologically confirmed GI GVHD and Lerner grade I-IV. A within-patient sensitivity analysis was performed on the first chronologically documented episode per patient (n=41), and additional sensitivity analyses were performed by stratification according to concurrent gastrointestinal infection and according to GVHD form (acute vs chronic).</p><p><strong>Results: </strong>The total CEUS-GVHD score showed a positive correlation with the Lerner grade (p < 0.001). Median CEUS scores across grades were 5.5 (Lerner I), 7 (II), 8.5 (III), and 10 (IV) (p < 0.001). Among individual parameters, transmural microbubble migration showed the highest correlation, followed by bowel-wall thickness and contrast wash-out; these three correlations remained significant after Bonferroni correction. The bowel-loop dilatation correlation did not retain significance after correction. In an exploratory analysis, the area under the ROC curve of the total CEUS-GVHD score for discriminating severe (Lerner III-IV) from mild (Lerner I-II) histopathological GI GVHD was 0.853, with the same point estimate retained in the within-patient sensitivity analysis (AUC 0.853).</p><p><strong>Conclusion: </strong>In this single-centre cohort of biopsy-confirmed GI GVHD, the CEUS-GVHD score showed a moderate-to-strong association with Lerner histopathological grade. Because the study included only confirmed GI GVHD episodes, these findings support CEUS as a potential adjunct for severity assessment, not as a replacement for diagnostic biopsy. External multicentre validation with multiple operators is required.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"133-148"},"PeriodicalIF":0.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932830","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 Utility of Sex-Specific Cut-offs for High-Sensitivity Troponin T for Long-Term All-cause Mortality Risk Assessment in Heart Failure.","authors":"Anamaria Draghici, Caterina Delcea, Gheorghe-Andrei Dan","doi":"10.2478/rjim-2026-0008","DOIUrl":"10.2478/rjim-2026-0008","url":null,"abstract":"<p><strong>Introduction: </strong>High-sensitivity troponin T (hs-TnT) is commonly elevated in heart failure (HF) and may have different prognostic meaning in women and men. We assessed sex-related differences in hs-TnT and whether sex-aware interpretation improves long-term risk stratification after HF hospitalization.</p><p><strong>Materials and methods: </strong>We conducted a retrospective single-center cohort study derived from the HI-HF registry (2011-2014). The analysis included adults hospitalized for HF with admission hs-TnT, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and in-hospital echocardiography. We derived outcome-optimized sex-specific hs-TnT cut-offs by ROC analysis. The endpoint was long-term all-cause mortality (ascertained through August 2024). Kaplan-Meier and multivariable Cox models (including sex stratification, interaction testing, and landmark/time-dependent analyses) were performed.</p><p><strong>Results: </strong>Our cohort included 404 patients. Over a median follow-up of 5.72 years (IQR 3.38-6.87), 149 deaths (36.9%) occurred. Women had lower hs-TnT concentrations than men (median 14.18 vs 22.44 pg/mL). ROC-derived sex-specific mortality prognostic cut-offs were >15.83 pg/mL for women (AUC 0.773; sensitivity 70.7%; specificity 78.3%) and >19.02 pg/mL for men (AUC 0.725; sensitivity 75.0%; specificity 65.0%). Compared to the conventional cut-off of 14 pg/mL, the gender-adjusted values improved risk stratification by 22% for women and 23% for men. For each gender-defined subgroup, increased hs-TnT levels were independently associated with all-cause long-term mortality in Cox analysis alongside NT-proBNP and hemoglobin levels in men (HR 1.91 (1.07 - 3.41), p=0.029), and NT-proBNP and age in women (HR 3.54 (2.07 - 6.07), p<0.001). Prognostic effects were time-dependent, with stronger sex-related divergence beyond 1 year.</p><p><strong>Conclusions: </strong>Sex-specific hs-TnT cut-off recalibration improved long-term mortality risk stratification in hospitalized heart failure patients. Increased levels of hs-TnT defined by the gender-specific analysis were independent predictors of the outcome in both men and women.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"116-132"},"PeriodicalIF":0.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820150","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 Implication of Chronic Hyperglycemia in Acute Ischemic Strokes of Different Etiologic Subtypes.","authors":"Azra Zafar, Mustafa Al Qarni, Rizwana Shahid, Ali Hafed Al Hashem, Aishah Albakr, Erum Shariff, Zaid Waqar","doi":"10.2478/rjim-2026-0007","DOIUrl":"10.2478/rjim-2026-0007","url":null,"abstract":"<p><strong>Background: </strong>The relationship of chronic hyperglycemia (CH) reflected by glycated hemoglobin A1c (HbA1c) with functional recovery in patients having acute ischemic stroke (AIS) remains controversial. This study evaluated how HbA1c values at admission could influence functional recovery following AIS of various etiologies.</p><p><strong>Methods: </strong>In total, 518 patients with AIS were included. Stroke etiology was determined by TOAST criteria. The modified Rankin Scale (mRS) was applied to evaluate the functional recovery. Independent-samples Mann-Whitney U test was applied to assess the distribution of HbA1c across different subtypes. The relationship between HbA1c levels and functional recovery was analyzed applying multivariate logistic regression for adjustment of variables. Models predicting poor functional recovery, without and with HbA1c were developed utilizing binary logistic regression.</p><p><strong>Results: </strong>HbA1c levels were significantly elevated among patients with poor functional recovery (p <0.001). The highest HbA1c values, median (IQR) [8.15(6.5-10.9)] were observed in patients with large artery atherosclerosis (LAA) subtype. Subgroup analyses by stroke subtype revealed significant associations of elevated HbA1c levels with poor functional recovery in the SVO (p = 0.021), LAA (p = 0.027), and cardio-embolic (CE), p = 0.046 groups. Elevated HbA1c remained independently associated with poor functional recovery (p = <0.001; OR = 1.27; 95% CI = 1.12-1.45) after full adjustment for clinical variables.</p><p><strong>Conclusions: </strong>Elevated admission HbA1c levels showed a fair to modest association with poorer functional recovery among patients with SVO, LAA, and CE stroke subtypes, which requires further external validation to establish its clinical implications and to consider HbA1c as an independent prognostic biomarker.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"105-115"},"PeriodicalIF":0.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779744","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":"Real-world Screening for Interstitial Lung Disease in Rheumatoid Arthritis: The Value of Spirometry, DLCO, and Clinical Risk Factors.","authors":"Oana-Georgiana Dinache, Claudiu C Popescu, Corina D Mogoșan, Cătălin Codreanu, Luminița Enache","doi":"10.2478/rjim-2026-0006","DOIUrl":"10.2478/rjim-2026-0006","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize pulmonary function patterns in rheumatoid arthritis (RA), explore their clinical and serologic correlates, and evaluate the ability of spirometry and DLCO together with routine clinical factors to identify patients with high-resolution computed tomography (hrCT)-confirmed interstitial lung disease (ILD).</p><p><strong>Methods: </strong>In this cross-sectional observational study, consecutive adults with RA underwent pulmonary function testing (PFT) and chest radiography irrespective of respiratory symptoms. Patients with unexplained dyspnea, abnormal PFT, or abnormal chest X-ray were referred for hrCT.</p><p><strong>Results: </strong>Among the 106 included patients (81.1% women; mean age 65.3±9.7 years), DLCO correlated negatively with age and inflammatory markers, while FVC and FEV1 showed associations with serologic status, treatment exposure, and radiographic abnormalities. Forty-seven patients (44.3%) underwent hrCT, of whom 24 (51.1%) had ILD, corresponding to an overall prevalence of 22.6%. In the hrCT subgroup, swollen joint count at RA diagnosis was higher in ILD cases, whereas radiographic emphysema occurred only in non-ILD patients. In multivariable analysis, age, smoking history, and DAS28-CRP were not independently associated with ILD (AUC=0.634; 95%CI=0.451-0.807). ROC analyses demonstrated poor discrimination of ILD by PFT z-scores: DLCO AUC=0.431, FVC AUC=0.562, and FEV1 AUC=0.444, with high sensitivity but low specificity at optimal thresholds.</p><p><strong>Conclusions: </strong>In this real-world RA cohort, spirometry/DLCO showed limited ability to discriminate hrCT-confirmed ILD once patients were clinically selected for imaging. These findings support an integrated screening strategy in which PFT results are interpreted alongside clinical and radiographic risk factors to guide hrCT referral rather than used as standalone screening tools.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"90-104"},"PeriodicalIF":1.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676380","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":"Blood Pressure Alterations in CML Patients Treated with Imatinib vs. Nilotinib: A Clinical Insight.","authors":"Wardiyanti Anwar, Tutik Harjianti, Pendrik Tandean, Syakib Bakri, Faridin Hp, Andi Alfian Zainuddin","doi":"10.2478/rjim-2026-0005","DOIUrl":"10.2478/rjim-2026-0005","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic Myeloid Leukemia is a hematologic malignancy characterized by the BCR-ABL fusion gene. Tyrosine Kinase Inhibitors such as imatinib and nilotinib have significantly improved the prognosis for CML patients. However, prolonged TKI therapy is associated with cardiovascular side effects, particularly hypertension. This study aims to compare the effects of imatinib and nilotinib on blood pressure in CML patients over a 12-month period.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at Wahidin Sudirohusodo Hospital, including 148 adult CML patients who received imatinib or nilotinib for at least 12 months. BP measurements were taken at baseline, and at 3, 6, 9, and 12 months. Statistical analyses included paired t-tests and multivariate regression to evaluate BP changes and their associations with demographic and treatment variables.</p><p><strong>Results: </strong>Both systolic and diastolic BP significantly increased in both groups over 12 months. In the imatinib group, systolic BP rose from 112 mmHg to 125 mmHg, and diastolic BP increased from 72 mmHg to 81 mmHg. In the nilotinib group, systolic BP increased from 111 mmHg to 130 mmHg, and diastolic BP rose from 70 mmHg to 83 mmHg. These increases were more pronounced in the nilotinib group (p < 0.001 for systolic and p = 0.006 for diastolic).</p><p><strong>Conclusion: </strong>Both imatinib and nilotinib therapies lead to significant increases in BP, with nilotinib showing a greater hypertensive effect. Monitoring BP is crucial, especially for patients on second-generation TKIs, to manage cardiovascular risks associated with long-term treatment.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"81-89"},"PeriodicalIF":1.6,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646336","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":"Anti-MDA5 Dermatomyositis with RP-ILD and CMV Reactivation: A Case Report.","authors":"Ömer Atakan Soğur, Dilara Bulut Gokten, Ridvan Mercan","doi":"10.2478/rjim-2026-0004","DOIUrl":"10.2478/rjim-2026-0004","url":null,"abstract":"<p><p>Anti-melanoma differentiation-associated gene 5 (anti-MDA5) dermatomyositis is a distinct subtype of dermatomyositis frequently associated with clinically amyopathic disease and rapidly progressive interstitial lung disease (RP-ILD), a complication characterized by high mortality despite aggressive treatment. Early recognition and prompt immunomodulatory therapy are therefore critical. We report a fatal case of anti-MDA5 dermatomyositis complicated by RP-ILD with concomitant cytomegalovirus (CMV) reactivation. A 40-year-old woman with known dermatomyositis presented with progressive dyspnea, fever, and hypoxemia. Physical examination revealed typical cutaneous findings, including Gottron's sign and papules. Laboratory evaluation demonstrated elevated inflammatory markers and marked lymphopenia. Anti-MDA5 antibody testing was positive. Chest computed tomography showed rapidly progressive bilateral fibrotic interstitial lung disease compared with imaging obtained 10 days earlier. Despite empirical antimicrobial therapy, mycophenolate discontinuation, and initiation of intravenous immunoglobulin, respiratory failure progressed rapidly, requiring mechanical ventilation. Infectious investigations were negative except for low-level CMV viremia. Due to the absence of lung-specific diagnostic evidence, CMV was interpreted as reactivation related to immunosuppression rather than a primary cause of pulmonary injury. The patient subsequently developed multiorgan failure and died on the fifth day of intensive care. This case highlights the fulminant course and poor prognosis of anti-MDA5-associated RP-ILD. Severe lymphopenia and CMV reactivation may represent markers of immune dysregulation rather than direct etiologic drivers. Anti-MDA5 positivity should be recognized as a high-risk biomarker warranting early risk stratification, rapid initiation of immunomodulatory therapy, and close monitoring for opportunistic infections.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"149-154"},"PeriodicalIF":0.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582040","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":"A Comprehensive Review of the Association between Sarcopenia and COPD.","authors":"Tănase Andreea Mădălina, Florentina Gherghiceanu, Beatrice Mahler, Octavian Andronic","doi":"10.2478/rjim-2026-0003","DOIUrl":"10.2478/rjim-2026-0003","url":null,"abstract":"<p><p>COPD is a complex disease with pulmonary and extrapulmonary manifestations intensively studied due to the numerous pathologic processes involved. Its prevalence is increasing, representing the fourth leading cause of mortality worldwide. Sarcopenia can occur in COPD patients with common risk factors. Sarcopenia is characterized by a decrease in muscle mass and function with consequences on muscle performance. Muscle changes can be measured by different methods: MRI, DXA, BIA, CT or biopsy. The prevalence of sarcopenia has been studied in numerous studies with varying results. This review identifies the main risk factors that contribute to the variable outcomes with a focus on the characteristics of the studied population, the criteria for defining sarcopenia and the methods used to measure muscle mass, strength and physical performance.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"55-61"},"PeriodicalIF":0.8,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326860","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":"Clinical Prognostic Scoring Systems in Heart Failure with Preserved Ejection Fraction: An Integrative Review of Risk Prediction Models.","authors":"Anamaria Draghici, Gheorghe-Andrei Dan","doi":"10.2478/rjim-2026-0002","DOIUrl":"10.2478/rjim-2026-0002","url":null,"abstract":"<p><strong>Introduction: </strong>Risk stratification in heart failure with preserved ejection fraction (HFpEF) remains inconsistent in routine care despite multiple prognostic scores. Key controversies persist. One concerns broad, clinically derived scores versus pathophysiology-grounded tools, including diagnostic frameworks used pragmatically for prognostication. Another concern is the distinction between static baseline risk and dynamic risk states that change across hospitalization and follow-up.</p><p><strong>Methods: </strong>We performed a narrative, comparative synthesis of clinician-usable prognostic instruments in HFpEF across conceptual domains and care settings. We extracted study context, endpoints, follow-up, and performance metrics. We emphasized feasibility and clinical interpretability.</p><p><strong>Results: </strong>Across studies, discrimination of baseline-only clinical instruments is generally moderate. Performance is often higher for tools that reflect congestion and physiological changes, particularly when reassessed at clinically meaningful time points. Discharge lung ultrasound B-lines, reflecting residual pulmonary congestion, frequently predict early post-discharge events. Immuno-nutritional indices derived from routine laboratory tests provide a complementary prognostic signal, especially in older or recently hospitalized patients. Serial trajectories appear more informative than single measurements. Patient-reported health adds independent prognostic information and supports risk communication. Diagnostic frameworks can stratify risk when constituent data are available, and phenotype distributions are compatible, but transportability and calibration remain recurrent limitations.</p><p><strong>Conclusion: </strong>HFpEF prognostication is best supported by a layered, phenotype-aware strategy. This approach integrates global clinical risk, selected biomarkers, discharge congestion assessment, and serial reassessment, rather than relying on a single score.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"62-80"},"PeriodicalIF":0.8,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326905","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}