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Tirzepatide, a dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, has shown promise in improving metabolic and cardiovascular profiles in patients with obesity. However, its potential benefits in patients with heart failure with preserved ejection fraction (HFpEF) remain unclear. We conducted a real-world, retrospective cohort study using the TriNetX global database. A total of 14,154 patients with HFpEF were included after 1:1 propensity score matching. Tirzepatide use was associated with significantly lower risks of the primary composite outcome of heart failure exacerbation and all-cause mortality (HR 0.52), as well as reductions in major adverse cardiovascular events (HR 0.64) and major adverse kidney events (HR 0.44). Subgroup analyses demonstrated consistent benefits across different strata. Sensitivity analyses using alternative exposure definitions confirmed the robustness of the findings. These results support the potential clinical utility of tirzepatide in HFpEF management and warrant further investigation in randomized controlled trials. Tirzepatide has shown promise for treatment of obesity but its effects in heart failure are unknown. Using real-world data from over 14,000 patients, the authors show that tirzepatide is associated with lower risks of death, heart failure worsening, cardiovascular events, and kidney complications in people with preserved ejection fraction heart failure.

Background This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia (sCAP). Methods A comprehensive search was conducted using the Medline, Embase, ClinicalTrials.gov, and Scopus databases for articles published until April 24, 2023. Only randomized controlled trials (RCTs) that assessed the clinical efficacy and safety of adjunctive corticosteroids for treating sCAP were included. The primary outcome was the 30-day all-cause mortality. Results A total of seven RCTs involving 1689 patients were included in this study. Overall, the study group had a lower mortality rate at day 30 than the control group (risk ratio [RR], 0.61; 95% CI 0.44 to 0.85; p  < 0.01) with low heterogeneity ( I 2  = 0%, p  = 0.42). Compared to the control group, the study group had a lower risk of the requirement of mechanical ventilation (RR 0.57; 95% CI 0.45 to 0.73; p  < 0.001), shorter length of intensive care unit (MD − 0.8; 95% CI − 1.4 to − 0.1; p  = 0.02), and hospital stay (MD − 1.1; 95% CI − 2.0 to − 0.1; p  = 0.04). Finally, no significant difference was observed between the study and the control groups in terms of gastrointestinal tract bleeding (RR 1.03; 95% CI 0.49 to 2.18; p  = 0.93), healthcare-associated infection (RR 0.89; 95% CI 0.60 to 1.32; p  = 0.56), and acute kidney injury (RR 0.68; 95% CI 0.21 to 2.26; p  = 0.53). Conclusions In patients with sCAP, adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events. However, because the pooled evidence remains inconclusive, further studies are required.

While the association between COVID-19 and acute kidney injury (AKI) is well documented, the impact of COVID-19 on the development of advanced chronic kidney disease (CKD) remains unclear, particularly in patients without initial AKI. Using the TriNetX healthcare database, we conducted a matched cohort study comparing 141,587 COVID-19 and 141,587 influenza patients. We excluded patients with AKI within one month of infection and matched groups on demographics, comorbidities, and baseline laboratory values. The primary outcome was the incidence of advanced CKD (stages 3–5) at the 12-month follow-up. COVID-19 patients showed higher 12-month risks of advanced CKD (hazard ratio [HR]:2.02, 95% confidence interval [CI]:1.69–2.42, p  < 0.0001), AKI (HR 3.04, 95%CI:2.61–3.55, p  < 0.0001), and estimated glomerular filtration rate < 60 mL/min/1.73 m 2 (HR:3.01, 95%CI:2.74–3.30, p  < 0.0001) compared to influenza patients. Subgroup analyses showed consistently elevated risks across sexes and in patients over 45 years, while younger patients did not demonstrate an increased risk of advanced CKD at the 12-month follow-up. Diabetes mellitus and hypertension have emerged as the strongest predictors of advanced CKD development. In conclusion, COVID-19 is associated with an increased risk of long-term renal dysfunction compared with influenza, suggesting the need for extended monitoring of kidney function in high-risk populations.

This study aimed to determine whether sugammadex use is associated with lower postoperative urinary retention (POUR) incidence than neostigmine-glycopyrrolate reversal in patients undergoing laparoscopic hernia repair. This retrospective cohort study used the TriNetX research network database to analyze adult patients who underwent laparoscopic hernia repair. Patients receiving rocuronium/vecuronium were divided into sugammadex (n = 92,543) or neostigmine-glycopyrrolate (n = 11,723) reversal groups. After 1:1 propensity score matching, 11,722 matched pairs were analyzed. The primary outcome was POUR within 30 days. The secondary outcomes included pneumonia, hospital readmission, and emergency department (ED) visits. Subgroup analyses were used to examine the effects of age and sex. In the matched cohort (n = 23,444), sugammadex was associated with a significantly lower risk of POUR (OR 0.23, 95% CI 0.18-0.31; p < 0.001) and ED visits (OR 0.76, 95% CI 0.66-0.87; p < 0.001). No significant differences were found in pneumonia or readmission rates. The POUR reduction was consistent across sexes (males: OR 0.32; females: OR 0.33) but more pronounced in patients aged >50 years (OR 0.35) than in younger patients (OR 0.50, p = 0.067). Among male patients receiving sugammadex, older age (OR, 1.01), history of urinary retention (OR, 9.94), and benign prostatic hyperplasia (OR, 4.04) were significant independent risk factors for POUR. Sugammadex use is associated with a 77% reduction in POUR and 24% fewer ED visits than neostigmine following hernia repair, suggesting that it may be the preferred reversal agent, particularly for older adults who gain the most benefit.

The predictive value of the prognostic nutritional index (PNI) for the long-term prognosis of patients with acute coronary syndrome (ACS) remains uncertain. Medline, Embase, Cochrane Library, and Google Scholar were searched from inception until January 2023 to study the relationship between all-cause mortality risk and PNI in patients receiving percutaneous coronary intervention for ACS (i.e., primary outcome). Thirteen observational studies were included in this meta-analysis. Analysis of seven studies using PNI as a categorical variable showed a pooled hazard ratio (HR) of all-cause mortality of 2.97 (95% CI 1.65 to 5.34, p  = 0.0003, I 2  = 89%, n = 11,245) for patients with a low PNI. The meta-analysis also showed a higher risk of major adverse cardiovascular events (MACEs) in patients with a low PNI (HR 2.04; 95% CI 1.59 to 2.61; p  < 0.00001; I 2  = 21%; n = 8534). Moreover, advanced age, diabetes mellitus, and high Global Registry of Acute Coronary Events risk scores were associated with a high risk of all-cause mortality, whereas a high body mass index was associated with a low risk of all-cause mortality. The results showed an association between a low PNI and an increased risk of long-term mortality in patients undergoing coronary interventions for ACS. Further randomized controlled trials are necessary to confirm these findings.

Although both chronic kidney disease (CKD) and vitamin D deficiency (VDD) are associated with increased surgical risk, their combined impact remains unclear. Using the TriNetX Analytics Network, we conducted a matched cohort study comparing postoperative outcomes in CKD patients with preoperative VDD (≤ 20 ng/mL) to those with normal vitamin D levels (≥ 30 ng/mL). The primary outcome was 30-day mortality; secondary outcomes included acute kidney injury (AKI), pneumonia, acute myocardial infarction (AMI), and atrial fibrillation/flutter (AF). After propensity score matching (21,033 patients per group), results showed that VDD was associated with higher 30-day mortality (Odds ratio[OR]: 2.33, 95% confidence interval [CI] 1.91–2.85, p  < 0.0001), AKI (OR:1.94, 95% CI1.80–2.10, p  < 0.0001), and pneumonia (OR:1.76, 95% CI 1.15–2.70, p  = 0.0087), with no significant difference in AMI and AF. These associations persisted for 90 days. The impact of VDD on mortality and AKI was consistent across sex and CKD stages. Vitamin D insufficiency (21–29 ng/mL) showed attenuated but significant associations, suggesting a dose-dependent effect. In conclusion, preoperative VDD in patients with CKD is associated with increased risks of mortality, AKI, and pneumonia. These findings suggest the potential value of preoperative vitamin D screening and correction in patients with CKD.

Diabetes is common in patients with chronic obstructive pulmonary disease. Sodium-glucose co-transporter-2 inhibitors are effective in treating type 2 diabetes and provide benefits for conditions like cardiovascular and kidney diseases. We use data from multiple institutions and countries to evaluate their role in patients with chronic obstructive pulmonary disease and diabetes. This study includes chronic obstructive pulmonary disease patients with diabetes who are newly prescribed sodium-glucose co-transporter-2 inhibitors or dipeptidyl peptidase-4 inhibitors between January 1, 2013, and August 25, 2024. The primary outcome is all-cause mortality. The results show that the sodium-glucose co-transporter-2 inhibitors group has a lower risk of all-cause mortality compared to the dipeptidyl peptidase-4 inhibitors group (hazard ratio, 0.757; 95% confidence interval, 0.716-0.801). It also shows significantly lower risks of all-cause hospitalization (hazard ratio, 0.864; 95% confidence interval, 0.845-0.884), exacerbation (hazard ratio, 0.924; 95% confidence interval, 0.888-0.962), pneumonia, upper respiratory infections, bronchitis, and major cardiovascular events. COPD patients are more likely to also have diabetes. Here the authors show that the use of SGLT2 inhibitors was associated with reduced all-cause mortality, hospitalization, acute exacerbations, and pneumonia in patients with COPD and diabetes.

The impact of adding glucagon-like peptide-1 receptor agonists (GLP-1RAs) to sodium-glucose co-transporter-2 inhibitors (SGLT2is) for metabolic dysfunction-associated steatotic liver disease (MASLD) is unclear. This retrospective study compared the effect of GLP-1RA plus SGLT2i versus SGLT2i alone for MASLD. Combination therapy was associated with a lower risk of primary composite outcomes of all-cause hospitalization, all-cause mortality, major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and major adverse liver outcomes (MALO) (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.84-0.91). Combination therapy also showed lower risks for all-cause hospitalization (HR, 0.86; 95% CI, 0.82-0.90), all-cause mortality (HR, 0.45; 95% CI, 0.38-0.53), MAKE (HR, 0.72; 95% CI, 0.60-0.89), and MALO (HR, 0.61; 95% CI, 0.53-0.69). In contrast, compared to GLP-1RA monotherapy, combination therapy did not confer additional benefit except for all-cause mortality. Overall, combination therapy with GLP-1RA plus SGLT2i was associated with better clinical outcomes of MASLD, compared to SGLT2i monotherapy. Here the authors report a retrospective analysis showing lower risk of composite outcomes of all-cause hospitalization, all-cause mortality, major adverse cardiovascular events, major adverse kidney events and major adverse liver outcomes for patients with MASLD treated with combination therapy with GLP-1 receptor agonists and SGLT2 inhibitors versus SGLT2 inhibitor monotherapy. However, a sensitivity analyses suggests that these effects may be driven by the GLP-1 receptor agonist treatment.

Background: Ciprofol (HSK3486) is a novel intravenous anesthetic agent that bears structural similarity to propofol and displays favorable pharmacodynamic characteristics such as rapid onset and offset. The meta-analysis aimed at comparing the efficacy and safety of ciprofol versus propofol in clinical practice. Methods: Medline, EMBASE, Google Scholar, Cochrane Library were searched from inception to April 2023. The primary outcome was success rate of sedation/anesthetic induction and differences in sedation/induction time. The secondary outcomes included risks of hemodynamic instability, respiratory complications, and pain on injection, as well as recovery profiles, satisfaction score, and top-up dose requirement. Results: Twelve RCTs (sedation: n = 6, anesthetic induction, n = 6, all conducted in China) involving 1,793 patients (age: 34–58 years) published from 2021 to 2023 were analyzed. Pooled results revealed no differences in success rate [risk ratio (RR) = 1, 95% confidence interval (CI): 0.99 to 1.01, I 2 = 0%, 1,106 patients, p = 1] and time required for successful anesthetic induction/sedation [mean difference (MD) = 7.95 s, 95% CI: −1.09 to 16.99, I 2 = 97%, 1,594 patients, p = 0.08]. The risks of top-up dose requirement (RR = 0.94, p = 0.48), cardiopulmonary complications [i.e., bradycardia (RR = 0.94, p = 0.67), tachycardia (RR = 0.83, p = 0.68), hypertension (RR = 1.28, p = 0.2), hypoxemia/pulmonary depression (RR = 0.78, p = 0.24)], and postoperative nausea/vomiting (RR = 0.85, p = 0.72), as well as discharge time (MD = 1.39 min, p = 0.14) and satisfaction score (standardized MD = 0.23, p = 0.16) did not differ significantly between the two groups. However, the ciprofol group had lower risks of hypotension (RR = 0.85, p = 0.02) and pain on injection (RR = 0.17, p < 0.00001) than the propofol group. The time to full alertness was statistically shorter in the propofol group (i.e., 0.66 min), but without clinical significance. Conclusion: Our results demonstrated similar efficacy between ciprofol and propofol for sedation and anesthetic induction, while ciprofol was associated with lower risks of hypotension and pain on injection. Future studies are warranted to evaluate the efficacy and safety of ciprofol in pediatric or the elderly populations. Systematic Review Registration: ( https://www.crd.york.ac.uk/prospero/ ), identifier (CRD42023421278).

Background Few studies have directly compared the risk and magnitude of post-acute sequelae following COVID-19 and influenza, and most of these studies were conducted before emergence of the Omicron. This study investigated the prevalence of post-COVID conditions and the long-term risk of emergency department (ED) visits, hospitalizations, and deaths in patients with COVID-19 and compared their risk with that of patients with influenza. Methods A retrospective study based on the TriNetX databases, a global health research network. We identified patients with COVID-19 and influenza who required hospitalization between January 1, 2022, and January 1, 2023. We compared the risk of developing any post-COVID conditions between the two groups and also analyzed each post-COVID-19 condition and all-cause ED visits, hospitalizations, and deaths in both populations during the follow-up 90–180 days. Results Before matching, 7,187 patients with COVID-19 were older (63.9 ± 16.7 vs. 55.4 ± 21.2) and were predominantly male (54.0% vs. 45.4%), and overweight/obese (16.1% vs. 11.2%) than 11,266 individuals with influenza. After propensity score matching, 6,614 patients were identified in each group, resulting in well-balanced baseline characteristics. During follow-up, the COVID-19 group had a higher incidence of any post-COVID-19 condition when compared with the influenza group (17.9% vs. 13.0%), with a hazard ratio (HR) of 1.398 (95% CI, 1.251–1.562). Compared to the influenza group, the COVID-19 group had a significantly higher incidence of abnormal breathing (HR, 1.506; 95% CI, 1.246–1.822), abdominal symptoms (HR, 1.313; HR, 1.034–1.664), fatigue (HR, 1.486; 95% CI, 1.158–1.907), and cognitive symptoms (HR, 1.815; 95% CI, 1.235–2.668). Moreover, the COVID-19 group had a significantly higher risk of the composite outcomes during all-cause ED visits, hospitalizations, and deaths when compared with the influenza group (27.5% vs. 21.7; HR, 1.303; 95% CI, 1.194–1.422). Conclusions This study indicates that hospitalized COVID-19 patients are at a higher risk of long-term complications when compared with influenza survivors.