Objectives: The role of inflammation in the pathophysiology of atherosclerosis is extensive. Our study aims to assess the predictive role of inflammatory indexes regarding in-hospital mortality in major vascular surgery of Leriche syndrome as a convenient, low-cost, and noninvasive prognostic marker to optimize the patient’s perioperative course. Methods: Our retrospective single-center study enrolled consecutive patients diagnosed with aortoiliac occlusive disease, Leriche syndrome, who underwent elective major vascular surgery between 2017 and 2023 in a tertiary cardiovascular center. Preoperative, postoperative, and day-one after-surgery data, including systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio, and monocyte–lymphocyte ratio, were studied to the endpoint, in-hospital death. We also tested the delta values of the indexes to the endpoint. The indexes were compared to the Revised Cardiac Risk Index (RCRI) and Vascular Surgery Group Cardiac Risk Index (VSG-CRI) for outcome prediction. Results: The tested inflammatory indexes significantly increased from the preoperative to postoperative and, further, to the day-one settings. Preoperative AISI (p = 0.040) emerged as the only independent risk factor regarding in-hospital death occurrence in Leriche patients who underwent major revascularization surgery. While RCRI did not significantly predict the endpoint (AUC = 0.698, p = 0.057), VSG-CRI (AUC = 0.864, p = 0.001) presented the best result in ROC analysis. Postoperative NLR (AUC = 0.758, p = 0.006) was next, followed by NLR postoperative–preoperative (_Preop-_Postop) delta value (AUC = 0.725, p = 0.004), postoperative SIRI (AUC = 0.716, p = 0.016), SIRI_Preop-_Postop delta value (AUC = 0.712, p = 0.016), postoperative SII (AUC = 0.692, p = 0.032), and SII_Preop-_Postop delta value (AUC = 0.631, p = 0.030). Conclusions: Inflammatory indexes are valuable tools for assessing perioperative risk in major vascular surgery, enhancing the value of the already validated risk scores.

Background: Acute kidney injury (AKI) following cardiac surgery can lead to chronic kidney disease, increased hospitalization costs, and higher mortality risk. Our retrospective study identified risk factors of severe AKI (AKI 3) in patients undergoing on-pump surgical aortic valve replacement (SAVR). Additionally, we analyzed the significance of inflammatory indexes and risk scores in predicting AKI 3, focusing on sex differences. These findings could provide cost-efficient tools for clinical practice to identify patients at risk, improve preoperative risk stratification, and personalize monitoring. Methods: We reviewed the on-pump SAVR patients from our tertiary center between 2022 and 2024. Results: Out of 422 patients, 121 (28.67%) experienced AKI, including 27 (6.39%) AKI 3 patients. The multivariable binary logistic regression identified AKI 3 independent risk factors: hemostasis reintervention (OR9.76, CI 95%: 3.565–26.716, p = 0.001), early postoperative vasoactive-inotropic score (VIS) (OR1.049, CI 95%: 1.013–1.086, p = 0.007), postoperative lymphocyte (OR2.252, CI 95%: 1.224–4.144, p = 0.009). Preoperative systemic inflammatory response index (AUC0.700, p = 0.019), preoperative aggregate index of systemic inflammation (AUC0.712, p = 0.011), postoperative platelet-to-lymphocyte ratio (PLR) (AUC 0.759, p = 0.001), and the delta value of preoperative-to-postoperative PLR (AUC0.752, p = 0.001) were better predictors of AKI 3 occurrence in female SAVR patients than the additive EuroSCORE (AUC0.692, p = 0.011), but were less accurate compared to EuroSCORE II (AUC0.841, p = 0.001). None of the studied inflammatory indexes or additive EuroSCORE predicted our endpoint in male SAVR patients, while Thakar score was able to predict it exclusively in males. Conclusions: Early postoperative VIS, lymphocyte count, and hemostasis reintervention were independent risk factors for severe AKI in SAVR patients. There is a differentiation between males and females from the AKI prediction perspective.

The myeloproliferative neoplasms (MPN), a heterogeneous group of disorders characterized by specific genetic mutations, have the development of arterial and venous thrombosis as their main complication. Almost 40–50% of MPN patients encountered arterial or venous thrombosis during the course of their disease. Moreover, arterial thrombosis is linked to significant mortality, progression to myelofibrosis, and an increased risk of developing second cancers. Despite significant advancements in medical research, there are still unmet needs in this field. Our narrative review provides clinical and genetic insights into thrombosis associated with myeloproliferative neoplasms. We focus on the underlying pathophysiological processes, assessment methods, and risk stratification related to thrombotic events. This information aims to assist clinicians in accurately assessing the risks associated with MPN thrombosis, enabling a more personalized and effective approach to patient care. We based our review on a rare case of MPN-associated thrombosis, whose clinical presentation was marked by acute ischemia in both lower limbs. The thrombosis affected the distal aortic arch, thoracic and abdominal aorta, celiac trunk, common and proper hepatic arteries, proximal left renal artery, several segmental arteries in the right kidney, and the portal vein thrombosis. Our review presents various therapeutic options for these conditions. In the presented case, the multiple thrombi were treated medically, except for the popliteal artery thromboses, which required surgical management. This case may serve as a valuable reference for choosing treatment options for aortic and portal vein thrombosis, highlighting the multidisciplinary approach.

Background: Surgical aortic valve replacement (SAVR) is the main treatment for severe aortic valve disease, the most common valvular heart disease worldwide. Methods: We evaluated the in-hospital mortality risk factors and predictors following on-pump SAVR. We retrospectively reviewed data from consecutive patients treated at a tertiary center from 2022 to 2024, focusing on routine hematological data and inflammatory indexes, alongside established factors. Results: Postoperative vasoactive-inotropic score (VIS) (OR 1.058, CI 95%: 1.007–1.112), platelet count (OR 1.033, CI 95%: 1.002–1.064), lymphocyte counts (OR 3.532, CI 95%: 1.507–8.278), and perioperative fresh frozen plasma transfusion (OR 1.335, CI 95%: 1.068–1.669) were independent risk factors for SAVR in-hospital mortality. VIS best predicted the endpoint (AUC 0.929, p = 0.001). Postoperative platelet count and platelet-to-lymphocytes ratio (PLR) outperformed the additive EuroSCORE in predicting the outcome, but not EuroSCORE II. Conclusions: Although EuroSCORE II remained superior to inflammatory indexes in predicting in-hospital death, the dynamic postoperative monitoring provided added value beyond static preoperative risk scores. This dynamic approach supported personalized monitoring and targeted therapeutic interventions. Postoperative VIS, platelet, lymphocyte counts, and PLR represent dynamic, low-cost predictors of in-hospital mortality after on-pump SAVR, offering a complementary value to EuroSCORE II–based models.

Background: Accurately assessing perioperative risk after elective on-pump coronary artery bypass grafting (CABG) is challenging, especially when it comes to identifying patients at high risk for early mortality. We explored whether including perioperative biochemical and hemodynamic variables could improve established preoperative risk evaluation. Methods: We analyzed 451 consecutive patients who underwent elective on-pump isolated CABG over two years, focusing on in-hospital mortality as the primary endpoint. The predictors were selected based on univariable analysis, clinical relevance, and multicollinearity assessment. To address the low number of mortality events, we used Firth-penalized logistic regression. The final model was assessed using discrimination, calibration, and internal validity using receiver operating characteristic analysis, calibration measures, and 1000-bootstrap resampling. A dataset-derived risk threshold was explored for risk stratification. Results: Eleven patients (2.44%) died during hospitalization. The final multivariable model included three variables independently associated with in-hospital mortalityEuroSCORE II (OR1.57, CI 95%: 1.13–2.14, p = 0.011), early postoperative vasoactive-inotropic score (VIS) (OR1.017, CI 95%: 1.008–1.033, p < 0.001) and preoperative CK-MB/CK ratio (OR21.06, CI 95%: 1.06–355, p = 0.046). The final model demonstrated good discrimination with an apparent AUC of 0.908 and an optimism-corrected AUC of 0.892. A dataset-derived risk-stratification threshold of predicted mortality ≥2.35% identified the highest-risk quintile, which contained 10 of the 11 observed deaths. Observed mortality was 11.1% in this quintile versus 0.28% among the remaining patients. Inflammatory indices showed limited predictive performance. Additionally, the use of an intra-aortic balloon pump was not independently associated with in-hospital mortality after adjusting for baseline risks. Conclusions: A dynamic model integrating preoperative risk assessment (EuroSCORE II and preoperative CK-MB/CK ratio) with early postoperative hemodynamic data (VIS) showed encouraging internal discrimination and calibration for mortality prediction after isolated on-pump CABG. Given the limited number of events and substantial uncertainty surrounding the CK-MB/CK ratio estimate, these findings should be considered exploratory and hypothesis-generating until externally validated.

Background/Objectives: We aim to identify the postoperative acute kidney injury (AKI) risk factors and the predictors of severe AKI derived from routine perioperative elements in patients with aortoiliac occlusive disease who underwent aorto-bifemoral bypass as arterial revascularization. This involves a dynamic assessment throughout the perioperative period. Methods: Preoperative, intraoperative, early postoperative and day-one-after-surgery data were retrospectively reviewed in consecutive patients who underwent elective aorto-bifemoral bypass for aortoiliac occlusive disease classified as TASC II D at the “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases in Bucharest, Romania, between 2017 and 2023. Results: Preoperative clearance of creatinine (OR 1.037, CI95%: 1.009–1.066), the duration of the surgery (OR 1.435, CI 95%: 1.100–1.873), and the change between the day-one-after-surgery and preoperative systemic inflammatory response index (DeltaSIRI_1_preop) (OR 1.080, CI 95%: 1.012–1.152) were identified as independent risk factors for postoperative AKI in patients undergoing aorto-bifemoral revascularization for aortoiliac occlusive disease. The most severe form of AKI was strongly predicted by the number of packed red blood cells transfused (AUC 0.924, p = 0.001), the patient’s age (AUC 0.895, p = 0.001), and the duration of the surgery (AUC 0.895, p = 0.001). Furthermore, various routine and cost-effective variables related to the preoperative period, the early postoperative period, and the first day after surgery also demonstrated significant predictive value. Conclusions: We conducted a dynamic perioperative assessment of AKI associated with major vascular surgery. This aims to equip clinicians with a practical and cost-effective tool for evaluating AKI, thereby facilitating a more individualized approach to the diagnosis of this complication.