Background: Sepsis remains a significant global health challenge, causing approximately 11 million deaths annually. The calculated globulin (CG) level, which is derived from total protein and albumin levels, plays crucial roles in the immune response and inflammation. However, the relationship between the CG level and sepsis mortality remains unexplored. Methods: This retrospective cohort study analyzed sepsis patients from the eICU Collaborative Research Database. The primary outcome was 28-day ICU mortality. The relationship between the CG level and mortality was examined via generalized additive models with penalized splines and two piecewise linear regression models. Confounders were adjusted in multivariate analyzes. Results: The overall 28-day ICU mortality was 10.0% among 9110 sepsis patients (mean age 65.3 ± 15.9 years, 48.7% male). An L-shaped relationship was observed between CG level and mortality, with a threshold of 2.9 g/dL (95% CI: 2.8– 2.9). This pattern revealed that mortality risk decreased sharply as globulin levels increased to 2.9 g/dL and then plateaued thereafter. Below this threshold, each 1 g/dL increase in the CG was associated with a significantly reduced mortality risk (adjusted OR = 0.51, 95% CI: 0.40– 0.64, P < 0.0001). Above 2.9 g/dL, no significant association was observed (OR = 1.04, 95% CI: 0.90– 1.19; P = 0.622). These findings remained robust in sensitivity analyzes using hospital mortality as the outcome. Conclusion: This study revealed an L-shaped relationship between CG level and sepsis mortality, with lower CG levels independently associated with increased mortality risk. This finding provides a simple and cost-effective indicator for risk stratification in sepsis patients, facilitating early identification of high-risk individuals and informing clinical decision-making.

The associations between blood count-derived inflammatory indices and mortality risk in individuals with diabetes and prediabetes have gained attention, but systematic studies are lacking. Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed to investigate various inflammatory indices (such as the SII and NLR) in relation to all-cause mortality, cardiovascular disease (CVD) mortality, and diabetes-specific mortality via the Cox proportional hazards model. A total of 12,119 participants were included, with an average age of 60 years and approximately 52 % being male. During the follow-up, the overall mortality rate was 25.7 %. All nine inflammatory indices were significantly associated with all-cause mortality and CVD mortality (P < 0.01), and eight indices were correlated with diabetes-specific mortality. Eight indices exhibited significant nonlinear relationships with all-cause mortality, with the exception of the NPR, whereas theSIRI, PLR, NPR, and MPRshowed significant nonlinear associations with CVD mortality. Inflammatory indices such as the SII, SIRI, and NLR are significantly associated with all-cause and CVD mortality among U.S. adults with diabetes and prediabetes, demonstrating index-specific association patterns and threshold characteristics.

Background and objective: Despite advances in intensive care, sepsis remains a leading cause of mortality in intensive care unit (ICU) patients, especially middle-aged and elderly individuals. Given the limitations of conventional scoring systems and the interpretability challenges of machine learning models, this study aims to develop and temporally validate a nomogram for predicting 28-day ICU mortality in middle-aged and elderly sepsis patients via the eICU database (2014--2015), providing a clinically practical prediction tool. Methods: This retrospective study included 13,717 sepsis patients aged ≥45 years. The cohort was temporally divided into training (n = 6,397, 2014) and validation (n = 7,320, 2015) sets. Variable selection was performed via random forest importance ranking and LASSO regression. A nomogram was developed on the basis of multivariable logistic regression analysis. Results: The 28-day ICU mortality rates were 9.08% and 9.49% in the training and validation cohorts, respectively. The final nomogram incorporated 11 independent predictors: red cell distribution width (RDW), SOFA score, lactate, pH, 24-hour urine output, platelet count, total protein, temperature, heart rate, GCS score, and white blood cell (WBC) count. The model showed good discrimination in both the training (AUC: 0.805) and validation (AUC: 0.756) cohorts. The calibration curves demonstrated good agreement between the predicted and observed probabilities. Conclusions: We developed and temporally validated a nomogram with good predictive performance for 28-day ICU mortality in middle-aged and elderly sepsis patients, providing a practical tool for risk stratification and clinical decision-making.

Axial gout is an underrecognized manifestation of monosodium urate (MSU) crystal deposition and frequently mimics inflammatory, infectious, or mechanical spinal disorders, particularly without overt hyperuricaemia. We report a 29-year-old man with recurrent low back pain for over two years and recurrent nephrolithiasis who had undergone three extracorporeal shock wave lithotripsy sessions with only transient relief. Admission laboratory investigations showed normal serum urate (262 µmol/L, ~ 4.4 mg/dL) but markedly elevated C‑reactive protein (119 mg/L) and erythrocyte sedimentation rate (53 mm/h). Retrospective review of prior hospitalizations for ureteral stones revealed that routine serum urate measurements had never been elevated. Conventional imaging, including plain radiography and non‑contrast computed tomography, was inconclusive. Dual‑energy computed tomography (DECT) revealed MSU deposition in the L4/L5 and L5/S1 facet joints and sacral foramina, supporting the diagnosis of axial gout. The patient was treated with etoricoxib (60 mg daily) and febuxostat (20 mg daily). On telephone follow‑up on 27 May 2026 (the only follow‑up to date), he reported that the J stent had been removed and low back pain had completely resolved without recurrence. A single repeat laboratory test performed locally was reported as normal, though specific values were unavailable. A systematic literature review of 58 eligible articles revealed that the lumbar spine was most frequently involved (≈ 60%), DECT sensitivity ranged from 78% to 100%, and 77.5% of historically reported cases required surgical diagnosis, underscoring the underrecognition of axial gout in non-surgical settings. This case‑based review highlights that axial gout should be considered in young non‑hyperuricaemic patients with persistent axial pain, and that DECT is a valuable non‑invasive diagnostic tool when interpreted alongside clinical and laboratory features.