Background: Inflammatory response and the coagulation system are pivotal in the pathogenesis of clinical deterioration in chronic obstructive pulmonary disease (COPD), prompting us to hypothesize that the systemic coagulation-inflammation (SCI) index is associated with clinical deterioration in COPD. Methods: A cohort of 957 COPD patients (mean age: 68.4 ± 7.8 years; 74.4% male) from January 2018 to December 2021 was analyzed. Six machine learning models (XGBoost, logistic regression, Random Forest, elastic net (ENT), support vector machine (SVM), and K-nearest neighbors (KNN)) were evaluated using accuracy, precision, recall, F1-score, and the area under the receiver operating characteristic curve (AUC-ROC). Results: Our study encompassed 957 patients, out of which 171 were classified in the clinical deterioration of COPD (cd-COPD) cohort. Significant disparities in age, comorbidities like respiratory failure, C-reactive protein, lymphocyte count, red blood cell distribution width (RDW), SCI, procalcitonin (PCT), and D-dimer were depicted between the cd-COPD and non-cd-COPD groups. Concerning machine learning and model comparison, the SVM model showcased consistent performance and strong generalization capabilities on both the training and testing sets compared to the other five machine learning (ML) models. The SCI index, as the most influential predictor, demonstrated a median of 93.08 in cd-COPD compared to 81.67 in non-cd-COPD patients. Conclusion: The SCI is markedly elevated in cd-COPD patients compared to COPD patients, and SVM demonstrates reliable performance in cd-COPD prediction.

Spontaneous esophageal rupture or Boerhaave's syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality. Here, we aimed to explore the clinical characteristics, diagnosis, treatment, and prognosis of spon taneous esophageal rupture, and to analyze the causes of misdiagnosis during the treatment of spontaneous esophageal rupture. The clinical features of the patient with spontaneous esophageal rupture misdiagnosed earlier as pleural effusion were retrospectively analyzed and the reasons for misdiagnosis are discussed based on a current review of the literature. The patient was admitted to a local hospital due to shortness of breath accompanied by vomiting and abdominal distension for five hours. Based on the computed tomography (CT) scan analysis, clinically, right pleural effusion was diagnosed. However, the patient was unwilling to undergo right closed thoracic drainage. The patient also had intermittent fevers against infection, and during the course of treatment, he complained of chest pain, following which, he was transferred to our hospital. Grapefruit-like residue drainage fluid was observed. Re-examination of the chest CT scans suggested the presence of spontaneous perforation in the upper left esophagus. Therefore, the patient underwent an urgent esophageal hiatus repair. Unfortunately, the patient died of infection and respiratory failure due to progressive dyspnea after surgery. Spontaneous esophageal rupture is a rare disease associated with high fatality. The patients do not present typical clinical symptoms and the disease progresses rapidly. This case report highlights the importance of a dynamic review of chest CT scan, not only for the initial identification of segmental injury but also for prioritizing subsequent treatment strategies. Moreover, we have presented some clues for clinicians to recognize and diagnose spontaneous esophageal rupture at rare sites (upper-esophageal segment) through this case report of spontaneous esophageal rupture that caused the patient's death. We have also summarized the reasons for the misdiagnosis and lessons learned.

Background: The platelet-to-white blood cell ratio (PWR) has been associated with adverse outcomes in critically ill patients. Nonetheless, its prognostic significance in individuals with concurrent septic shock and heart failure remains insufficiently validated externally. This study sought to examine this association utilizing a large public database and to validate the findings in an independent real-world cohort. Methods: This retrospective cohort study included adult patients with septic shock and heart failure. The discovery cohort was derived from the MIMIC-IV and eICU databases. The validation cohort was retrospectively collected from The Central hospital of Enshi Tujia and Miao Autonomous Prefecture (August 2023–June 2025). The primary outcome was ICU mortality. Multivariable Cox regression, Kaplan-Meier analysis, and subgroup analyses were performed. Results: The study incorporated 934 patients in the discovery cohort and 124 patients in the validation cohort. In the discovery cohort, restricted cubic spline analysis demonstrated a linear relationship between platelet-to-white blood cell ratio (PWR) and mortality (nonlinearity P=0.655), prompting a tertile-based classification (Q1: ≤ 9.95; Q2: > 9.95–≤ 17.72; Q3: > 17.72). Compared to Q1, Q3 was associated with significantly reduced ICU mortality in the fully adjusted model (HR 0.66, 95% CI 0.44– 0.99). Applying the same cut-off (9.95) in the validation cohort, patients with a low PWR (≤ 9.95) exhibited significantly higher mortality compared to those with a high PWR (> 9.95) (HR 3.11, 95% CI 1.46– 6.66; log-rank P=0.002). Subgroup analyses substantiated the robustness of these findings. Conclusion: A reduced platelet-to-white blood cell ratio serves as an independent predictor of elevated ICU mortality among patients experiencing septic shock and heart failure. This straightforward and cost-effective biomarker demonstrated a consistent association in an external real-world cohort, underscoring its potential utility for early risk stratification.

Objective: To characterize the link of the C-reactive protein-albumin-lymphocyte index (CALLY index) to preserved ratio impaired spirometry (PRISm), and to determine its incremental contribution to PRISm risk prediction in clinical practice. Methods: A total of 189 participants were included in this study and were classified into the PRISm group ( n = 70) and the non-PRISm group ( n = 119) according to the presence or absence of PRISm. Baseline demographic characteristics, comorbidities, and laboratory parameters were collected. Multivariable Logistic regression models with sequential adjustment for confounding factors were used to assess the independent association between the CALLY index and PRISm. Restricted cubic splines (RCS) and subgroup analyses were performed to evaluate the robustness of this association. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were used to assess the incremental clinical predictive value of the CALLY index. Results: The CALLY index was significantly lower in the PRISm group than in the non-PRISm group (1.4 ± 2.5 vs. 4.7 ± 8.1, P < 0.001). In the fully adjusted model controlling for 11 confounding factors (adjusted model II), each one-unit increase in the CALLY index as a continuous variable was associated with 16% lower odds of PRISm (OR = 0.84, 95% CI: 0.74–0.95, P = 0.007). After dichotomizing the CALLY index, the high-level group showed 73% lower odds of PRISm than the low-level group (OR = 0.27, 95% CI: 0.13–0.57, P < 0.001). The RCS curve demonstrated a significant inverse trend between the CALLY index and the odds of PRISm. Subgroup analyses indicated that this inverse association remained robust across populations stratified by age, gender, smoking history, and comorbidities. In addition, after the CALLY index was incorporated into a model containing baseline clinical characteristics, the area under the ROC curve (AUC) increased significantly from 0.611 to 0.703 ( P = 0.003), and DCA further confirmed a higher net clinical benefit. Conclusion: A high CALLY index is independently associated with lower odds of PRISm. Integrating the CALLY index into routine clinical assessment can significantly improve the predictive performance for PRISm and provide net clinical benefit.