Pulmonary complications are an important yet underappreciated aspect of inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC). These conditions often manifest with extraintestinal symptoms that can significantly influence the clinical trajectory of the disease. Pulmonary involvement in IBD can range from mild symptoms, such as a persistent cough, to severe conditions, including interstitial lung disease or pulmonary embolism. This systematic review aims to assess the prevalence, clinical presentations, and implications of pulmonary involvement in IBD patients. A comprehensive literature search was conducted using PubMed database up to the 1st of May 2024. Inclusion criteria focused on studies involving adult IBD patients with documented pulmonary symptoms, evaluated through clinical, radiological, and histopathological approaches. Of the 463 studies identified, 27 met the inclusion criteria, consisting of 36,264 patients. Pulmonary manifestations were classified into airway diseases and parenchymal involvement. Airway diseases, including bronchiectasis and chronic bronchitis, were the most common, followed by parenchymal conditions such as organizing pneumonia and interstitial lung disease (ILD). Smoking was identified as a significant risk factor for pulmonary involvement. Pulmonary involvement in IBD is diverse and often underdiagnosed. Early recognition and management are crucial to improving patient outcomes.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) necessitates advanced prognostic tools to anticipate disease progression and optimize patient outcomes. This study evaluates the predictive value and diagnostic potential of interleukins interleukin (IL) IL-10, IL-17A, IL1-β, IL-6, chemokine ligand (CXCL), and Monocyte Chemotactic Protein (MCP) for severe coronavirus disease 2019 (COVID-19) and COVID-19 mortality, aiming to correlate cytokine levels with disease severity. Conducted from January 2023 to January 2024, this prospective cohort study involved patients hospitalized with moderate and severe COVID-19 from Romania. This study analyzed statistically significant predictors of severe COVID-19 outcomes. IL-6 and MCP emerged as significant, with hazard ratios (HRs) of 2.35 (95% confidence interval (CI): 1.54–3.59, p = 0.014) and 2.05 (95% CI: 1.22–3.45, p = 0.007), respectively. Compound scores integrating multiple inflammatory markers also demonstrated predictive value; Compound Score 2 had an HR of 2.23 (95% CI: 1.35–3.68, p = 0.002), surpassing most single markers in association with severe disease. Notably, interleukins IL-10 and IL-1β did not show significant associations with disease severity. This study underscores the importance of IL-6 and MCP as robust predictors of severe COVID-19, substantiating their role in clinical assessments to foresee patient deterioration. The utility of compound scores in enhancing predictive accuracy suggests a composite approach may be more effective in clinical settings.

Background: Psychological distress is a common comorbidity in chronic obstructive pulmonary disease (COPD), yet its relationship with disease severity remains incompletely understood. This study aimed to assess depression, anxiety, and stress using the Depression Anxiety Stress Scales–21 (DASS-21) and to examine their distribution across COPD severity stages. Methods: This multicenter, cross-sectional observational study included 285 clinically stable COPD patients enrolled between 2023 and 2025. COPD severity was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Multinomial and binary logistic regression models were constructed to identify independent predictors of COPD severity and clinically significant psychological distress, adjusting for demographic and clinical covariates. Bayesian independent sample analyses and ANOVA effect size estimates were additionally performed. Results: Smoking exposure was independently associated with advanced COPD stages (GOLD 4 vs. GOLD 1–3: aOR 1.05, p < 0.001), as was dyspnea severity (mMRC: aOR 14.66, p < 0.001). In multivariable models examining psychological outcomes, COPD severity was not independently associated with clinically significant depression (p = 0.899), anxiety (p = 0.460), or stress (p = 0.843). In contrast, symptom burden measured using the COPD Assessment Test (CAT) score was consistently associated with depression (aOR 1.133, p < 0.001), anxiety (aOR 1.179, p < 0.001), and stress (aOR 1.144, p < 0.001). ANOVA effect sizes across GOLD stages were small (η² ≤ 0.047), and Bayesian analyses provided moderate to strong evidence supporting minimal differences in DASS-21-R scores between severity groups. Conclusions: Psychological distress is prevalent across all COPD severity stages and is not independently determined by airflow limitation. Symptom burden rather than spirometric severity appears to be more closely associated with emotional outcomes.

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by psychological distress, but the relationship between GOLD stage, dyspnea, functional limitation, and depression/anxiety symptoms remains incompletely defined. This study examined clinical and psychological profiles across GOLD stages, with particular attention to GOLD stages 3 and 4. Methods: This multicenter observational study included 285 adults with spirometry-confirmed COPD evaluated in Romania between 2023 and 2026. COPD severity was classified according to GOLD stages. Clinical assessment included FEV1, peripheral oxygen saturation, smoking exposure, the COPD Assessment Test (CAT), and the modified Medical Research Council dyspnea scale (mMRC). Psychological and well-being measures included DASS depression, anxiety, and stress scores; WHO-5; major depressive disorder score, and generalized anxiety disorder score. Descriptive analyses were performed across GOLD stages, and GOLD 3 was directly compared with GOLD 4. Results: GOLD 3 was the largest subgroup (n = 106, 37.2%), followed by GOLD 4 (n = 81, 28.4%), GOLD 2 (n = 69, 24.2%), and GOLD 1 (n = 29, 10.2%). GOLD 3 patients showed marked dyspnea and symptom burden, with mean mMRC = 2.92 and CAT = 24.44. DASS depression, anxiety, and stress scores were higher in GOLD 3 than GOLD 2, but did not increase further in GOLD 4. Direct GOLD 3 versus GOLD 4 comparisons showed no significant differences in DASS depression or DASS anxiety, whereas GOLD 4 had a significantly higher mMRC, major depressive disorder score, and generalized anxiety disorder score. Conclusions: GOLD 3 COPD was associated with substantial dyspnea, functional limitation, and measurable psychological distress. However, depression and anxiety patterns varied by instrument, suggesting that psychological burden in COPD is multidimensional and not explained by spirometric severity alone.

Endocrine disturbance and impaired physical reserve coexist in cirrhosis, but female-specific associations between circulating sex hormones and frailty remain insufficiently characterized. We examined hormone–frailty associations across menopausal categories in a clinical database of women with cirrhosis. This exploratory, single-centre, record-based cross-sectional analysis used retrospectively reviewed clinical records of 94 women with cirrhosis treated at “Sf. Apostol Andrei” Emergency County Hospital, Constanța, Romania, during January 2021–March 2025. The continuous Liver Frailty Index (LFI) was the principal outcome; handgrip strength and L3 skeletal muscle index were complementary phenotypes. Six separate linear models evaluated estradiol, follicle-stimulating hormone (FSH), luteinizing hormone, progesterone, total testosterone, and sex hormone-binding globulin, adjusting for age, recorded MELD-Na, and body mass index. HC3 heteroscedasticity-robust confidence intervals and Benjamini–Hochberg false-discovery-rate correction were used. Sensitivity analyses addressed menopausal status, exogenous hormones, inflammation, disease severity, sampling context, and severe hepatic encephalopathy (HE). There were 10 premenopausal, 11 perimenopausal, and 73 postmenopausal women. Median LFI was 3.76 (interquartile range, 3.14–4.48); 25 women (26.6%) had LFI ≥ 4.4. Estradiol was not clearly associated with LFI after adjustment: coefficient −0.022 per doubling (95% confidence interval, −0.257 to 0.214; p = 0.855). FSH was associated with higher LFI: 0.125 per 10 mIU/mL (0.042–0.208; p = 0.004; adjusted q = 0.022). The FSH estimate remained positive in postmenopausal women, but its interval crossed zero after excluding records labelled with severe HE. No hormone–muscle correlation survived correction across 18 exploratory comparisons. FSH, but not estradiol, showed an adjusted cross-sectional association with frailty. These findings do not establish causality, prognostic utility, or an indication for hormone treatment. Unresolved sampling-context and physical-assessment timing require source-record verification before clinical interpretation.

Machine learning (ML) studies of the gut microbiota rarely test whether microbial data add anything to routine clinical and inflammatory markers. We examined this question in inflammatory bowel disease (IBD) using quantitative stool culture. In this exploratory case–control study, 52 adults with IBD and 34 hospital controls underwent clinical, anthropometric, bioimpedance, biochemical and inflammatory assessment, together with quantitative stool culture interpreted against laboratory reference intervals. Six classifiers were evaluated with repeated nested cross-validation (5 folds × 10 repeats) using culture-only (23), clinical-only (78) and integrated (101) feature sets, and were compared with single inflammatory markers and a three-marker logistic model. Calibration, decision curves and both impurity-based and permutation importance were assessed. After false discovery rate correction, the IBD group had higher C-reactive protein (CRP), high-sensitivity CRP and interleukin-6 (IL-6), higher body mass index, and lower fasting glucose and dietary fibre intake. Culture differences, such as more frequent overgrowth above reference intervals (90.4% vs. 64.7%, q = 0.056), did not survive correction. Gradient boosting reached an AUC of 0.912 [95% CI 0.855–0.969] on the integrated set. The clinical-only model performed similarly (AUC 0.903 [95% CI 0.841–0.964], DeLong p = 0.367), and a logistic model on CRP, hs-CRP and IL-6 discriminated comparably (AUC 0.885 [95% CI 0.808–0.962]). The culture-only model discriminated weakly (AUC 0.637 [95% CI 0.508–0.765]) and was not distinguishable from chance in a label-permutation test (p = 0.25). Within IBD, the treatment-response model (AUC 0.789 [95% CI 0.655–0.924]) did not outperform disease severity alone (AUC 0.87), because all responders had mild disease. In this cohort, discrimination between IBD and controls came from systemic inflammatory markers, and quantitative stool culture added no measurable value. These results do not support diagnostic or screening use; studies including faecal calprotectin, symptomatic controls and external validation are needed.