Early risk stratification is essential for determining the appropriate therapeutic management approach of pulmonary embolism (PE). This study aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients hospitalized with acute pulmonary embolism by investigating its association with mortality in a large-scale population diagnosed and hospitalized with acute PE. We retrieved all consecutive patients hospitalized in an internal medicine department or an intensive care unit in a tertiary medical center from December 2007 to April 2021 with a discharge diagnosis of pulmonary embolism. A total of 2072 patients were included. Patients with above-median NLR (i.e., 5.12) had a higher 30-day mortality risk (adjusted odds ratio (aOR), 2.82; 95% confidence interval (CI) 2.14–3.70) and higher one-year mortality risk (aOR, 2.51; 95% CI 2.04–3.08). Similar trends were demonstrated in a sub-analysis of patients without cancer and hemodynamically stable (i.e., systolic blood pressure over 90 mmHg). Furthermore, the median hospital length of stay in patients with an elevated NLR was higher, and so was the in-hospital mortality rate. Elevated NLR in acute PE is associated with a worse short-term and long-term prognosis and with a longer duration of hospitalization.

Solid organ transplant recipients were demonstrated to have reduced antibody response to the first and second doses of the COVID-19 mRNA vaccine. This review evaluated published data on the efficacy and safety of the third dose among solid organ transplant recipients. We performed a systematic search of PubMed, EMBASE, and Web of Science to retrieve studies evaluating the efficacy of the third dose of anti-SARS-CoV-2 vaccines in adult solid organ transplant recipients. Serologic response after the third vaccine was pooled using inverse variance and generalized linear mixed and random-effects models. Seven studies met our inclusion criteria. A total of 853 patients received the third dose. Except for one randomized controlled trial, all studies were retrospective in design. Following the third COVID-19 vaccine dose, antibody response occurred in 6.4–69.2% of patients. The pooled proportion of antibody response rate after the third vaccine was 50.3% (95% confidence interval (CI): 37.1–63.5, I² = 90%). Five papers reported the safety profile. No severe adverse events were observed after the third vaccine dose. In conclusion, a third dose of the SARS-CoV-2 mRNA vaccine in solid organ transplant recipients is associated with improved immunogenicity and appears to be safe. Nevertheless, a significant portion of patients remain seronegative.

We aimed to investigate the prevalence of decreased folate levels in patients hospitalized with Coronavirus Disease 2019 (COVID-19) and evaluate their outcome and the prognostic signifi-cance associated with its different levels. In this retrospective cohort study, data were obtained from the electronic medical records at the Sheba Medical Center. Folic acid levels were available in 333 out of 1020 consecutive patients diagnosed with COVID-19 infection hospitalized from January 2020 to November 2020. Thirty-eight (11.4%) of the 333 patients comprising the present study population had low folate levels. No significant difference was found in the incidence of acute kidney injury, hypoxemia, invasive ventilation, length of hospital stay, and mortality be-tween patients with decreased and normal-range folate levels. When sub-dividing the study population according to quartiles of folate levels, similar findings were observed. In conclusion, decreased serum folate levels are common among hospitalized patients with COVID-19, but there was no association between serum folate levels and clinical outcomes. Due to the important role of folate in cell metabolism and the potential pathologic impact when deficient, a follow-up of folate levels or possible supplementation should be encouraged in hospitalized COVID-19 patients. Fur-ther studies are required to assess the prevalence and consequences of folate deficiency in COVID-19 patients.

Pneumonia in hospitalized patients is associated with myocardial injury. In this study, we evaluated risk factors for myocardial injury in hospitalized patients with pneumonia and its prognostic value. We retrieved all patients who were hospitalized in internal medicine departments in a tertiary medical center between 2008 and 2019 with a diagnosis of pneumonia. From 2008 to 2019 a total of 20,683 adult patients were hospitalized in internal medicine wards in the Sheba Medical Center with a diagnosis of pneumonia, 8195 were tested for troponin levels, and 3207 had elevated levels. Risk factors for elevated troponin levels were age, prior diagnosis of ischemic heart disease, and elevated creatinine level upon admission. The in-hospital mortality and 1-year mortality rate were higher among patients who had elevated troponin levels when using a propensity score-based matched analysis. In conclusion, in hospitalized patients with pneumonia elevated troponin levels have a major impact on prognosis. Hence, troponin levels may be used as another tool of risk stratification for patients hospitalized with pneumonia.

Key Points: Sodium-glucose cotransporter 2 (SGLT2) inhibitors were associated with a reduced prevalence of hyponatremia and a lower risk of hospitalizations because of hyponatremia. SGLT2 inhibitors were associated with a reduced prevalence of hypernatremia and a lower risk of hospitalizations because of hypernatremia. SGLT2 inhibitors could serve as a therapeutic option for patients with hyponatremia and potentially lower health care costs caused by it. Background: To investigate the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on the prevalence, severity, and complications of hyponatremia and hypernatremia in diabetic patients using real-world data, compared with dipeptidyl peptidase 4 (DPP4) inhibitors. Methods: This was a retrospective cohort study, and the dataset was sourced from the data repositories of Clalit Health Services. From January 1, 2016, through December 31, 2021, we identified diabetic patients who received SGLT2 inhibitors, comparing them with a propensity matched control group treated with DPP4 inhibitors. The coprimary end points were a composite outcome of the prevalence of severe hyponatremia and hospitalizations because of hyponatremia and the prevalence of moderate hypernatremia and hospitalizations because of hypernatremia. Results: The study included 22,686 patients, with 11,343 receiving SGLT2 inhibitors and an equal number treated with DPP4 inhibitors. A significant reduction in the risk of the hyponatremia primary composite outcome was observed in patients treated with SGLT2 inhibitors (hazard ratio [HR], 0.60; 95% confidence intervals [CI], 0.53 to 0.69), as well as in the risk of the hypernatremia composite primary with a HR of 0.54 (95% CI, 0.44 to 0.63), compared with DPP4 inhibitors. In addition, the risk of hospitalizations because of hyponatremia and hypernatremia was significantly lower in the SGLT2 inhibitor group (HR, 0.64; 95% CI, 0.54 to 0.74; P < 0.001; and HR, 0.55; 95% CI, 0.36 to 0.74; P = 0.002; respectively). Conclusions: SGLT2 inhibitors were associated with a reduced prevalence of hyponatremia and a lower risk of hyponatremia-related hospitalizations compared with DPP4 inhibitors in patients with diabetes.