Background: The prognostic value of baseline inflammatory markers in sepsis remains controversial, with conflicting evidence regarding their association with mortality. The dynamic changes in these markers over time might offer additional insights into disease progression and patient outcomes. Methods: This retrospective observational study included 138 patients with severe infections. The inflammatory biomarkers procalcitonin (PCT), C-reactive protein (CRP), and lactate (LAC) were measured at three time points: upon hospital admission (baseline), approximately 24–48 h after admission (second measurement; M2), and 48–72 h after admission (third measurement; M3). The primary outcome was 30-day mortality. A Mann–Whitney U test was used to compare the biomarker levels between the survivors and non-survivors. A Spearman’s correlation was used to assess the relationships between the baseline parameters. A logistic regression and a receiver operating characteristic (ROC) curve analysis were employed to evaluate the prognostic value of the baseline markers and their dynamic changes. Results: The baseline LAC and SOFA score were significantly associated with 30-day mortality. The percentage decrease in PCT, CRP, and LAC from the baseline to M3 emerged as strong predictors of survival, with the ROC curve analysis demonstrating superior discriminatory ability compared to the baseline values. CRP_Delta exhibited the highest AUC (0.903), followed by PCT_Delta (0.843) and LAC_Delta (0.703). Conclusions: The dynamic changes in these inflammatory biomarkers, particularly PCT, CRP, and LAC, offer valuable prognostic information beyond their baseline levels in predicting 30-day mortality in severe infections. These findings highlight the importance of monitoring biomarker trends for early risk stratification and potential treatment guidance.

Urinary tract infections (UTIs) remain a leading cause of healthcare-associated morbidity, particularly in patients with indwelling urinary catheters. This study aimed to compare catheter-associated (CAUTIs) and non-catheter-associated UTIs of the lower tract among hospitalized adults in Western Romania, identify potential predictors of prolonged hospital stay, and explore the interplay of inflammatory markers and clinical outcomes. We retrospectively examined 130 patients diagnosed with UTIs from 2020 to 2024. Demographic data, comorbidities, laboratory parameters (CRP, procalcitonin, fibrinogen, white blood cell counts), and microbiology results were assessed. Patients were divided into CAUTI (n = 72) and non-catheter UTI (n = 58) groups. CAUTI patients had a significantly longer mean hospital stay (13.9 ± 4.3 vs. 11.7 ± 3.8 days, p = 0.01). E. coli (29.2%), Klebsiella pneumoniae (18.5%), and mixed flora (11.5%) predominated overall, with Pseudomonas aeruginosa trending higher in CAUTIs (15.3% vs. 5.2%). Diabetic status correlated with higher CRP (54.7 ± 18.2 vs. 46.9 ± 15.7 mg/dL, p = 0.04) and increased intensive care unit (ICU) admission (23.5% vs. 9.4%, p = 0.03). In a subgroup of 65 patients, CRP demonstrated a moderate positive correlation with length of stay (r = 0.47, p = 0.02). Logistic regression indicated that CAUTI was associated with 2.3-fold higher odds of extended hospitalization (95% CI: 1.2–4.4, p = 0.02), adjusting for age, diabetes, and CRP levels. CAUTIs are linked to more resistant pathogens, longer hospitalizations, and potentially greater clinical complications. Diabetes further compounds risk, as reflected in higher inflammatory markers and ICU admissions.

(1) Background: Since the advent of zidovudine in 1987, antiretroviral therapy has undergone significant evolution, marked by the introduction of 34 antiretroviral drugs and 24 fixed-dose combinations. Despite these advances, hepatotoxicity remains a formidable challenge, influencing morbidity, mortality, and treatment adherence in HIV-infected patients. This study aims to compare the hepatotoxic effects of latest-generation antiretroviral medications with those of older-generation therapies, assessing their long-term impact on liver health in HIV patients. (2) Methods: This retrospective study analyzed data from 304 HIV patients treated with either latest-generation or older-generation antiretroviral drugs over four years. Patients were monitored for hepatotoxicity through liver function tests at diagnosis, six months, and one-year post-treatment initiation. (3) Results: Initial and six-month liver function tests showed no significant differences between the two groups. However, at one-year post-treatment, patients on latest-generation antiretrovirals exhibited significant improvements in ALT, AST, and ALP levels, suggesting a better safety profile regarding hepatotoxicity. Additionally, a significantly lower incidence of splenomegaly was observed in patients treated with newer medications. (4) Conclusions: The findings suggest that the latest-generation antiretroviral medications may offer a safer profile in terms of hepatotoxicity compared to older therapies, with potential benefits for long-term liver health. This study underscores the importance of continuous monitoring and further research to optimize ART strategies, ensuring improved patient outcomes and quality of life for individuals living with HIV.

Background/Objectives: Obstructive urosepsis mandates rapid source control, yet actionable time-to-decompression (TTD) thresholds and the influence of diversion route remain debated. This review synthesized evidence on TTD, early outcomes, and predictive biomarkers. Methods: Following PRISMA-2020, ten studies met eligibility: three large administrative cohorts and seven clinical series/trials comparing outcomes by TTD and/or initial decompression (retrograde stent [RUS] vs. percutaneous nephrostomy [PCN]) and reporting biomarkers. Results: Delays were consistently harmful. In a national cohort, a TTD of ≥ 2 days increased in-hospital mortality (adjusted OR, 1.29; 95% CI, 1.03–1.63). Another analysis showed mortality of 0.16% with ≤48 h vs. 0.47% when delayed (derived OR, 0.43; p = 0.044). Absence of decompression yielded the highest mortality (19.2% vs. 8.82%; OR, 2.6; 95% CI, 1.9–3.7). Septic shock remained frequent despite low crude mortality in clinical series: 20.8% and 33.3% across two cohorts. Post-decompression urosepsis occurred in 18.7% in a randomized study and was associated with pyonephrosis and higher procalcitonin (PCT). An ED cohort showed that earlier stenting reduced length of stay (≤6 h: 35.6 h vs. 71.6 h, p = 0.01; ≤10 h: 45.7 h vs. 82.4 h, p = 0.04). Modality effects were modest; one cohort reported higher ICU use with PCN vs. RUS (OR, 3.23; 95% CI, 1.24–8.41), likely reflecting confounding by indication. Conclusions: Across designs, timeliness—not device choice—was the dominant determinant of early outcomes. Biomarkers (notably, PCT) and imaging features can prioritize ultra-early decompression.

Background and Objectives: Early bedside tools that flag non-response in hospitalized adults with lower urinary tract infection (UTI) could align clinical care with antimicrobial stewardship. We evaluated REACT-UTI, a 72 h composite combining C-reactive protein (CRP) clearance ≥35%, defervescence (temperature < 37.5 °C), and ≥2-point symptom improvement, to predict early non-response and hospital length of stay (LOS), and we assessed modifiable processes of care. Methods: We conducted a prospective observational study of adults with culture-confirmed lower UTI (n = 126) admitted to a tertiary hospital in Timișoara (December 2023–August 2025). The primary outcome was 72 h early clinical response (ECR) defined by REACT-UTI. Multivariable logistic regression examined associations of catheter-associated UTI (CAUTI), time-to-effective therapy, baseline CRP, diabetes, early catheter removal/exchange (≤48 h), and early intravenous-to-oral switch (≤72 h) with non-response. Results: Overall, 76/126 patients (60.3%) achieved ECR. Non-responders more often had CAUTI, higher baseline CRP, longer time-to-effective therapy, ESBL or fluoroquinolone-resistant Enterobacterales, and longer LOS (14.1 vs. 9.8 days; p < 0.001). Adjusted models showed that CAUTI, delayed active therapy, higher baseline CRP, and diabetes increased the odds of non-response, whereas early catheter removal (adjusted odds ratio [aOR] 0.5, 95% confidence interval [CI] 0.3–0.9) and early IV-to-oral switch (aOR 0.4, 0.2–0.8) were protective. Greater CRP clearance correlated with shorter LOS (ρ = −0.52; p < 0.001). Conclusions: In this single-center setting with a high burden of antimicrobial resistance, REACT-UTI at 72 h identified patients at risk of early non-response and prolonged hospitalization and highlighted actionable levers—timely active therapy, catheter management, and early oral step-down. External validation in diverse settings is needed before broader implementation.

Background/Objectives: Sepsis is clinically dynamic, and isolated admission biomarker values may insufficiently capture early biological evolution after treatment initiation. This study evaluated whether routine biomarker reassessment at approximately 48 h provides incremental prognostic information beyond admission Sequential Organ Failure Assessment (SOFA) score for 28-day mortality in sepsis. The analysis was framed as an exploratory 48 h landmark prognostic assessment among patients who were alive and had complete biomarker reassessment data at 48 ± 6 h. Methods: We conducted a prospective single-center observational cohort study including adult patients with sepsis. Clinical and laboratory data were collected at baseline (M1) and repeated 48 ± 6 h later (M2). The primary outcome was 28-day mortality. Candidate biomarkers included C-reactive protein (CRP), procalcitonin (PCT), lactate (LAC), and neutrophil-to-lymphocyte ratio (NLR). PCT clearance and NLR change were calculated as relative changes between M1 and M2, whereas 48 h CRP and 48 h lactate were evaluated as early reassessment values. Exploratory logistic regression models were constructed using admission SOFA as the clinical reference model. Model discrimination and fit were summarized using receiver operating characteristic analysis, likelihood-ratio testing, and Nagelkerke R²; the models were not intended as validated individual-level risk calculators. Results: The 48 h landmark analytical cohort included 126 patients, of whom 44 (34.9%) died within 28 days. Admission biomarker values showed limited prognostic signal. SOFA alone showed fair discrimination (AUC 0.740). Among the primary SOFA-augmented models, SOFA plus PCT clearance showed the highest discrimination and explanatory performance (AUC 0.810; Nagelkerke R² 0.332) and significantly improved model fit compared with SOFA alone. SOFA plus NLR change and SOFA plus 48 h lactate also provided incremental prognostic information, although their gains were more modest. In exploratory combined modeling, SOFA plus PCT clearance and NLR change provided the most coherent additional signal, with all predictors retaining independent associations with 28-day mortality. Conclusions: In this exploratory single-center 48 h landmark analysis, selected routine biomarker reassessment measures were associated with 28-day mortality beyond admission SOFA. PCT clearance provided the clearest incremental prognostic signal, while NLR change offered complementary information. Persistent 48 h lactate elevation was also informative, whereas lactate clearance was not. These findings should be interpreted as hypothesis-generating and require validation in larger cohorts, ideally including serial organ dysfunction measures such as 48 h SOFA or SOFA change.