Dementia is associated with high rates of admission to hospital, due to acute illness, and in-hospital mortality. The study aimed to investigate the impact of dementia on in-hospital mortality and identify the predictors of in-hospital mortality in these patients. This was a retrospective study evaluating all the patients ≥65 years consecutively admitted to our Emergency Department (ED). We compared the clinical outcomes of the patients with dementia at ED admission with those who did not have dementia, using a propensity score-matched (PSM) paired cohort of controls. The patients were matched for age, sex, Charlson Comorbidity Index value, and clinical severity at presentation (based on NEWS ≥ 5). The primary study endpoint was all-cause in-hospital death. After the PSM, a total of 7118 patients, 3559 with dementia and 3559 in the control group, were included in the study cohort. The mean age was 84 years, and 59.8% were females. The overall mortality rate was higher for the demented patients compared with the controls (18.7% vs. 16.0%, p = 0.002). The multivariate-adjusted hazard ratio (HR) showed that dementia was an independent risk factor for death (HR 1.13 [1.01–1.27]; p = 0.033). In the patients with dementia, respiratory failure (HR 3.08 [2.6–3.65]), acute renal failure (HR 1.64 [1.33–2.02]; p < 0.001), hemorrhagic stroke (HR 1.84 [1.38–2.44]; p < 0.001), and bloodstream infection (HR 1.41 [1.17–1.71]; p = 0.001) were significant predictors of worse outcomes. Finally, the comorbidities and severity of illness at ED admission negatively influenced survival among the patients with dementia (CCI HR 1.05 [1.01–1.1] p = 0.005; NEWS ≥ 5 HR 2.45 [1.88–3.2] p < 0.001). In conclusion, among the hospitalized older patients, dementia was associated with a higher risk of mortality. Furthermore, among the older patients with dementia, respiratory failure and bloodstream infections were independently associated with an increased risk of in-hospital mortality.

Peripheral arterial disease (PAD) is a prevalent medical condition associated with high mortality and morbidity rates. Despite the high clinical burden, sex-based differences among PAD patients are not well defined yet, in contrast to other atherosclerotic diseases. This study aimed to describe sex-based differences in clinical characteristics and outcomes among hospitalized patients affected by PAD. This was a retrospective study evaluating all patients with a diagnosis of PAD admitted to the Emergency Department from 1 December 2013 to 31 December 2021. The primary endpoint of the study was the difference between male and female PAD patients in cumulative occurrence of Major Adverse Cardiovascular Events (MACEs) and Major Adverse Limb Events. A total of 1640 patients were enrolled. Among them, 1103 (67.3%) were males while females were significantly older (median age of 75 years vs. 71 years; p =< 0.001). Females underwent more angioplasty treatments for revascularization than men (29.8% vs. 25.6%; p = 0.04); males were treated with more amputations (19.9% vs. 15.3%; p = 0.012). A trend toward more MALEs and MACEs reported in the male group did not reach statistical significance (OR 1.27 [0.99–1.64]; p = 0.059) (OR 0.75 [0.50–1.11]; p = 0.153). However, despite lower extremity PAD severity seeming similar between the two sexes, among these patients males had a higher probability of undergoing lower limb amputations, of cardiovascular death and of myocardial infarction. Among hospitalized patients affected by PAD, even if there was not a sex-based significant difference in the incidence of MALEs and MACEs, adverse clinical outcomes were more common in males.

Today, few clinicians are still convinced that lipids are sepsis risk factors in patients receiving parenteral nutrition. This dogma is principally based on old literature. This review deals with the most recent literature search that provided up-to-date data over the past ten years. Systematic research was performed on Pubmed, MEDLINE, and Web of Science. The recent evidence does not justify the exclusion of lipid emulsions in patients receiving parenteral nutrition for fear of bloodstream infection risk. Moreover, lipids represent a substantial proportion of the energy source providing essential fatty acids, potentially improving clinical outcomes in patients often malnourished. Understanding the actual risk factors of sepsis during parenteral nutrition is necessary to optimize patient nutritional status and care and avoid essential fatty acid deficiency. There is an urgent need to make updated nutrition training available at all levels of medical education.

Right ventricular (RV)-pulmonary circulation (PC) uncoupling is associated with poor outcome in patients with Heart Failure with Preserved Ejection Fraction (HFpEF). Tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) ratio is simple echo-derived indicator of RV-PC uncoupling. This study aimed to investigate the prognostic impact of TAPSE/PASP ratio among patients with HFpEF hospitalized for acute heart failure (AHF). Single-centre, retrospective study including patients hospitalized for AHF over a 4-year period. Receiver operating character (ROC) curves for the TAPSE/PASP ratio were used to identify the cut-off value for the composite outcome of all-cause in-hospital mortality and hospital readmission. Overall, 398 patients were included (median age 83 years, 56.0% females). According to ROC curve analysis, we calculated an ideal cut-off of 0.36 mm/mmHg for TAPSE/PASP ratio. Patients were divided into two categories, preserved RV-PC coupling (TAPSE/PASP ratio > 0.36) and RV-PC uncoupling (TAPSE/PASP ratio ≤ 0.36). Overall, both in-hospital mortality and readmission rate were higher among HFpEF patients with TAPSE/PASP ratio ≤ 0.36 compared to those with TAPSE/PASP ratio > 0.36 (31.4 % vs 20.3%; p = 0.008). At multivariate analysis, TAPSE/PASP ratio ≤ 0.36 emerged as an independent risk factor both for death (HR 2.18 [1.08 - 4.42]; p = 0.03) and the composite outcome (HR 1.95 [1.22 - 3.12]; p = 0.005). Among patients with HFpEF and hospitalized for AHF, the RV-PC uncoupling was associated with a more than two-fold increased risk of in-hospital mortality.

Liver involvement is closely related to the progression and prognosis of heart failure (HF). This review evaluates the role of FIB-4, a non-invasive and easily calculable index of hepatic fibrosis, as a prognostic biomarker across different HF phenotypes, compared with other established biomarkers of HF. Current evidence demonstrates that elevated FIB-4 scores are closely associated with systemic venous congestion and right ventricular dysfunction and represent a strong independent predictor of adverse cardiovascular events, particularly in HFpEF. In contrast, in HFrEF and HFmrEF, its prognostic value appears less pronounced and more strongly influenced by concomitant primary liver disease, such as MASLD. In acute heart failure, FIB-4 reflects congestion severity and its dynamic reduction during hospitalization carries independent prognostic significance. Compared with NT-proBNP, FIB-4 provides complementary or superior prognostic information in HFpEF, particularly in the presence of predominant right ventricular dysfunction. Additionally, FIB-4 may serve as a screening tool to identify subjects at risk for HFpEF. In conclusion, FIB-4 is a promising tool for risk stratification in HF. However, further prospective studies are needed to establish standardized cut-off values, support its incorporation into clinical guidelines, and clarify its response to SGLT2 inhibitor therapy. Moreover, emerging cardio-metabolic therapies targeting both HF and hepatic fibrosis may further increase the clinical relevance of FIB-4 as a dynamic biomarker of the cardio–hepatic axis.

Peripheral arterial disease (PAD) is a prevalent medical condition associated with high mortality and morbidity rates. Despite the high clinical burden, sex-based differences among PAD patients are not well defined yet, in contrast to other atherosclerotic diseases. This study aimed to describe sex-based differences in clinical characteristics and outcomes among hospitalized patients affected by PAD. This was a retrospective study evaluating all patients with a diagnosis of PAD admitted to the Emergency Department. The primary endpoint of the study was the difference between male and female PAD patients in cumulative occurrence of a Major Acute Cardiovascular Event (MACE) and of a Major Acute Limb Events (MALE). A total of 1640 patients were enrolled. Among them, 1103 (67,3%) were males while females were significantly older (median age of 75 years vs 71 years). Females underwent more angioplasty treatments for revascularization than men (29.8% vs 25.6%); males were treated mostly with amputations (19.9 % vs 15.3%). Although MALE and MACE events were more commonly reported in the male group, there was not a statistically significant gender related-difference (OR 1.27 [0.99 – 1.64]; p=0.059) (OR 0.75 [0.50 – 1.11] p=0.153). However, despite lower extremity PAD severity seeming similar between the two sexes, among these patients males had a higher probability of undergoing lower limb amputations, of cardiovascular death and of myocardial infarction. Among hospitalized patients affected by PAD, even if there was not a sex-based significant difference in the incidence of MALE and MACE, adverse clinical outcomes were more common in males.