Early Prediction of In-Hospital Mortality in Patients with Acute Infections: Development of the Acute Severity Infection Score (ASIs)

Introduction: Early prognostic stratification in patients hospitalized for acute infections is a major clinical challenge. Existing tools, such as the Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI), were not specifically developed for this purpose. Objectives: We aimed to design a novel multidimensional prognostic score, the Acute Severity Infection score (ASIs), to predict in-hospital mortality using routinely available clinical data. Methods: This retrospective cohort study included 149 adults admitted with acute infections to an internal medicine unit between January 2023 and December 2024. In-hospital all-cause mortality was the primary outcome. Demographic, clinical and laboratory variables obtained within 12 h of admission were analyzed. Variables significantly associated with mortality in both univariate and multivariate regression were incorporated into the ASIs, which ranges from 0 to 7 points. Its performance was compared to SOFA and CCI using ROC curve and Cox regression models. Results: In-hospital mortality occurred in 25.5% of patients. Five variables were independently associated with mortality: lactate ≥ 2.2 mmol/l, frailty composite (confined to bed status, long-term oxygen therapy or advanced malignancy), hemodynamic instability or need for non-invasive ventilation, age ≥ 79.5 years and symptom onset ≥ 3.5 days before admission. ASIs showed the highest discriminative ability (AUC = 0.883) compared to SOFA (AUC = 0.612) and CCI (AUC = 0.742). In multivariate models including all three scores, only ASIs retained independent prognostic significance. Conclusions: The ASIs is a simple tool for early prognostic stratification of patients hospitalized with acute infections. It outperforms existing scores and may enhance clinical decision-making in real-world medical settings

Multipronged dental analyses reveal dietary differences in last foragers and first farmers at Grotta Continenza, central Italy (15,500–7000 BP)

This paper provides results from a suite of analyses made on human dental material from the Late Palaeolithic to Neolithic strata of the cave site of Grotta Continenza situated in the Fucino Basin of the Abruzzo region of central Italy. The available human remains from this site provide a unique possibility to study ways in which forager versus farmer lifeways affected human odonto-skeletal remains. The main aim of our study is to understand palaeodietary patterns and their changes over time as reflected in teeth. These analyses involve a review of metrics and oral pathologies, micro-fossils preserved in the mineralized dental plaque, macrowear, and buccal microwear. Our results suggest that these complementary approaches support the assumption about a critical change in dental conditions and status with the introduction of Neolithic foodstuff and habits. However, we warn that different methodologies applied here provide data at different scales of resolution for detecting such changes and a multipronged approach to the study of dental collections is needed for a more comprehensive and nuanced understanding of diachronic changes

Predictive factors of body weight loss in patients with type 2 diabetes treated with GLP-1 receptor agonists: a 52-week prospective real-life study

IntroductionGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely prescribed for their efficacy in glycemic control and weight reduction, but patient response is heterogeneous and predictors of weight loss remain insufficiently defined. This 52-week prospective, observational study aimed to identify predictors of weight reduction (≥5% from baseline) in patients with type 2 diabetes mellitus (T2D) undergoing GLP-1RA therapy (semaglutide or dulaglutide, including oral formulations).MethodsA total of 194 adults with T2D initiating GLP-1RA therapy were evaluated at baseline, and after 6, and 12 months of therapy. To identify predictors of weight loss, variables differing between Responders (weight loss ≥5% than baseline) and Non-Responders were evaluated by ROC analysis and tested in univariate and multivariate logistic regression models adjusted for age, gender, GLP-1RA type and dosage.ResultsAt 6 and 12 months, 58% and 49% of patients, respectively, achieved the primary outcome. Responders at 12 months exhibited elevated BMI, waist circumference, hepatic steatosis indices, fat mass, and insulin levels at baseline, along with reduced muscle-to-fat and muscle-to-visceral adipose tissue ratios. Moreover, female gender, younger age, shorter disease duration, and non-use of metformin prior to enrollment were significantly associated with response. Notably, early response at 6 months strongly predicted 12-month success.ConclusionsOur results highlight a valuable interplay between body composition, liver involvement, and the incretin response, also suggesting a maximal synergistic effect between metformin and GLP-1RAs when treatments are initiated concurrently rather than sequentially. These data provide valuable insights for the development of individualized treatment strategies

The Impact of COVID-19 Lockdown on Patients with Type 2 Diabetes Mellitus: A Brief Report

Background: The Italian population's habits changed dramatically during the "COVID-19 lockdown" due to physical distancing and self-isolation. Moreover, medical consultations of patients with chronic diseases, such as type 2 diabetes (T2D), were suspended or postponed, unless urgent or semi-urgent, for several consecutive months. Thus, it is expected that the lockdown could have affected glucometabolic control in T2D. Purpose: The aim of the study was to assess changes in glucometabolic control in a cohort of T2D patients before (T1) and after (T2) the COVID-19 lockdown (March-May 2020). Methods: The study was approved by the Ethics Committee of the University of Bari, and all patients provided informed written consent to participate. Medical history, complete physical examination, and laboratory assessment were conducted as real-life clinical practice. Changes in clinical and laboratory variables between T1 and T2 were calculated. Results: In detail, 13 patients were on metformin as monotherapy, 36 on GLP-1RA, 12 on sodium-glucose transporter 2 inhibitors (SGLT-2i), and 2 on dipeptidyl-peptidase 4 inhibitors (DPP4i). The mean age was 65.3 years (43-83). Study participants were mainly men (73%). The body weight (BW) ranged from 56 to 145 kg, and the waist circumference ranged from 88 to 146 cm. The mean HbA1c was 51.0 mmol/mol. At T2, no statistically significant changes were observed from baseline except for BW [-1.6 (-2.60 to -0.62)] and HbA1c [-2.90 (-4.69; -1.12)]. Conclusion: We evaluated the effects of the COVID-19 lockdown on glucometabolic control in patients with background well-controlled T2D. We found that the lockdown had no adverse effects on metabolic profile regardless of background clinical characteristics and antihyperglycemic management. Despite limitations due to the nature of this study (sample size, retrospective observation, lack of data on lifestyle changes in our patients' everyday lives), T2D patients managed in our Diabetes Centers faced the lockdown-related restrictions without any detrimental consequence

Effectiveness and clinical benefits of new anti-diabetic drugs: A real life experience

We evaluated the clinical impact, in daily clinical practice, of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) therapies in patients with type 2 diabetes. Data from 500 unselected consecutive patients were retrospectively analyzed. Only those with a full assessment at baseline (T0) and after 3 (T3), 6 (T6), and 12 (T12) months of treatment with SGLT2i or GLP1RA were included in the study (n = 167). At baseline, patients had a high mean body weight (BW), abdominal circumference (AC), body mass index (BMI), and HOMA index. Despite normal C-peptide values, 39 patients were being treated with insulin (up to 120 IU/day). During therapy, a progressive improvement in BW, BMI, and AC was observed with both the molecules. Fasting glucose and glycated Hb decrease was already significant at T3 in all patients, while the HOMA index selectively improved with SGLT2i therapy. Renal function parameters remained stable regardless of the drug used. Finally, SGLT2i reduced serum uric acid and improved the lipid profile, while GLP1RA reduced serum levels of liver enzymes. Both the therapeutic regimens allowed a significant reduction or complete suspension of unnecessary insulin therapies. Our real life data confirm the results obtained from randomized clinical trials and should be taken as a warning against inappropriate use of insulin in patients with preserved beta-cell function

Clinical phenotyping in sarcoidosis management

Sarcoidosis is a heterogeneous granulomatous disease. Biological markers and clinical features could allow specific phenotypes to be associated with different prognosis, severity and treatment responses. This retrospective multicentre study aims to analyse the clinical and immunological features of sarcoidosis and to identify a routine non-invasive biomarker useful in clinical practice. Materials and methods: 129 Caucasian patients with sarcoidosis (median age IQR, 56 (47-62)) were enrolled retrospectively in the study. Medical history, routine laboratory findings, lung function results and radiological features from the last examination of October 2019 - February 2020 were gathered from the patients' clinical records. Results: Regardless their clinical status at disease onset, at the last clinical examination we didn't observe any differences in terms of therapeutic management between symptomatic and asymptomatic patients. Stratifying sarcoidosis population according to therapeutic management, the N/L ratio was higher in the treated group than in the non-treated group (p=0.0034). Receiver operating curve (ROC) analysis distinguished these two groups according to N/L ratio with an area under the curve (AUC) of 65.3% and a best cut-off value of 2.21. Peripheral N/L ratio was significantly higher in radiological stages 2-4 than in stages 0-1 (p=0.0090) distinguishing these two groups with an AUC of 64% and a best cut-off value of 2.13. Discussion: In our multicentric cohort study similar periodic follow-up can be suggested for symptomatic and asymptomatic sarcoidosis patients at onset. In the heterogeneous context of this disease, N/L ratio proved to be a useful and simple routine laboratory biomarker related to disease activity and need for treatment

Effectiveness and clinical benefits of new anti-diabetic drugs: A real life experience

Abstract We evaluated the clinical impact, in daily clinical practice, of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) therapies in patients with type 2 diabetes. Data from 500 unselected consecutive patients were retrospectively analyzed. Only those with a full assessment at baseline (T0) and after 3 (T3), 6 (T6), and 12 (T12) months of treatment with SGLT2i or GLP1RA were included in the study (n = 167). At baseline, patients had a high mean body weight (BW), abdominal circumference (AC), body mass index (BMI), and HOMA index. Despite normal C-peptide values, 39 patients were being treated with insulin (up to 120 IU/day). During therapy, a progressive improvement in BW, BMI, and AC was observed with both the molecules. Fasting glucose and glycated Hb decrease was already significant at T3 in all patients, while the HOMA index selectively improved with SGLT2i therapy. Renal function parameters remained stable regardless of the drug used. Finally, SGLT2i reduced serum uric acid and improved the lipid profile, while GLP1RA reduced serum levels of liver enzymes. Both the therapeutic regimens allowed a significant reduction or complete suspension of unnecessary insulin therapies. Our real life data confirm the results obtained from randomized clinical trials and should be taken as a warning against inappropriate use of insulin in patients with preserved β-cell function.</jats:p

Glucagon-Like Peptide 1 Receptor Agonists and Sodium–Glucose Cotransporter 2 Inhibitors Improve Renal Resistive Index in Patients With Type 2 Diabetes: A 26-Week Prospective Observational Real-Life Study

Diabetic kidney disease (DKD) is one of the most life-threatening complications of diabetes and a leading cause of chronic kidney disease. Glucagon-like peptide 1 receptor agonists (GLP1-RAs) or sodium–glucose cotransporter 2 inhibitors (SGLT2is) appear to improve renal outcome in patients with Type 2 diabetes (T2D). In this context, the renal resistive index (RRI) is a useful doppler measure to study DKD and predict its evolution. The aim of this work was to study the effect of treatment with GLP1-RA or SGLT2i on RRI and the relationship between RRI and glycometabolic parameters. One hundred forty-five patients with T2D were enrolled in the study and treated for 26 weeks with once-weekly GLP1-RA (38 patients with dulaglutide and 39 with semaglutide), SGLT2i (40 patients), or other therapies (28 control patients). Clinical, anthropometric, and hematochemical parameters and RRI were measured at baseline (T0) and after 6 months of treatment (T6). Changes at 6 months were studied and compared by treatment group. Patients were predominantly male (58.6%), overweight (93.0%) or frankly obese (60.0%), with hypertension (90.0%) and high (> 0.64) or pathological (> 0.7) RRI values (82.0% or 37.0%, respectively). At baseline, RRI correlated positively with age, fasting blood glucose, glycated hemoglobin (HbA1c), triglycerides, and albuminuria and negatively with estimated-glomerular filtration rate (e-GFR). At T6, patients treated with either GLP1-RA or SGLT2i showed a significant improvement in RRI but not in albuminuria or e-GFR, compared with homologous at baseline. In particular, RRI normalized in 32% and 30% of patients on therapy with GLP1-RA and SGLT2i, respectively, while remaining almost unchanged in controls. Notably, the RRI improvement was independent of age, gender, diabetes duration, and changes in BMI, waist circumference, HbA1c, and e-GFR. In conclusion, RRI can be used to detect early kidney damage and follow the evolution of DKD. GLP1-RA and SGLT2i improve RRI, demonstrating benefits on cardiovascular risk and renal outcomes

Once-Weekly Semaglutide Induces an Early Improvement in Body Composition in Patients with Type 2 Diabetes: A 26-Week Prospective Real-Life Study

Background: Body weight (BW) loss is an essential therapeutic goal in type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists are effective in reducing BW, but their effect on body composition has not yet been fully explored. The study aim was to assess the impact of Semaglutide on body composition in patients with T2D. Methods: Forty patients with T2D were treated with subcutaneous Semaglutide and evaluated at the baseline (T0) and after three (T3) and six (T6) months. Body composition was assessed by a phase-sensitive bioimpedance analyzer. Visceral adipose tissue (VAT) thickness was also measured with an ultrasonographic method (US-VAT). Anthropometric variables, muscular strength, and laboratory tests were analyzed and compared. Results: A significant decrease in VAT, the fat mass index (FMI), and BW loss was observed at all observation times. US-VAT, the skeletal mass index (SMI), the fat-free mass index (FFMI), waist circumferences, and glycated hemoglobin had lessened after three months and remained stable at T6. No variations in muscle strength, the muscle quality index, and body water were found. Discussion: In a real-life setting, Semaglutide provided significant weight loss mainly due to a reduction in the FMI and VAT, with non-clinically relevant changes in the SMI, the FFMI, and muscle strength. Most importantly, the results were obtained after three months of treatment and persisted thereafter