Uyen Pham Phuong Vo

Background: Despite advances in intensive care, short-term mortality in acute pancreatitis (AP) remains substantial. The phosphate-to-albumin ratio (PAR) reflects metabolic and inflammatory stress and may enable simple early risk stratification, but its prognostic value in critically ill AP is unknown. We evaluated PAR for predicting 30-day mortality and developed a PAR-integrated machine learning (ML) model. Methods: Adult intensive care unit (ICU) patients with AP were identified from multicenter databases [Medical Information Mart for Intensive Care (MIMIC)-IV, MIMIC-III, eICU)]. The primary endpoint was 30-day all-cause mortality. PAR was evaluated using Kaplan–Meier curves, restricted cubic splines, and multivariable Cox regression, and its discrimination was compared with phosphate, albumin, SOFA, and APACHE II by receiver operating characteristic analysis. Mediation analysis examined pathways through lactate and creatinine. For ML, features selected by Boruta and recursive feature elimination were used, and the best model was selected with class imbalance corrected by the adaptive synthetic minority oversampling technique. Model utility and interpretability were assessed using decision curve analysis and SHAP, and the finalized model was deployed as a web calculator. Robustness was tested with multiple imputation, E-values, propensity score methods, and inverse probability of treatment weighting. Results: High PAR independently predicted higher 30-day mortality (adjusted HR 1.94; 95% CI 1.11–3.38). PAR showed good discrimination (MIMIC-III area under the receiver operating characteristic curve (AUC) 0.78; eICU AUC 0.67), comparable to or superior to SOFA and APACHE II. Mediation analysis indicated partial effects through tissue hypoxia and renal dysfunction. Light Gradient Boosting Machine (LightGBM) achieved the best performance (MIMIC-III AUC 0.844; eICU AUC 0.841) with good calibration and net benefit, and SHAP consistently highlighted PAR among the most important predictors. Associations were stable across subgroups and sensitivity analyses. Conclusion: PAR is an accessible biomarker that independently predicts 30-day mortality in ICU patients with AP. A PAR-integrated LightGBM model provides accurate, interpretable, and clinically applicable risk stratification, with deployment via a user-friendly web tool. Graphical abstract available at: http://links.lww.com/JS9/H526

Colonic diverticulosis is common in gastrointestinal disease with a rising prevalence in Asia. Regional differences exist in prevalence, distribution, and risk factors of diverticulosis; however, data from Vietnam are still lacking. The purpose of our study was to ascertain the prevalence, colonoscopic features, and risk factors of colonic diverticulosis among Vietnamese adults undergoing colonoscopy. A descriptive cross-sectional study was performed prospectively on patients undergoing colonoscopy at the Gastrointestinal Endoscopy Department of the University Medical Center-Ho Chi Minh City. Metabolic syndrome was established on the Adult Treatment Panel III guidelines. Univariate and multivariate analyses were conducted to identify risk factors. There were 480 participants, with a mean age of 53.2±12.7 years. The male-to-female ratio was 0.8. The prevalence of diverticulosis was 29.6%. Right-sided diverticulosis was observed in 69% of cases. Multiple diverticula were present in 68.4% of cases. Multivariate analysis identified advanced age (odds ratio [OR]=2.38, 95% confidence interval (CI): 1.41–4.05, p=0.001), male sex (OR=1.78, 95% CI: 1.05–3.02, p=0.033), central obesity (OR=1.61, 95% CI: 1.03–2.50, p=0.037), metabolic syndrome (OR=1.91, 95% CI: 1.12–3.27, p=0.021), and heavy alcohol consumption (OR=2.23, 95% CI: 1.03–4.84, p=0.042) as independent risk factors of diverticulosis. Diverticulosis was prevalent in Vietnamese, with a right-sided predominance of the colon and multiple diverticula. Advanced age, male sex, central obesity, metabolic syndrome, and heavy alcohol consumption were risk factors.

Despite many medical advances, acute lower gastrointestinal bleeding in Asia has been increasing gradually and has resulted in substantial mortality. The study aimed to describe the clinical characteristics, interventions, and outcomes of acute lower gastrointestinal bleeding in Vietnamese people. A multicenter cohort study was prospectively and retrospectively conducted in patients presenting with acute lower gastrointestinal bleeding in Vietnam. Severe lower gastrointestinal bleeding was defined as persistent bleeding within the first 24 hours and/or recurrent bleeding after 24 hours of stability accompanied by a reduction in hematocrit of ≥ 20% and/or transfusion of ≥ 2 units of red blood cells. The clinical characteristics, interventions, and adverse outcomes were recorded. There were 811 patients with a male:female ratio of 1.07 and a mean age of 61 years. A total of 85.6% of patients presented with hematochezia. The common causes of acute lower gastrointestinal bleeding were hemorrhoids (28.6%), diverticulosis (9.7%), and unknown origin (16%). The rates of blood transfusion, endoscopic therapy, radiologic intervention, and surgery were 39.8%, 8.6%, 0.5%, and 7.3%, respectively. Severe lower gastrointestinal bleeding was observed in 222 (27.4%) patients. In-hospital deaths were recorded in 17 (2.1%) patients. The majority of in-hospital deaths were due to unstable comorbidities. Hemorrhoids were the most common cause of acute lower gastrointestinal bleeding. The rates of blood transfusion, endoscopic hemostasis, interventional radiology, and surgery were 39.8%, 8.6%, 0.5%, and 7.3%, respectively. A total of 27.4% of cases progressed to severe bleeding.