Comorbidity count changes what a hot day does to a patient

The edition in brief

A Japanese matched case-control study of 21,724 heatstroke cases and 65,172 controls found that heat risk scales with comorbidity burden. Taking 25C and no conditions as the reference, the odds ratio at a wet-bulb globe temperature of 33C was 2.04 (95% CI 1.84-2.25) in people with no conditions and 2.66 (2.40-2.94) in those with four. Individual conditions mattered little; the count did. Smoking, liver dysfunction and obesity stayed associated after adjusting for heat-sensitive medication. Across 853,131 US veterans with imaging-confirmed steatotic liver disease, 3.96% developed cirrhosis and 0.35% hepatocellular carcinoma within ten years. FIB-4, APRI and SAFE discriminated cirrhosis best, and SAFE gave the greatest net benefit on decision-curve analysis. No score was useful for deciding on hepatocellular carcinoma surveillance in people without cirrhosis. A single-centre review of 337 paracenteses in malignant ascites found 19 positive cultures. The cirrhosis threshold of 250 polymorphonuclear cells/mm3 performed poorly here, at 73.7% sensitivity and 72.4% specificity; a count above 1318 cells/mm3 reached 93.0% specificity but the same sensitivity. An observational cohort of 1,835 patients with heart failure and an eGFR of 30 or below reported lower mortality with calcium channel blockers (weighted HR 0.85, 95% CI 0.73-0.99), a claim its design cannot support. The PACER trial randomised 375 adults discharged from emergency departments with low-risk chest pain and anxiety; peer-supported internet cognitive behavioural therapy improved anxiety 1.22 GAD-7 points more than a referral letter over twelve months, and 2.8 points more in those with severe anxiety.