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This article discusses a case report of a patient with pulmonary arterial hypertension who experienced recurrent gastrointestinal bleeding while receiving sotatercept, an investigational agent. The patient had no prior history of chronic anemia or gastrointestinal bleeding and had received stable background therapy for 30 years. The bleeding episodes resolved when sotatercept was discontinued. The article suggests that further investigation is needed to determine if sotatercept increases the risk of gastrointestinal bleeding and if it affects vascular remodeling in the gastrointestinal tract. The authors recommend careful evaluation of the risks and benefits of sotatercept therapy in patients with unexplained gastrointestinal bleeding. [Extracted from the article]

Patients with cirrhosis have an increased risk of postoperative mortality for a range of surgeries; however, they are also at risk of postoperative complications such as infection and cirrhosis decompensation. To date, there are no prediction scores that specifically risk stratify patients for these morbidities. This was a retrospective study using data of patients with cirrhosis who underwent diverse surgeries in the Veterans Health Administration. Validated algorithms and/or manual adjudication were used to ascertain postoperative decompensation and postoperative infection through 90 days. Multivariable logistic regression was used to evaluate prediction models in derivation and validation sets using variables from the recently-published Veterans Outcomes and Costs Associated with Liver Disease (VOCAL)-Penn cirrhosis surgical risk scores for postoperative mortality. Models were compared with the Mayo risk score, Model for End-stage Liver Disease (MELD)-sodium, and Child-Turcotte-Pugh (CTP) scores. A total 4712 surgeries were included; patients were predominantly male (97.2 %), white (63.3 %), and with alcohol-related liver disease (35.3 %). Through 90 postoperative days, 8.7 % of patients experienced interval decompensation, and 4.5 % infection. Novel VOCAL-Penn prediction models for decompensation demonstrated good discrimination for interval decompensation (C-statistic 0.762 vs 0.663 Mayo vs 0.603 MELD-sodium vs 0.560 CTP; P <.001); however, discrimination was only fair for postoperative infection (C-statistic 0.666 vs 0.592 Mayo [ P =.13] vs 0.502 MELD-sodium [ P <.001] vs 0.503 CTP [ P <.001]). The model for interval decompensation had excellent calibration in both derivation and validation sets. We report the derivation and internal validation of a novel, parsimonious prediction model for postoperative decompensation in patients with cirrhosis. This score demonstrated superior discrimination and calibration as compared with existing clinical standards, and will be available at www.vocalpennscore.com. [ABSTRACT FROM AUTHOR]

Individuals on immunosuppressive (IS) therapy have increased mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and delayed viral clearance may lead to new viral variants. IS therapy reduces antibody responses following coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccination; however, a comprehensive assessment of vaccine immunogenicity is lacking. Here we show that IS therapy reduced neutralizing, binding, and nonneutralizing antibody functions in addition to CD4 and CD8 T-cell interferon-γ responses following COVID-19 mRNA vaccination compared to immunocompetent individuals. Moreover, IS therapy reduced cross-reactivity against SARS-CoV-2 variants. These data suggest that the standard COVID-19 mRNA vaccine regimens will likely not provide optimal protection in immunocompromised individuals. [ABSTRACT FROM AUTHOR]