Search

Background and AimsAbnormal liver tests are common in patients with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection, but their association with short-term outcomes is controversial. We aimed to compare the pattern of abnormal liver tests in SARS-CoV-2 patients with those of patients infected with influenza or respiratory syncytial virus (RSV), two non-hepatotropic respiratory viruses, and their association with in-hospital mechanical ventilation or death.MethodsA retrospective cohort study of 1271 hospitalized patients (872 influenza, 218 RSV, and 181 SARS-Cov-2) in a tertiary medical center. We defined abnormal liver tests as GPT, GOT or GGT≥40IU/ML at any time-point during hospitalization.ResultsAbnormal liver tests were mild-moderate in the majority of patients regardless of infection type but the majority of patients with influenza or RSV had a transaminases peak earlier during hospitalization compared to patients with SARS-Cov-2. Abnormal liver tests correlated with markers of severe disease across all types of infections, and were associated with mechanical ventilation or death, occurring mainly in patients with severe liver tests abnormalities (>200IU/L) (27.2%, 39.4% and 55.6% of patients with influenza, RSV or SARS-Cov-2). In multivariate analysis, controlling for age, gender, lymphopenia and CRP, liver tests abnormalities remained significantly associated with mechanical ventilation or death for influenza (OR= 3.047, 95% CI 1.518-6.117) and RSV (OR= 3.402, 95% CI 1.032-11.220) but not for SARS-Cov-2 (OR= 0.995, 95% CI 0.198-4.989). These results were confirmed upon propensity score matching.ConclusionsAbnormal liver tests during hospitalization with different viral respiratory infections are common, may differ in their time-course and reflect disease severity. They are associated with worse outcomes, mainly in patients with severe liver test abnormalities, regardless of infection type.

Low muscle mass, commonly known as sarcopenia, has been a focus of gerontologic research for many years and is related to reduced health-related quality of life, functional impairment, and shortened survival. In oncology, body composition research, including sarcopenia, has emerged as an area of particular interest in the last several years, as sarcopenia is highly prevalent in patients with cancer regardless of age and is correlated with adverse treatment outcomes and shorter survival. In this review, we discuss the differences between sarcopenia in gerontology and oncology, including the differences in definition, diagnosis, pathophysiology, outcomes, and future directions.

Background A strong recommendation has been made to perform repeat biopsy for recurrent metastatic breast cancer (RMBC), to reconfirm the histologic features, and to assess for possible changes in hormone receptors (HRs) or human epidermal growth factor receptor 2 (HER2) status. The present study was undertaken to assess the documented and nondocumented factors affecting physicians' decisions to perform a repeat biopsy in patients with RMBC. Patients and Methods We reviewed the medical records of 410 patients with RMBC for whom recurrence had developed between January 2000 and August 2014. The demographic data and characteristics regarding early and metastatic disease were recorded. The written follow-up records were examined, seeking considerations for or against repeat biopsy. Multivariate analysis was performed using logistic regression to determine the nondocumented reasons for repeat biopsy. Results A new biopsy was performed in 295 of 410 patients (72%). However, only 88 of the 295 patients (30%) had a documented reason for rebiopsy. The reason for not performing repeat biopsy was documented for only 1 of the 115 patients. The main documented consideration for rebiopsy was to obtain a new receptor status (recorded in 47 of 88 patients; 53%). The other recorded reasons were suspicion of a second primary, differential diagnosis of metastasis from a second primary, the time from early diagnosis, and patient desire. Significant, but undocumented, considerations for repeat biopsy were low stage at early diagnosis, year of recurrence, interval to recurrence, and site of recurrence. Only for 165 of 295 patients (56%) was the full HR and HER2 status from the new biopsy specimen obtained. Conclusion Nondocumented factors influence physicians' decisions for referring patients for rebiopsy. This might reflect a low rate of patient involvement in their disease management and decision making.

Background Discordance in hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) status between primary tumors and metastatic sites for breast cancer is well established. However, it is uncertain which patient-related factors lead to biopsy when metastases are suspected and whether having a biopsy impacts survival. Methods The medical charts of metastatic breast cancer (MBC) patients diagnosed January 2000-August 2014 were retrospectively reviewed. A biopsy was defined as a procedure where tissue was obtained and assessed for both HR and HER2. Both bivariate and multivariate analyses were performed to assess patient characteristics related to biopsy and whether having a biopsy was associated with improved survival. Results Of 409 patients suspected of having MBC, 165 (40%) had a biopsy, and 34% of these had discordant HR or HER2 status when compared to the initial diagnosis. In multivariate analysis, having a biopsy was associated with: recurrence in years 2010–2014, disease-free interval of > =3 years, stage 0-IIA at presentation, suspected locoregional recurrence, being HR+/HER2-, or missing HR/HER2 at diagnosis. A similar multivariate analysis revealed that having a biopsy was associated with improved survival (HR = 0.67, p = 0.002). The association of biopsy and improved survival was noted in specific subgroups: patients with missing HR and HER2 data at initial diagnosis (p = 0.001), those without metastases in liver, lung or brain (p = 0.001), and being younger than 70 years old at recurrence (p