Outcome of percutaneous drainage for septic complications coexisted with COVID-19.

BACKGROUND: The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019 (COVID-19) combined with viral load, and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration. AIM: To describe the clinical, radiological, and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their post-procedural outcomes. METHODS: This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications. The mean age ± SD of the patients was 48.5 ± 14 years (range 30-72 years). Three patients underwent cholecystostomy for acute acalculous cholecystitis. Percutaneous drainage was performed in seven patients; two peripancreatic collections; two infected leaks after hepatic resection; one recurrent hepatic abscess, one psoas abscess and one lumbar abscess. One patient underwent a percutaneous nephrostomy for acute pyelonephritis. RESULTS: Technical success was achieved in 100% of patients, while clinical success was achieved in 4 out of 11 patients (36.3%). Six patients (54.5%) died despite proper percutaneous drainage and adequate antibiotic coverage. One patient (9%) needed operative intervention. Two patients (18.2%) had two drainage procedures to drain multiple fluid collections. Two patients (18.2%) had repeat drainage procedures due to recurrent fluid collections. The average volume of the drained fluid immediately after tube insertion was 85 mL. Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients. There was no significant statistical difference (P = 0.6 and 0.4) between the mean of WBCs and neutrophils count before drainage and seven days after drainage. The lymphocyte count shows significant increased seven days after drainage (P = 0.03). CONCLUSION: In this study, patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.

BAR Score Performance in Predicting Survival after Living Donor Liver Transplantation: A Single-Center Retrospective Study.

METHODS: 146 adult liver transplant recipients were included. Univariate and multivariate analyses were used to determine the independent predictors of survival at 3 months, 1 year, and 5 years. The receiver operating characteristic (ROC) curve for the BAR score was plotted, and the area under the ROC curve (AUROC) was calculated. Kaplan-Meier curve and log-rank test were used to compare survival above and below the best cutoff values. RESULTS: The mean age was 52.45 ± 8.54 years, and 59.6% were males. The survival rates were 89, 78.8, and 72% at 3 months, 1 year, and 5 years, respectively. The BAR score demonstrated a clinically significant value in the prediction of 3-month (AUROC = 0.89), 1-year (AUROC = 0.76), and 5-year survival (AUROC = 0.71). Among the investigated factors associated with survival, BAR score <10 points was the only independent predictor of 3-month (OR 7.34, p < 0.0001), 1-year (OR 3.37, p=0.001), and 5-year survival (OR 2.83, p=0.044). CONCLUSIONS: BAR is a simple and easily applicable scoring system that could significantly predict short- and long-term survival after LDLT. A large multicenter study is warranted to validate our results in the Egyptian population.

Long-Term Impact of Hepatitis C Virus Eradication on Liver Stiffness in Egyptian Patients.

Methods: Liver stiffness measurements (LSM) have been serially assessed 1, 3, and 5 years after HCV clearance in 655 patients who have been treated with DAAs. Results: The mean age was 51.44 ± 10 years. 73% of patients were males. 48% were cirrhotics. In noncirrhotics, the mean LSM was significantly decreased from 8.29 ± 2.3 kPa to 4.03 ± 1.0 kPa (p < 0.0001) at the end of the follow-up. Likewise, LSM decreased in cirrhotics from 29.66 ± 14.25 kPa to 22.50 ± 11.16 kPa (p < 0.0001). The proportions of F1, F2, F3, and F4 patients at the baseline were 17.7%, 17.9%, 16.6%, and 47.8%, which became 56.5%, 4.1%, 4.9%, and 34.5%, respectively, with a substantial reversal of cirrhosis in 87 patients (27.7%) at the end of follow-up. Conclusions: There was an overall significant regression of liver stiffness in all patients after sustained HCV eradication. Liver stiffness reflecting mild fibrosis (F0-F2) usually improves shortly after treatment, while measurements reflecting advanced fibrosis (F3-F4) take a longer time to regress to lower fibrosis stages.