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Effective prognostication for a novel disease presents significant challenges, especially given the stress induced during a pandemic. We developed a point-of-care tool to summarize outcome data for critically ill patients with COVID-19 and help guide clinicians through a thoughtful prognostication process. Two authors reviewed studies of outcomes of patients with critical illness due to COVID-19 and created a visual infographic tool based on available data. Survival data were supplemented by descriptions of best- and worst-case clinical scenarios. The tool also included prompts for clinician reflection designed to enhance awareness of cognitive biases that may affect prognostic accuracy. This online, open-source COVID-19 Prognostication Tool has been made available to all clinicians at our institution and is updated weekly to reflect evolving data. Our COVID-19 Prognostication Tool may provide a useful approach to promoting consistent and high-quality prognostic communication across a health care system.

Introduction The ability to prognosticate in both cirrhosis and hepatocellular carcinoma (HCC) is vital for correct treatment decisions. For HCC, many staging systems incorporate tumour characteristics but inadequately consider underlying liver dysfunction. Therefore, models that accurately stratify the degree of liver dysfunction, may improve our understanding of its impact on survival in patients with HCC. We aimed to compare current and potential prognostication models of survival for patients with cirrhosis, and to determine their applicability in HCC patients. Method A single-centre retrospective comparative analysis of cohorts of consecutive patients diagnosed with cirrhosis alone was performed against HCC patients with background cirrhosis. The Child-Pugh score, MELD score, UKELD score, the D’Amico clinical stage of cirrhosis (D’Amico G, et al ., J Hepatol, 2006) and the Albumin-Bilirubin (ALBI) grade – a composite model of liver function using serum bilirubin and albumin levels (Johnson PJ, et al ., J Clin Oncol, 2015), were determined at diagnosis. The patient outcome at 1 year post diagnosis was also determined. The primary outcome was the models’ ability to predict death at 1 year. The impact of liver dysfunction on survival in patients with HCC was also evaluated. Results A total of 117 patients were included in this study (67% male, median age: 57 years). The aetiologies were ALD (52%), NASH (15%), HCV (11%), PBC (5%), HBV (2%), AIH (2%), mixed aetiology (9%) and others (5%). 75% of patients had cirrhosis alone while 25% had HCC. All the evaluated models accurately predicted death at 1 year (all with p Conclusion All the evaluated prognostication models performed well, though the study was limited by a small cohort of patients with HCC. Despite a better liver function, the survival of patients with HCC was inferior, suggesting that tumour biology has a greater impact overall compared to the degree of underlying liver dysfunction. However, future studies specifically looking at the impact of liver dysfunction on survival in non-surgical treatment of HCC should be considered. Disclosure of interest None Declared.

Tumor marker serum levels of 580 patients in different stages of breast cancer were examined in a retrospective analysis. Patients with nonmetastatic breast cancer showed a preoperatively elevated CA 15-3 in 16% and an elevation of CEA in 12%. In case of local recurrence in 24% CA 15-3- and in 9% CEA-levels were positive. The sensitivity of both markers increased in stage of distant metastasis (58%/48%). CA 15-3 was significantly more sensitive than CEA in case of visceral metastatic spread (56%/34%).

In einer retrospektiven Untersuchung wurden Markerbestimmungen von 580 Mammakarzinompatientinnen in verschiedenen Stadien der Erkrankung ausgewertet.