Dear Editor, While studies have established risk factors for clinical deterioration in coronavirus disease 2019 (COVID-19) patients [1, 2], or attempted to identify phenotypes based on experts opinion [3], identifying sub-phenotypes based on more easily obtained data could help identify patients at highest risk of clinical deterioration and refine inclusion of more homogeneous subpopulations in clinical trials. We here applied an unsupervised, multivariate clustering algorithm using easy-to-obtain clinical variables to identify COVID-19 sub-phenotypes and examined the association with clinical deterioration. This retrospective cohort study was performed among adult COVID-19-positive patients (using real-time reverse transcriptase-polymerase chain reaction assay) with a hospital visit between February 28 and March 26, 2020, at eight teaching hospitals of the Assistance Publique-Hôpitaux de Paris. The Institutional Review Board (IRB) of Ile-de-France VII approved the study and waived the need for informed consent from individual patients (DC 2009/CO-15-000). We selected 22 candidate variables for the clustering analysis including demographic information among 608 patients with available candidate variables, disease history, major clinical symptoms, and medications on the day of positive diagnostic, which represents the final cohort (Supplementary file). We

Background: Pancreatic fistula (PF), i. e., a failure of the pancreatic anastomosis or closure of the remnant pancreas after distal pancreatectomy, is one of the most feared complications after pancreatic surgery. PF is also one of the most common complications after pancreatic surgery, occurring in about 30% of patients. Prevention of a PF is still a major challenge for surgeons, and various technical and pharmacological interventions have been investigated, with conflicting results. Pancreatic exocrine secretion has been proposed as one of the mechanisms by which PF occurs. Pharmacological prevention using somatostatin or its analogs to inhibit pancreatic exocrine secretion has shown promising results. We can hypothesize that continuous intravenous infusion of somatostatin-14, the natural peptide hormone, associated with 10–50 times stronger affinity with all somatostatin receptor compared with somatostatin analogs, will be associated with an improved PF prevention.Methods: A French comparative randomized open multicentric study comparing somatostatin vs. octreotide in adult patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy with or without splenectomy. Patients with neoadjuvant radiation therapy and/or neoadjuvant chemotherapy within 4 weeks before surgery are excluded from the study. The main objective of this study is to compare 90-day grade B or C postoperative PF as defined by the last ISGPF (International Study Group on Pancreatic Fistula) classification between patients who receive perioperative somatostatin and octreotide. In addition, we analyze overall length of stay, readmission rate, cost-effectiveness, and postoperative quality of life after pancreatic surgery in patients undergoing PD.Conclusion: The PreFiPS study aims to evaluate somatostatin vs. octreotide for the prevention of postoperative PF.

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