Introduction: Our understanding of the COVID-19 disease has been steadily evolving since the original outbreak in December 2019. Advanced disease is characterised by a hyperin ammatory state, systemic coagulopathies and multiorgan involvement, in particular respiratory distress.We here describe our initial experience with treating of COVID-19 patients based on early initiation of extracorporeal blood puri cation, systemic heparinisation and respiratory support.Methods: 15 patients were included; 2 were females. We monitored real-time several biochemical, immunological and coagulation biomarkers associated with disease severity following admission to our dedicated COVID-19 intensive care unit. To guide personalised treatment, we monitored among others levels of IL-6, IL-8, TNF-α, C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte ratios, Thrombocyte counts, D-Dimers, Fibrinogen, and Activation Clotting time (ACT).Treatment consisted of individualised respiratory support supplemented with 1 -4 cycles of 24-hour Extracorporeal Organ Support (ECOS) and Blood Puri cation using the AN69ST (oXiris ® ) hemo lter. We administered heparin (300 U/kg) to counter suspected hypercoagulability (= elevated Fibrinogen or Ddimers) states to maintain ACT ≥ 180 seconds.Results: N = 10 presented with severe to critical disease (= dyspnoea, hypoxia, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). A single case was admitted with a critical condition (= respiratory failure). One patient died after 5 days of hospitalisation after developing Acute Respiratory Syndrome. 8 Patients have been discharged -average ICU length-ofstay was 9.9 ± 2.4 days. Clinical improvement was associated with normalisation (increase) of thrombocytes, white blood cells, stable levels of IL-6 (< 50 ng/mL) and a decrease of CRP and Fibrinogen. Conclusion:Means to monitor COVID-19 disease severity during hospitalisation are crucial to control disease progression and prevent hyperin ammation and irreversible multiorgan failure. We present here a real-time monitoring system accounting for biochemical, immunological, coagulation parameters and radiological imaging.The combination of systemic heparin anticoagulation regimens and blood puri cation may prevent hyperin ammation, thromboembolism during hospitalisation and thus support clinical recovery.

Introduction: Our understanding of the COVID-19 disease has been steadily evolving since the original outbreak in December 2019. Advanced disease is characterised by a hyperinflammatory state, systemic coagulopathies and multiorgan involvement, in particular respiratory distress. We here describe our initial experience with treating of COVID-19 patients based on early initiation of extracorporeal blood purification, systemic heparinisation and respiratory support.Methods: 15 patients were included; 2 were females. We monitored real-time several biochemical, immunological and coagulation biomarkers associated with disease severity following admission to our dedicated COVID-19 intensive care unit. To guide personalised treatment, we monitored among others levels of IL-6, IL-8, TNF-α, C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte ratios, Thrombocyte counts, D-Dimers, Fibrinogen, and Activation Clotting time (ACT).Treatment consisted of individualised respiratory support supplemented with 1 - 4 cycles of 24-hour Extracorporeal Organ Support (ECOS) and Blood Purification using the AN69ST (oXiris®) hemofilter. We administered heparin (300 U/kg) to counter suspected hypercoagulability (= elevated Fibrinogen or D-dimers) states to maintain ACT ≥ 180 seconds.Results: N = 10 presented with severe to critical disease (= dyspnoea, hypoxia, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). A single case was admitted with a critical condition (= respiratory failure). One patient died after 5 days of hospitalisation after developing Acute Respiratory Syndrome. 8 Patients have been discharged - average ICU length-of-stay was 9.9 ± 2.4 days. Clinical improvement was associated with normalisation (increase) of thrombocytes, white blood cells, stable levels of IL-6 (< 50 ng/mL) and a decrease of CRP and Fibrinogen. Conclusion: Means to monitor COVID-19 disease severity during hospitalisation are crucial to control disease progression and prevent hyperinflammation and irreversible multiorgan failure. We present here a real-time monitoring system accounting for biochemical, immunological, coagulation parameters and radiological imaging. The combination of systemic heparin anticoagulation regimens and blood purification may prevent hyperinflammation, thromboembolism during hospitalisation and thus support clinical recovery.

Background The ACEF II score has been proposed as a parsimonious, alternative, operative mortality risk prediction model for cardiac surgery. External validation is warranted to establish its use. Aim The primary goal was to evaluate the ACEF II model performance for cardiac surgery mortality risk stratification. We also tested the discriminatory power to classify patients in need of prolonged postoperative respiratory support and hospitalisation. Methods We evaluated 743 Cardiac Surgery patients – median age 65 (range 20–80 years), 27.4% females - operated between November 2017 and October 2018. Receiver Operating Curves (ROC) were generated based on a dichotomous outcome, “yes/no”, for intrahospital mortality, prolonged mechanical ventilation time (>24 hours), ICU length-of-stay (>48 hours) and postoperative hospitalisation (>7 days). The ACEF II was compared to the ACEF I and the EuroSCORE II (ESII). The DeLong method was used to test the statistical significance of the difference between the areas under different dependent ROC curves. Results The median ACEF II scores for low risk (= ESII <2%), medium risk (= ESII ≥2–≤5%) and high-risk patients (= ESII >5%) were 1.24 (IQR 1.05–1.505), 1.48 (IQR 1.28–1.928) and 2.240 (IQR 1.560–2.933), respectively. The observed mortality for low risk, medium risk and high-risk patients were 1.48% (5/337), 3.26% (9/275) and 19.23% (25/130), respectively. ACEF II outperformed the ACEF I but was similar to the EuroSCORE II in discriminating intrahospital mortality cases and patients in need of prolonged mechanical ventilation (Table 1). All risk models lacked sufficient power to classify patients requiring prolonged ICU-LOS and postoperative hospitalisation time (AUC <0.7). Table 1. Pairwise comparison of ROC Risk Score Model AUC + CI95% – Intrahospital Mortality Area difference when compared to ACEF II AUC + CI95% p-value ACEF II 0.766 [0.733 to 0.796] ACEF I 0.645 [0.609 to 0.679] 0.121 [0.0288 to 0.212] 0.0100 EuroSCORE II 0.809 [0.778 to 0.836] 0.0429 [−0.0431 to 0.129] 0.3284 AUC + CI95% – Prolonged MVT Area difference when compared to ACEF II AUC + CI95% p-value ACEF II 0.721 [0.687 to 0.753] ACEF I 0.632 [0.596 to 0.667] 0.0891 [0.0224 to 0.156] 0.0088 EuroSCORE II 0.721 [0.687 to 0.753] 0.000128 [−0.0732 to 0.0735] 0.9973 AUC = Area Under the Curve, DeLong et al., 1988 – Binomial exact CI95% for the AUC, MVT = Mechanical Ventilation time. Conclusion The ACEF II risk model has a fair discriminative capacity to classify intrahospital mortality cases and patients who will require prolonged mechanical respiratory support following cardiac surgery. Acknowledgement/Funding None

Background and Aims: Malnutrition and cachexia are frequent in Head and Neck Cancers (HNC) patients. These complications occur as a result of the cancer but worsened by surgery, radiotherapy or chemotherapy that further challenge oral intake but also airway obstruction.

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