To assess the role of protein-energy malnutrition on perioperative outcomes in patients with pancreatic cancer undergoing open pancreaticoduodenectomy. We conducted a retrospective observational cohort study and investigated patients ≥ 18 years old with pancreatic cancer undergoing open pancreaticoduodenectomy within the National inpatient sample database during 2012–2014. The study population was divided into two groups based on the presence of protein-energy malnutrition. In-hospital mortality, length of stay, cost of hospitalization, and in-hospital complications were compared between the two groups. Logistic and linear regression analyses were used to adjust for potential confounders. A trend analysis was further conducted on the in-hospital outcomes. Of the 12,785 patients aged ≥ 18 years undergoing open pancreaticoduodenectomy during years 2012–2014, 9865 (77.0%) had no protein-energy malnutrition and 2920 (23.0%) had protein-energy malnutrition. Patients with protein-energy malnutrition were found to have significantly higher mortality rate, longer length of hospital stay, and higher total hospital cost compared to those without protein-energy malnutrition. The risks of gastroparesis, small bowel obstruction, intraoperative and postoperative hemorrhage, infectious complications, and several systemic complications were found to be significantly higher in the protein-energy malnutrition group in a multivariate regression model. A study of trends from 2009 to 2012 revealed an increasing prevalence of protein-energy malnutrition, a declining trend in mortality and length of stay and a stable total hospital cost in the protein-energy malnutrition group. Protein-energy malnutrition was found to be associated with higher mortality, longer length of hospital stay and greater hospital cost in pancreatic cancer patients undergoing open pancreaticoduodenectomy, as well as increased occurrence of various systemic complications. Attention should be paid to patients’ nutritional status, which can be corrected before surgery as an effective means to optimize postoperative results.

BK virus-associated nephropathy develops in renal transplant patients with the main manifestation of tubulointerstitial nephritis or ureteral stenosis. Nephrotic syndrome is a rare manifestation of BK virus-associated nephropathy. Here we report a case of a 69-year-old female presenting with nephrotic and nephritic syndrome related to BK virus infection. Kidney biopsy revealed severe acute tubular injury, collapsing glomerulopathy, and focal microangiopathic changes. Four weeks of leflunomide and intravenous immunoglobulin (IVIG) resulted in the recovery of kidney function and improvement of proteinuria.

Background: Cystic fibrosis (CF) is a genetic, multisystem disorder characterized by progressive lung disease driven by mucus obstruction, chronic inflammation, and recurrent infections. Although chronic liver disease (CLD) is a recognized complication of CF, its prevalence and clinical impact among hospitalized adults with CF have not been well characterized using large-scale national databases. Methods: We utilized the National Inpatient Sample (NIS) database to identify adults aged ≥18 years hospitalized between 2015 and 2019 with a diagnosis of CF. Patients were stratified based on the presence or absence of CLD. International Classification of Diseases (ICD) codes were used to identify comorbidities, including congestive heart failure, prior myocardial infarction, atrial fibrillation, obesity, chronic kidney disease, and end-stage renal disease. Multivariable regression analyses were performed to evaluate in-hospital mortality, length of stay, hospital costs, and in-hospital complications, including sepsis, pneumonia, acute kidney injury (AKI), and the need for intubation, tracheostomy, and gastrostomy. Results: Among an estimated 90,675 hospitalized adults with CF, 11.68% had concomitant CLD. In multivariable analyses, patients with CLD had significantly higher in-hospital mortality compared with those without CLD (2.50% vs. 1.24%, P<0.001). The CLD group also experienced longer hospital stays (10.4 vs. 8.6 days, P<0.001) and higher hospitalization costs ($38,880 vs. $31,246, P=0.019). The coexistence of CF and CLD was associated with a significantly increased risk of in-hospital complications, including sepsis (6.47% vs. 4.20%, P<0.001), AKI (17.13% vs. 11.79%, P<0.001), and malnutrition (42.63% vs. 31.49%, P=0.002). There were no significant differences between groups in the rates of pneumonia (21.00% vs. 20.57%, P=0.596), need for intubation (2.74% vs. 1.92%, P=0.139), tracheostomy (0.69% vs. 0.54%, P=0.072), or gastrostomy (0.89% vs. 0.66%, P=0.499). Conclusions: CLD is common among adults hospitalized with CF and is independently associated with higher in-hospital mortality, longer length of stay, and increased hospital costs. Additionally, CLD confers a significantly higher risk of sepsis, AKI, and malnutrition. These findings underscore the importance of early recognition and proactive management of liver disease in hospitalized patients with CF.