Check out “What’s New in Research” to find out about discoveries and advancements from Brigham researchers. This month, we feature new research from Brigham researchers on risk of symptoms and viral rebound after COVID-19, access to complex liver surgery and more.  

Among Untreated Patients with COVID-19, Combined Symptom and Viral Rebound is Rare

Jonathan Li

 After completing a course of nirmatrelvir-ritonavir, a treatment for at-risk patients who have contracted COVID-19, some patients have reported worsening symptoms and viral rebound. But does viral rebound and the reemergence of symptoms also occur in patients who are not given this treatment? To further understand this phenomenon, researchers from the Brigham’s Division of Infectious Diseases analyzed the rates of symptom and viral rebound in COVID-19 patients who did not receive nirmatrelvir-ritonavir, in comparison with those who did. The project involved 563 patients who participated in anterior nasal swabs for two weeks and 29 days of symptom tracking in a diary. Symptom tracking focused on the severity of 13 specific symptoms: feeling feverishness, coughing, shortness of breath or difficulty breathing, sore throat, body pain or muscle pain or aches, fatigue, headache, chills, nasal obstruction or congestion, nasal discharge, nausea, vomiting, and diarrhea. Participants self-assessed their symptoms on a scale of zero (absence of symptom) to three (severe symptom) and viral rebound was classified as a symptom scoring at least four points higher than the lowest score after initial improvement. The results showed that symptom rebound was found in 26 percent of participants, viral rebound in 31 percent of participants and high-level viral rebound in 13 percent of participants. However, these results were considered short-term as 89 percent of symptom rebounds and 95 percent of viral rebounds only occurred once before improving long-term. Only three percent of participants experienced both symptom and high-level viral rebound. It is important to note that most participants were unvaccinated and were infected with pre-Omicron COVID-19 variants.

“What these results show is that baseline rates of symptom and viral relapse in those not receiving treatment for COVID-19 need to be accounted for when studying the risk of rebound after antiviral therapy,” said Jonathan Li, MD, of the Brigham’s Division of Infectious Diseases. “In other words, you need a control group of untreated individuals when studying rates of Paxlovid rebound.”

Read more in Annals of Internal Medicine.

Location May Play Role in Likelihood of Patients to Seek Complex Liver Surgery

George Molina

A study led by investigators from Brigham and Women’s Hospital investigated variation within the United States for undergoing liver metastasectomy for colorectal liver metastasis (CRLM). Only half of eligible patients elect to receive this surgery and it was hypothesized that this is due to socioeconomic factors and poverty rates. Using the Surveillance, Epidemiology and End Results Research Plus database, researchers examined those who had a colorectal adenocarcinoma diagnosis between 2010 and 2018, received surgical resection of the primary cancer site and had liver metastasis without extrahepatic metastasis.  Using 11,348 patients from over 194 counties in the U.S., the study concluded that rates of liver metastasectomy were lower in areas with greater poverty. More specifically, the analysis showed that a 10 percent increase in county-level poverty rate resulted in decreased odds of receiving the surgery for CRLM patients. In comparison, undergoing surgery for stage I colorectal cancer (CRC) was not associated with county-level poverty as these findings did not remain the same for patients receiving surgical treatment for stage I CRC.

“Higher poverty at the county-level was associated with lower receipt of liver metastasectomy for U.S. patients with colorectal liver metastasis. However, surgery for a more common and less complex cancer comparator, such as stage I colorectal cancer, was not observed to be associated with county-level poverty rates,” said George Molina, MD, MPH, of the Brigham’s Division of Surgical Oncology . “These findings suggest that access to complex liver surgery for colorectal liver metastasis might be partially influenced by where patients live. Other factors include financial toxicity and lack of trust in the healthcare system and practitioners.”

Read more in JAMA Open Network.

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