bluuebunny/crossref_metadata_2025 huggingface dataset:
415. Misdiagnosis of multisystem inflammatory syndrome in children: A diagnostic challenge
Authors: Avcu Gülhadiye , Arslan Aslı , Arslan Sema Yildirim , Sahbudak Zumrut , Turan Caner , Ersayoglu Irem , Cebeci Kübra , Kurugol Zafer , Ozkınay Ferda
Published: November 2023

Background

As the COVID-19 pandemic continues, multisystem inflammatory syndrome in children (MIS-C) maintains its importance in the differential diagnosis of common febrile diseases. MIS-C should be promptly diagnosed because corticosteroid and/or intravenous immunoglobulin treatment can prevent severe clinical outcomes. In this study, we aimed to evaluate clinical presentation, diagnostic parameters and management of MIS-C and compare its clinical features of common febrile disease.

Methods

This study was conducted at a tertiary-level hospital between December 2020 and October 2022. One hundred and six children who were initially considered to have MIS-C disease were included in the study. During the follow-up period in the hospital, when the clinical and laboratory findings were re-evaluated, 38 out of 106 children were diagnosed differently. The clinical and laboratory findings of 68 children followed up with the diagnosis of MIS-C and 38 children who were initially misdiagnosed as MIS-C but with different final diagnoses were retrospectively compared.

Results

We identified 68 patients with MIS-C and 38 patients misdiagnosed as MIS-C during the study period. Infectious causes (71%), predominantly bacterial origin, were the most frequently confused conditions with MIS-C. Patients with MIS-C were older and had a more severe clinical course with high rates of respiratory distress, shock, and paediatric intensive care unit admission. While rash and conjunctivitis were more common among patients with MIS-C, cough, abdominal pain, diarrhoea were observed more frequently in patients misdiagnosed as MIS-C. Lower absolute lymphocyte counts, platelet counts and higher C-reactive protein and fibrinogen levels, pathological findings on echocardiography were the distinctive laboratory parameters for MIS-C. Multivariate analysis showed that older age, presence of conjunctivitis, high level of serum CRP and lower platelets were the most discriminative predictors for the diagnosis of MIS-C.

Conclusion

There are still no specific findings to diagnose MIS-C, which therefore can be confused with different clinical conditions. Further data are needed to assist the clinician in the differential diagnosis of MIS-C and the diagnostic criteria should be updated over time.

Disclosures

All Authors: No reported disclosures
418. Possible Risk Factors and Clinical Features of Post-COVID-19 Syndrome in a Veteran Affairs population
Authors: Lum Michael D , Sajib Monirul I , Lier Audun
Published: November 2023

Background

Post-COVID-19 syndrome (PCS) refers to debilitating physical and neuropsychiatric symptoms for at least ≥ 4 weeks following the recovery from COVID-19 infection. The goal of this study is to identify shared epidemiological and clinical features among patients with PCS to identify possible risk factors that can guide studies in the prevention of PCS.

Methods

Chart reviews of patients referred to the post-COVID clinic of Northport VA Medical Center, NY between January 2021 to March 2023 were performed. 57 patients with mild COVID-19 infection without requiring hospitalization that met CDC definition of PCS were included. Cases were reviewed and demographics, comorbidities, treatment/vaccine status, common symptoms reported and baseline inflammatory markers were recorded and analyzed.

Results

The mean age was 56 years, and most patients were between the ages of 46-60 years old (28.1%, table 1). More male patients reported symptoms of PCS compared to females (56.1% vs. 43.9%, table 1). Common comorbidities included pre-existing psychiatric diagnoses (47.4%), obesity (40.4%), hypertension (40.4%), hyperlipidemia (43.9%), and chronic lung disease (36.9%), with an average Charlson comorbidity index of 1.9. Most patients (59.6%) reported only being infected with COVID-19 once (table 1). Most patients (75.4%) did not receive outpatient therapy against COVID-19 and most had only two vaccines against COVID-19 (38.6%, table 2). Predominant symptoms included fatigue (56.1%), brain fog (56.1%), dyspnea on exertion/decreased exercise tolerance (42.1%), and cough (24.6%) (table 3). Of those with values measured, baseline ESR, CRP, ferritin values were normal and a small percentage had elevated D-dimer >150 ng/mL D-DU (table 4).

Conclusion

Majority had comorbidities such as hypertension, hyperlipidemia, pre-existing mental health conditions and obesity. Most had only 2 doses of a COVID-19 vaccine and did not receive any outpatient treatment for COVID-19. This suggests that these features may serve as potential risk factors for PCS and further study is needed to elucidate the relationship between these attributes and PCS.

Disclosures

All Authors: No reported disclosures
421. Impact of SARS-CoV-2 Infection on Physical Fitness in Air Force Basic Trainees
Authors: Crouch Elena M , Marcus Joseph , Yun Heather , Casey Theresa , Kieffer John , Winkler Erin , Kasper Korey , Kiley John
Published: November 2023

Background

The impact of SARS-CoV-2 infection on physical fitness in previously healthy adults is not well known. In this study we assess the impact of SARS-CoV-2 infection on the physical fitness test scores of Air Force basic trainees

Methods

SARS-CoV-2 testing data and trainee fitness test scores for the calendar year 2021 were obtained from US Air Force basic military trainees. Trainees perform a standardized fitness test involving push-ups, sit-ups, and a 1.5 mile run at the beginning and end of their training. Basic trainees who performed two fitness tests in 2021 and also tested positive for SARS-CoV-2 were defined as the infected (Inf) cohort and were 1:1 matched by sex to an uninfected control (Ctl) group of basic trainees. Categorical variables were compared using Chi-squared or Fisher’s exact test and continuous variables were compared using Mann-Whitney-U.

Results

23,450 basic trainees performed a fitness test in calendar year 2021, 975 (4%) of whom tested positive for SARS-CoV-2. 621 (64%) had completed two fitness tests during the defined study period and were included in the Inf cohort. There were 96 females (15.5%) in each group and 525 males (84.5%) in each group. There was no difference in body mass index between the Inf and the Ctl group (24.0 (IQR 21.8 – 36.0) vs 24.3 (IQR 21.7-36.9), p=0.253). The Inf group had a higher rate of failing their physical fitness test at the end of training when compared to Ctl (15.7% vs. 4.3%, p< 0.001). When comparing those who passed their first fitness test and went on to fail their second fitness test, this occurred more frequently in the Inf group (2.3% vs. 0.81%, P = 0.037). When comparing trainees who failed their first fitness test and went on to pass their second fitness test, this occurred more frequently in the Ctl group (46.3% vs. 39.6%, P = 0.016). Amongst the Inf group, there were no differences in 2nd test failure rates when comparing symptomatic to asymptomatic trainees (16.9% vs. 11.8%, P = 0.143).

Conclusion

SARS-CoV-2 infection was associated with an increased risk of physical fitness test failure as well as conversion from a passing to failing test score. The presence of symptoms was not associated with failing test two. Possible confounders include lost fitness training time due to illness.

Disclosures

All Authors: No reported disclosures
426. The diagnosis and treatment of COVID Associated Pulmonary Aspergillosis in patients requiring Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) in the Republic of Ireland during the COVID-19 pandemic: A Retrospective Review
Authors: O’Regan Rhea , Crowe Gillian , Lynch Maureen , Muldoon Eavan , Hastings Jennifer
Published: November 2023

Background

During the advent of the COVID-19 pandemic, multiple cases were reported of the association between SARS-CoV-2 and invasive pulmonary aspergillosis. The diagnosis of Covid associated pulmonary aspergillosis (CAPA) remains difficult, especially in critically unwell patients. We describe those treated with VV ECMO and diagnosed with CAPA in the national centre for ECMO in Ireland during the COVID-19 pandemic, as well as their treatment course and outcomes.

Methods

We retrospectively collected data on all patients who received ECMO during the COVID-19 pandemic in Ireland’s national ECMO centre between May 2020 and January 2022. Data was collected from electronic health care records and cross referenced with positive microbiological samples. The 2020 ECMM/ ISCHAM consensus criteria was used to classify CAPA diagnoses.

Results

37 patients with diagnosed SARS-CoV-2 infection were treated using ECMO. The average age was 46 years (SD 9.3). 15 (41%) of those were female. The mean number of days spent in an intensive care unit (ICU) was 50 (IQR 45-67). 14 (38%) had diagnosed Hypertension, 10 (27%) had Diabetes Mellitus and 1 (2.7%) had known Chronic Kidney Disease requiring dialysis. CAPA was diagnosed in 7 (19%) cases. Using the criteria, no cases were proven as histology samples were not obtained. 1 (14%) case fitted the criteria for possible diagnosis while 6 (86%) cases fitted criteria for probable diagnosis based on biochemical, microbiological and radiological findings. Of these, all received steroids prior to diagnosis, while 3 (43%) also received tociluzumab. 6 (86%) patients received dual antifungal agents and 1 (14%) patient received voriconazole alone. In terms of outcome, 15 (41%) were discharged to another intensive care unit, 1 (3%) discharged to another acute hospital and 2 (5%) to a rehabilitation unit. 16 (43%) patients died while 3 (8%) were discharged home. Of the 7 patients diagnosed with CAPA, 5 (71%) patients died in ICU while 2 (29%) were transferred to other units with final outcome unknown.

Conclusion

Although 2020 guidelines available from ECMM/ISCHAM are used to define strict diagnostic criteria of CAPA, our study demonstrates the need for further research into how other factors may contribute to this diagnosis, including pre-determined risk factors or the use of ECMO.

Disclosures

All Authors: No reported disclosures
431. Title Implementing a Comprehensive Care Model as a Proposal for Long Covid Syndrome Care in a Latin American Country
Authors: Capera Jaime Andres Pineda , Alvarez Carlos , Alvarado Nathali Carolina Gonzalez , Hernandez Juan Manuel Correa , Bobadilla Paola Andrea Rengifo , Aparicio Patrick Francois Tarquino
Published: November 2023

Background

Post-COVID-19 long syndrome or "LONG COVID" is defined by WHO criteria according to the Post-COVID Functional Score (PCFS) and Barthel scales and classified by the persistence of symptoms up to 12 weeks after initial infection. Through a survey conducted in a population of 33500 adults in Bogotá, Colombia, and the confirmatory of SARSCoV2 infection via (PCR or antigen test), we demonstrated 63% of people reported some persistent symptoms after three months of the acute event. With its high frequency, this new clinical condition makes a breach where comprehensive care centers for its management and rehabilitation were necessary. We designed an innovative, individualized, comprehensive transdisciplinary model to provide integral attention to patients diagnosed with Long COVID.

Methods

Patients identified by the questionnaire as a Long COVID were scheduled for submission and care at the Center for Comprehensive Care Post Covid (CAIP). An integral evaluation included the assessment by several specialties, such as physiatry, physiotherapy, psychology, nutrition, nursing, social work, and internal medicine practitioners, according to an established attention model in our clinic (Fig 1).Figure 1.Follow up route of patients with suspected Long COVID. A. Screening questionnaire.

Results

448 patients with long covid were screened between September 2022 and March 2023 in the CAIP. The average age of the population served was 52.6 years. The Barthel average score was 97.8. Patients classified as PCFS grade 1 were 282, 133 were grade 2, and 32 were grade 3. A total of 2230 physical and occupational therapy interventions were performed and 120 psychotherapy sessions with positive findings in functional and aerobic capacity between circuits (Fig 2). With the successful discharge of 50 patients, without remaining limitations to perform their basic activities, 48% were asymptomatic with PCFS: 0 and the remaining with PCFS 1, with a minimum symptomatic compromise.

Conclusion

There are governmental and clinical challenges to the comprehensive care of the population with disabilities related to Long COVID. CAIP, as a transdisciplinary health care and recovery model, which was born in response to long COVID patients, showed great effectiveness in return people great improvement in functionality to reincorporate into our society from the pandemic COVID19 in Colombia.

Disclosures

All Authors: No reported disclosures
436. SARS-CoV-2 Seropositivity and Association with Dengue Severity in Adults
Authors: Priyadarshi Megha , Soneja Manish , Paul Saurav Sekhar , Agarwal Ayush , Tirlangi Praveen Kumar , Sachan Shilpa , Gupta Nimesh , Wig Naveet
Published: November 2023

Background

The effect of SARS-CoV-2 on the pathogenesis and virulence of the dengue virus is unknown. The cross-reactivity of the immune responses in these infections is an emerging concern, as it may influence the clinical outcomes by establishing cross-immunity or antibody-dependent enhancement. This study evaluated the association between SARS-CoV-2 seropositivity and clinical severity in dengue patients.

Fig 1

SARS-CoV-2 cases in the region where the study was conducted and adults with dengue presenting to the study site

Methods

We performed a cross-sectional study on confirmed dengue cases admitted at a tertiary care hospital in North India. Baseline demographic data, clinical severity, past history of symptomatic COVID infection, and COVID-19 vaccination were noted. IgG antibodies against the receptor binding domain (RBD) of the SARS-CoV-2 virus were measured in all patients. The association between the SARS-CoV-2 antibody titer and severity of dengue was statistically analyzed using one-way ANOVA - Kruskal Wallis followed by Dunn's multiple comparisons, with a p-value less than 0.05 considered statistically significant.

Results

A total of 62 confirmed dengue patients were enrolled in the study (September 2021–December 2021). The median age of the study population was 27 years (IQR: 21–35 years), with a male preponderance of 64.5%. According to WHO dengue severity criteria, 30.6% of patients had dengue without warning signs, 50% had dengue with warning signs, and 19.3% had features suggestive of severe dengue. All patients were seropositive for IgG COVID antibodies, with a median titer of 2700 AU/ml (IQR 900–8100). We observed no statistically significant difference in overall SARS-CoV-2 antibody responses among the three dengue severity groups (p-value 0.9).

Table 1

Demographic and clinical characteristics of study population and comparison of presentation with varying severity of dengue

Table 2

Association of SARS CoV2 infection and COVID vaccination with dengue severity

Fig 2

Effect of COVID-19 vaccination on SARC-CoV-2 specific antibodies in acute dengue patients. Acute dengue patients categorized as non-vaccinated (Green circles, N=12), single (Red circles, N=12) and double dose vaccinated (Blue circles, N=24) with SARS-CoV-2 vaccines. Yellow triangle represents severe dengue (N=11). (A-B) Graph demonstrates the spread of SARS-CoV-2 binding IgG in three groups respectively. Dotted line represents the cut-off for IgG positivity

Conclusion

This study concludes that SARS-CoV-2 seropositivity is not associated with clinical severity in dengue patients. This may imply that past infection with COVID or vaccination against COVID does not alter the severity of dengue.

Fig 3

Association of SARS CoV2 infection COVID vaccination and COVID antibody titer with dengue severity

Disclosures

All Authors: No reported disclosures
439. Impact of viral load in HIV adult patients hospitalized with COVID-19
Authors: Garcia Alberto Romero , Lim Chee Yao , Gutierrez Jorge , Afzal Afsheen , Miller Dwayvania , La Fortune Alexander , Feinstein Addi , Menon Vidya
Published: November 2023

Background

There is no difference in mortality in COVID-19 patients with and without HIV. The purpose of our study was to assess the outcomes of patients with HIV (PWH) and COVID-19 when stratified by their viral load (VL).

Methods

In this retrospective single center study, data was collected from electronic medical records from March 2020 to December 2021. All adult patients admitted with a diagnosis of COVID-19 pneumonia were included. They were stratified according to their HIV status and subsequently PWH were stratified and analyzed according to their VL. We compared mortality rate, length of stay (LOS), incidence of septic shock, and severity of COVID-19 infection (by Quick COVID-19 Severity Index) using chi-square and we performed a multivariate analysis.

Results

During this period a total of 1902 patients were admitted for COVID-19 infection and 78 patients were PWH. 32 patients had undetectable VL vs 46 with detectable VL. Baseline characteristics are described in table 1. PWH had a mortality rate of 15% (12 out of 77) compared with 27% (508 out of 1824) of the rest of population P=0.016. Among PWH, when stratified by their viral load, patients with detectable viral load had lower mortality incidence (4.3% vs 32.4% p=0.001), lower incidence of septic shock (5% vs 23%, p=0.015), and lower rates of severe and critical COVID-19 infection (52% vs 80.6%, p=0.011). Analysis by logistic regression was conducted to determine the impact of age and other comorbidities on mortality risk.. No association was found between VL status and incidence of mortality, septic shock, or severity of COVID-19. Length of stay and COVID-19 severity had no significant difference between these groups.

Conclusion

It was thought that PWH with detectable viral load experienced less severe COVID-19 disease course due to the unsuppressed disease by the defective immunity and ART, as evidenced by observed lower rates of mortality and complications like septic shock. However, our study found no significant impact of VL in PWH on COVID-19 outcomes when accounting for age and comorbidities. These findings emphasize the need to consider the higher prevalence of comorbidities in PWH and other social determinants of health when examining the course of COVID-19 infection in an aging HIV population.

Disclosures

All Authors: No reported disclosures
440. Steroid Use and Elevated Rates of Coinfections and Mortality in Mild-COVID-19 Patients
Authors: Rebellon-Sanchez David E , Llanos-Torres Julio , Álvarez-Ortega Carolina , Guzman-Gonzales Tania M , Rodríguez Sarita , Rosso Fernando
Published: November 2023

Background

Systemic corticosteroids are used to treat patients with COVID-19. Since the findings of the RECOVERY trial, steroids have been broadly used in critical patients. However, their use in patients with mild disease was unclear and may even be harmful. In the hard times of the pandemic in the absence of widely available vaccines or antivirals agents, hospital overcrowding, patients had to be referred to home care and steroids could be overused. The aim of this study was to explore the relationship between the use of corticosteroids, secondary infections and overall mortality in adults with COVID-19

Methods

A prospective observational study was performed in a university hospital in Cali, Colombia. Severity was assessed with NEWS score 2. The study included patients at various levels of severity, including patients admitted to the emergency department, inpatients, and those admitted to the intensive care unit

Results

A total of 12,227 patients were treated at our hospital during the first four waves of the pandemic. 54.8% were female, with median age of 45 years (IQR: 31 - 62). 68.5% were classified as mild COVID-19, 8.8% as moderate, and 22.68% as severe. 5.49% of patients were pregnant. Of all patients, 24.30% received corticosteroids upon admission, 11.6% developed secondary infections, and 8.4% died. Mild COVID-19 cases were 1,988 (wave 1), 2,147 (wave 2), 1,628 (wave 3), and 1,608 (wave 4). The proportions of corticosteroid used by waves were 4.3%, 7.18%, 12.5%, and 8.1%, respectively. Corresponding proportions for secondary infections were 2.80%, 5.26%, 6.14%, and 3.8%, while death proportions were 1.7%, 2.5%, 3.2%, and 2.1%. A positive correlation was found between corticosteroid use and secondary infection and mortality rates (Fig. 1). Correlation coefficients were r= 0.9 (p= 0.09) for corticosteroid use and mortality, r= 0.84 (p= 0.15) for corticosteroid use and secondary infection, and r= 0.94 (p= 0.01) for secondary infection and mortality. These correlations were not observed in moderate and severe COVID-19 cases

Relationship between corticosteroid use, secondary infection and mortality in patients with COVID-19

A. Relationship in mild COVID-19 patients. B. Relationship in moderate-to-severe COVID-19 patients

Conclusion

Our study shows that the use of corticosteroids in mild cases could correlate with a greater proportion of secondary infections and mortality

Disclosures

All Authors: No reported disclosures
452. Ongoing Surveillance of SARS-CoV-2 for In Silico Analysis to Monitor the Performance of SARS-CoV-2 Assays in BIOFIRE® Panels
Authors: Horrocks Eleanor K , Todorov Toma , Debernardi Alexandra , Spaulding Usha , Robinson Tanner , Antosch Jeremiah , Lu Zhenmei , Jones Matthew , Cloud Joann
Published: November 2023

Background

In response to the COVID-19 pandemic, bioMérieux has incorporated assays to detect SARS-CoV-2 into the BIOFIRE® Respiratory 2.1 (RP2.1) Panel, the BIOFIRE® SPOTFIRE® Respiratory (R) Panel and the BIOFIRE® SPOTFIRE® Respiratory (R) Panel Mini. All panels use two assays for SARS-CoV-2 detection, each targeting a different gene. Positive detection in only one of the two assays is required for a positive SARS-CoV-2 result. As new variants of SARS-CoV-2 emerge, in silico analysis remains crucial to ensure that both SARS-CoV-2 assays are reactive to circulating strains.

Methods

Sequence data (https://gisaid.org/) for SARS-CoV-2 variants deemed significant by the WHO and UKHSA are analyzed monthly. Assay primer regions are assessed for mismatches using Geneious Prime® as well as proprietary software tools. When primer mismatches with potential to affect the sensitivity of SARS-CoV-2 detection are identified (mismatches occurring in the 3’ half of a primer in both assays), and meet the testing criteria, the BIOFIRE RP2.1 Panel is used to empirically evaluate the impact by comparing synthetic templates with mismatches of concern to synthetic template without mismatches.

Results

As of March 21, 2023, nearly 1,000 variants and 12,744,136 sequences have been analyzed. Of these, only 481 sequences (0.0038%) contain paired mismatches of concern. Wet testing showed < 10x lower projected sensitivity for 288 (72 unique) sequences, 10-100x lower sensitivity for 16 (10 unique) sequences, and only 1 sequence had 100-1000x lower projected sensitivity. Lineage defining mutations were seen within a SARS-CoV-2 assay primer region in 27 variants. However, most lack mutations in the second assay, indicating no major risk for SARS-CoV-2 detection. Wet testing shows that the inclusion of two SARS-CoV-2 assays in the panels helps to mitigate the effect of mismatches of concern.

Conclusion

Based on the comprehensive in silico analysis of available sequences and variants, BIOFIRE RP2.1 Panel, SPOTFIRE R Panel and SPOTFIRE R Panel Mini continue to function as intended with >99.99% detection of SARS-CoV-2 sequences.

Disclosures

Eleanor K. Horrocks, bioMerieux: employee|bioMerieux: Stocks/Bonds Toma Todorov, n/a, bioMerieux: employee|bioMerieux: Stocks/Bonds Alexandra Debernardi, n/a, bioMerieux: employee|bioMerieux: Stocks/Bonds Usha Spaulding, n/a, bioMerieux: employee|bioMerieux: Stocks/Bonds Tanner Robinson, n/a, bioMerieux: employee|bioMerieux: Stocks/Bonds Jeremiah Antosch, n/a, bioMerieux: employee|bioMerieux: Stocks/Bonds Zhenmei Lu, n/a, bioMerieux: employee|bioMerieux: Stocks/Bonds Matthew Jones, MS, bioMerieux: employee|bioMerieux: Stocks/Bonds Joann Cloud, PhD, bioMerieux: employee|bioMerieux: Stocks/Bonds
459. Characteristics and Presentations of Hospitalized Children due to three predominate COVID-19 variants within a healthcare network
Authors: Bhavsar Sejal M , Clouser Katharine N , Connolly Hailey , Gadhavi Jasmine , Kaur Ranbir , Lozy Tara , Naganathan Srividya , Pierre Margarette , Cruz Mariawy Riollano , Shah Pooja , Siu Anita , Swenson Carly , Ballance Cathleen M
Published: November 2023

Background

Variants of SARS-CoV-2 caused three major waves of infections in NJ. Children and young adults were hospitalized with varying symptoms and severity of illness depending on the variant. The objectives of this study are to describe differences in the demographic and clinical characteristics, severity of illness and outcomes in pediatric patients during the different SARS-CoV-2 waves in our hospital network.

Methods

We conducted a retrospective study of pediatric patients admitted to one of our three network hospitals with SARS-CoV-2 infection or with post-COVID-19 inflammatory conditions such as Multisystem Inflammatory Syndrome in Children (MIS-C) during the different waves of infection. Patients who were asymptomatic but incidentally tested positive for SARS-CoV-2 and were hospitalized for unrelated indications were excluded. We defined the timelines as follows: Wave 1 occurred between March 1, 2020 and May 31, 2020; wave 2 occurred between November 1, 2020-January 31, 2021; and wave 3 occurred between December 1, 2021-February 28, 2022. Demographic characteristics, clinical features, and outcomes were recorded and compared with respect to the different variants.

Results

Of 351 total patients included in this study, 74 were admitted during wave 1, 94 during wave 2, and 181 during wave 3. The median age of patients decreased from wave 1 (11.5 years) to wave 3 (3 years) (p=0.0034). 87.7% of the patients were unvaccinated. The overall incidence of admissions related to COVID-19 pneumonia decreased in wave 3 compared to wave 1 and 2. COVID-19 bronchiolitis or croup admissions occurred mostly in wave 3. No significant difference in intensive care admissions was observed in any wave. Length of stay decreased across the waves (p< 0.0001). Treatments required did not vary between the waves except for a decrease in antibiotic use with each subsequent wave (p< 0.0001).

Conclusion

The impact of COVID-19 on the pediatric population differs from the adult population, and the overall numbers of hospitalized children has mirrored the peak in cases observed during each infection wave. Our study illustrates the changes in clinical presentation and severity observed with the different coronavirus variants.

Disclosures

Tara Lozy, MA in Data Science, Eli Lilly & Company: Stocks/Bonds
460. SARS-CoV-2 Infection-Induced Antibody Seroprevalence in Previously Infected Persons with Immunocompromising Conditions — United States, 2020–2022
Authors: Bratcher Anna , Jones Jefferson M , Harris Aaron , Clarke Kristie E N
Published: November 2023

Background

People with immunocompromising conditions (IC) are at increased risk of severe COVID-19 and death. These individuals show weaker immunogenicity following vaccination than individuals without IC, yet immunogenicity after SARS-CoV-2 infection is poorly understood. To address this gap, the presence of infection-induced antibodies in sera following a positive COVID-19 test result was compared between people with and without IC.

Methods

Data were from CDC’s national commercial laboratory seroprevalence study, a repeated, cross-sectional survey that includes associated diagnostic codes and previous COVID-19 viral test results. Infection-induced antibody seroprevalence in sera from people with a positive COVID-19 test result was compared by IC status for three post-infection periods: 14–90 (early), 91–180 (mid), and >180 (late) days. A logistic regression produced adjusted odds ratios (aOR) comparing infection-induced antibody prevalence among specimens with and without associated IC adjusted for age, sex, and infection-induced antibody assay used (Abbott Architect, Ortho VITROS, or Roche Elecsys).

Results

The analytic sample consisted of 15,554 specimens across the three periods (4,571 early, 4,465 mid, and 6,518 late). Of these, 188, 157, and 283 specimens had one or more associated, recorded IC, respectively. During the early period, 22.3% of specimens with IC lacked infection-induced antibodies compared with 6.8% of those without IC. After adjustment, specimens with IC were more likely to lack infection-induced antibodies in the early (aOR: 4.85; 95% CI: 3.20–7.38), mid (aOR: 2.53; 95% CI:1.57–4.09), and late (aOR:1.62; 95% CI:1.12–2.36) periods compared to specimens without IC.

Conclusion

Sera from people with IC is less likely to contain infection-induced antibodies following SARS-CoV-2 infection compared to sera from those without IC within the studied periods. These findings stress the importance of prevention measures for people with IC, such as pre-exposure prophylaxis, additional vaccination doses, and consistent mask use before and after a documented infection.

Disclosures

All Authors: No reported disclosures
465. Use of Monoclonal Antibodies for COVID-19 in Solid Organ Transplant Recipients: A Single-Center Experience
Authors: Gomez Keven , Arcobello Jonathan T , Chang Sandy
Published: November 2023

Background

The use of coronavirus disease 2019 (COVID-19) monoclonal antibody (mAb) treatment in solid organ transplant (SOT) patients have been shown to reduce the rates of hospitalization, Emergency Department (ED) visits, and mortality in previous studies. However, most of these studies provide little or no data in minority patients, specifically Hispanic patients, a group that has been associated with worse outcomes with COVID-19. Our study describes the use of COVID-19 mAbs in the SOT recipients at our institution, where a majority of patients are of Hispanic ethnicity.

Methods

We performed a retrospective chart review of all adult SOT patients who received COVID-19 mAbs from December 2020 to December 2022.

Results

We identified 54 patients who were SOT recipients. The mean age was 46.3 (IQR 33-59), and 30 (55.6%) were male. Of the 54 patients, 34 (63.0%) identified as Hispanic, 17 (31.5%) as White, 2 (3.7%) as Asian, and 1 (1.9%) as Black. There were 23 (42.6%) heart, 22 kidney (40.7%), 6 liver (11.1%), 2 (3.7%) combined kidney and liver, and 1 (1.9%) combined kidney and pancreas recipients. There were four mAbs available during the study period. Of the 54 SOT recipients, 16 (29.6%) received casirivimab/imdevimab, 5 (9.3%) received bamlanivimab, 19 (35.2%) received bebtelovimab, and 14 (25.9%) received sotrovimab. Average time from symptom onset to receipt of infusion was 4 (IQR 1-5) days. The 30-day hospitalization rate due to COVID-19 from time of diagnosis in our cohort was 5.6%. There were 3 (5.6%) patients who visited the ED due to COVID-19 within 30 days of diagnosis and there were no deaths due to COVID-19 within 30 days of diagnosis. When comparing between the Hispanic and non-Hispanic groups in our cohort, the 30-day hospitalization rate due to COVID-19 from time of diagnosis was not statistically significant (5.6% vs 0, p=0.29). There was one patient who had an infusion reaction and 3 patients who developed allograft rejection within 90 days of mAb infusion.

Conclusion

In our small cohort of SOT recipients, the majority of which are Hispanic, use of COVID-19 mAbs had low rate of poor outcomes and adverse events. There was no statistically significant difference in hospitalization rate following mAb infusions between the Hispanic and non-Hispanic SOT recipients in our group.

Disclosures

All Authors: No reported disclosures
469. Outcomes of COVID-19 among hospitalized patients under Rituximab: the experience of a Portuguese hospital
Authors: Gonçalves Maria João M S , Pena Eduarda , Duarte Frederico , Oliveira Susana , Batista Clara , Guimarães Mário , Abreu Ricardo Correia , Neves Isabel , Jordão Sofia
Published: November 2023

Background

Rituximab (RTX) is a monoclonal antibody commonly used for various hematological and autoimmune disorders. B-cell–depleting therapies also blunt humoral responses to SARS-CoV-2 vaccines. Whether this carries an increased risk of hospitalization or death from COVID-19 is unclear.

Methods

We conducted a retrospective study of hospitalized patients with COVID-19 who received RTX prior to hospitalization (maximum 18 months before). We analysed their outcomes, including length of stay, antiviral treatment, inflamatory markers and mortality.

Results

A total of 43 hospitalized COVID-19 patients who received RTX were included in the study (from April 2020 to April 2023) . The median age was 67 years (range, 25-88), and 58% were female. The average length of stay was 28 days (range, 1-29). Upon admission, average value of severity predictor markers: CRP 94.6 mg/L, procalcitonine 0.66 ng/mL, lactate dehydrogenase (LDH) 383.5 U/L, D-dimers 1530.3 ng/mL. Treatment was performed in 44% with dexamethasone and in 48% with remdesivir. The mortality rate was 42%.

Conclusion

In our study, previous treatment with rituximab was associated with high severity predictor markers and serious outcomes of COVID-19.

Patients and healthcare professionals should be aware of the risk associated with COVID-19 in this population. Clinicians must choose carefully patients for anti-CD20 treatments. Preventive measures, active and passive immunization, as well as early antivirals therapy may decrease COVID-19 severity.

Disclosures

All Authors: No reported disclosures
488. Initial laboratory markers may help distinguish between Kawasaki Disease and Multisystem Inflammatory Syndrome in Children
Authors: Miretzky Shir , Clouser Katharine N , Bhavsar Sejal M , Baer Aryeh Z , Sagcal-Gironella Anna Carmela , Pinto Jamie M , Tozzi Meghan , Patel Vaidehi
Published: November 2023

Background

In May of 2020, the Centers for Disease Control and Prevention defined a new diagnosis, Multisystem Inflammatory Syndrome in Children (MIS-C), described as a Kawasaki-like illness and related to the SARS-CoV-2 virus. Patients with this syndrome met criteria for inflammation, along with multiple organ system involvement. Clinically distinguishing between Kawasaki Disease (KD) and MIS-C is challenging due to significant overlap between the two disease entities. Furthermore, approximately 25-50% of MIS-C cases also meet criteria for KD. Currently there is very limited data describing specific differences in laboratory markers between KD and MIS-C to guide clinicians in diagnosis and management. This study aims to assess if quantitative laboratory data markers help distinguish between KD and MIS-C.

Methods

We conducted a retrospective study of patients hospitalized within two network pediatric hospitals with the diagnosis of MIS-C [M35.81] or Kawasaki Disease [M30.3] between January 1, 2019 and March 31, 2021. Children with an alternate diagnosis at discharge were excluded. Demographic characteristics and laboratory data were recorded and analyzed.

Results

A total of 91 pediatric patients were included in the study: 40 with MIS-C and 45 with KD. Patients with MIS-C were significantly older with a median age 5.3 years, compared to 2.4 years for KD (p=0.001). Patients with KD presented with higher median white blood cell (WBC) count, absolute lymphocyte count, and platelet count compared to those with MIS-C (p< 0.001). A higher alanine aminotransferase (ALT) was also noted (p=0.01). Patients with MIS-C were noted to have higher median ferritin levels and C-reactive protein (CRP) (p< 0.001) (Table 1).

Conclusion

Both MIS-C and KD are autoinflammatory disease processes that have significant overlap. Identifying differences in initial laboratory values upon presentation can lead to earlier diagnosis. A normal ferritin level may indicate KD.

Disclosures

All Authors: No reported disclosures
497. Safety and tolerability of 2000mg intravenous sotrovimab dose in immunocompromised participants uninfected with SARS-CoV-2 in the PROTECT-V trial
Authors: Dosanjh Davinder , Qian Wendi , Dowling Francis , Crowley Louise , Chen-Xu Michael , Smith Rona M
Published: November 2023

Background

There remains a need for pre-exposure prophylaxis against SARS-CoV-2 infection in vulnerable patients in whom response to vaccination is often sub-optimal. The PROTECT-V platform trial is testing pre-exposure prophylactic interventions for COVID-19 in vulnerable patient populations: transplant recipients, individuals with oncological/haematological diagnoses, immune deficiency, autoimmune diseases requiring immunosuppression, and individuals receiving dialysis.

Methods

Sotrovimab is a dual-action monoclonal antibody and the second agent to be added to the PROTECT-V platform (Clinicaltrials.gov: NCT04870333; EudraCT: 2020-004144-28). Although a single sotrovimab 500mg intravenous (IV) dose has been widely used for early treatment, data on a 2000mg IV dose are limited. Tolerability data in the first 143 participants randomized to this arm of the trial are presently available. Patients are randomized 1:1 sotrovimab to placebo. Data remain blinded.

Results

Median age was 66 years (range 21 – 86) and 82 (57%) patients were female. 132 (96%) had received ≥3 doses of SARS-CoV-2 vaccine. Patient populations were: 82 (57%) autoimmune disease; 26 (18%) haematological/oncological diseases; 21 (15%) transplant recipients; 12 (8%) immunodeficiency; 2 (1%) on dialysis.

Two (1%) participants experienced a mild infusion related reaction (IRR). The infusion was briefly interrupted, but completed. Thirty (21%) participants experienced at least one symptom in the 24 hours post-infusion, but none were severe or required hospital admission. The most common symptoms were dizziness (7 [5%]), headache (7 [5%]), rigors (5 [4%]) and fever (4 [3%]). No severe adverse events were reported within 72 hours of IMP infusion at the time of writing.

The first 55 patients underwent routine hematological and biochemical blood test evaluation 72 hours post-infusion. Ten events from 9 participants exhibited worsening of laboratory parameters, meeting at least grade two DAIDS criteria or worse. None of these were clinically significant.

Conclusion

A 2000mg IV dose of sotrovimab was tolerated well in this blinded analysis of immunocompromised participants, with no severe IRRs or significant change in haematological or biochemical markers up to 72 hours post infusion.

Disclosures

Davinder Dosanjh, n/a, Astrazeneca: Honoraria|Astrazeneca: Employee|Boehringer Ingelheim: Advisor/Consultant|Boehringer Ingelheim: Honoraria|Gilead: Advisor/Consultant|GSK: Grant/Research Support|Synairgen: Advisor/Consultant Louise Crowley, n/a, GSK: Grant/Research Support Michael Chen-Xu, n/a, GSK: Grant/Research Support Rona M. Smith, MD MRCP, GSK: Grant/Research Support|Union Therapeutics: Grant/Research Support
501. Risk Factors for Persistent Active COVID-19 Among Patients Receiving B-Cell Depleting Therapy versus Non-B-Cell Immunosuppression
Authors: Voll Kevin , Kartes Jacob , Spivak Emily S , Imlay Hannah
Published: November 2023

Background

Cases of COVID-19 characterized by prolonged replication of SARS-CoV-2 (persistent active COVID [PAC]) have been reported among immunocompromised patients, particularly those receiving B-cell depleting therapy (BCDT); however, the risk has not been quantified. We aimed to identify risk factors associated with PAC, including quantifying the risk associated with receipt of BCDT vs. other types of immunosuppression.

Methods

We retrospectively identified four groups of immunocompromised patients who tested positive for SARS-CoV-2 between 4/01/2020 and 4/30/2021. These groups included one group of patients who received an anti-CD20 BCDT within 1 year before a positive SARS-CoV-2 PCR and three groups who received non-BCDT which included hematopoietic cell transplant (HCT) recipients, solid organ transplant (SOT) recipients, and patients receiving chemotherapy for hematologic malignancies (HM). Chart review was performed to characterize the clinical course and development of PAC, which was defined as any of the following: (1) initial clinical improvement followed by progression of illness extending beyond 14 days, characterized by persistent fevers or progressive respiratory failure; or (2) persistent symptoms with demonstration of absent seroconversion ≥ 14 days into illness. This distinction may be supported by low crossing thresholds that occurred ≥ 14 days into illness. Logistic models were performed to identify factors associated with development of PAC and other COVID outcomes.

Results

We identified 67 COVID-positive patients who had received BCDT as well as 30 HM, 118 SOT, and 29 HCT patients. PAC occurred in 15/67 (22%) of patients receiving BCDT vs. 3/177 (1.7%) patients (all SOT recipients) in the non-BCTD group (SOT, HCT, HM) (Odds Ratio, 16.7; 95% confidence interval [CI] 4.7 to 60.0; p=0.00005). 30-day hospitalization and 90-day mortality were similar in BCDT and non-BCDT groups (Table 1, Figure 1) (p > 0.05).

Table 1.

Risk factors for specific outcomes of COVID-19

Figure 1.

Proportion of patients from each cohort of immunocompromised patients who developed persistent active COVID (1A), required hospitalization within 30 days (1B), required mechanical ventilation (1C), required ICU admission (1D), or died within 90 days after diagnosis of COVID-19 (1E)

Conclusion

Receipt of BCDTs was significantly associated with the development of PAC in comparison to other forms of severe immunosuppression. However, rates of severe outcomes associated with COVID-19 were similar across all groups. More research is necessary to determine effective prevention or treatment strategies for PAC.

Disclosures

All Authors: No reported disclosures
507. Impact of COVID-19 variant prevalence on hospitalization rate among individuals receiving monoclonal antibodies within a community health-system
Authors: Arnoczy Gretchen S , Kessell Andrew , Vielbaum Felicia M , Brock Brenda , Carter Rebecca , Scholl Jan M
Published: November 2023

Background

During the COVID-19 pandemic, multiple targeted monoclonal antibodies were used in high risk patients with early COVID-19 to prevent complications. Serving as the primary referral site for a large geographic region in central North Carolina, our rural community health-system administered monoclonal agents to COVID-19 positive patients from December 2020 to November 2022. During this time period three predominate variants emerged (alpha, delta and omicron).

Monoclonal Antibody Infusions at FirstHealth of the Carolinas, December 2020-November 2022

Methods

A retrospective study was conducted at FirstHealth of the Carolinas Moore Regional Hospital examining patients from December 1st, 2020 to November 30th, 2022. All COVID-19 positive patients receiving one of the COVID-19 monoclonal therapies granted emergency use authorization during the study period were included. Patients were sub-divided into three distinct time periods representing different variants based on the prevalent pathogen in our region: December 2020 – June 2021 (alpha); July 2021- December 2021 (delta); January 2022-November 2022 (omicron). Hospitalization rates post monoclonal treatment were compared between time periods.

Results

1820 monoclonal antibody infusions for COVID-19 were administered within the FirstHealth of the Carolinas system in the period studied. Number of infusions were highest during delta with over 60% of the infusions occurring during this period. Hospitalization rates in this group were 3.5% (alpha), 3.5% (delta), and 2.0% (omicron). Vaccination status among individuals getting monoclonal antibody infusions changed over time based on changing infusion criteria and variant prevalence.

Conclusion

In a real world, rural, community health care setting in the Southeast United States - hospitalization rates for high-risk individuals receiving monoclonal antibody infusions for COVID-19 were similar to reported rates and varied by variant prevalence. This is may be due to alterations in variant severity as well as vaccination status of the population.

Disclosures

All Authors: No reported disclosures
513. Evaluating the safety of baricitinib versus tocilizumab in hospitalized patients with COVID-19
Authors: Brickel Kendall , Meyenburg Lyndsi , Rose Dusten T T , Pan Neil
Published: November 2023

Background

Tocilizumab and baricitinib are immunomodulators that combat immune dysregulation observed in patients with COVID-19. To date, no studies have explicitly looked at the safety of baricitinib versus tocilizumab in patients with COVID-19.

Methods

This evaluation is a multicenter, retrospective cohort study of adult patients treated with either baricitinib or tocilizumab for COVID-19 within the Ascension Seton network from May 1st, 2020 - August 31st, 2022. A control group consisted of patients who would otherwise have qualified for treatment but did not receive either agent. The primary objective was the incidence of adverse effects in patients with COVID-19 treated with baricitinib versus tocilizumab. Secondary objectives include rates of thromboembolism, hematologic toxicity, hospital-acquired infection, hepatic enzyme elevation, gastrointestinal perforation, death, and any adverse effect believed to be secondary to or that resulted in the discontinuation of either study medication. A chi-squared test was used to assess the primary outcome. Secondary outcomes were analyzed using appropriate statistical tests.

Results

Of the 737 patient encounters screened, 145 patients were included in each group. Adverse event rates were 112/145 (77.2%) for the baricitinib group and 114/145 (78.6%) for the tocilizumab group (p = 0.78). In the control group, adverse event rates were 86/145 (59.3%), and a Kruskal–Wallis test revealed a difference between the three groups (p = 0.007). Twenty-two (15.3%) of patients who received baricitinib experienced a documented adverse drug reaction based on progress notes from the provider versus one (1.4%) patient in the tocilizumab group (p < 0.001). Baricitinib was associated with significantly higher rates of thrombocytosis (p = 0.008).

Conclusion

Among our study population, baricitinib was associated with increased rates of adverse events documented in progress notes. However, baricitinib was comparable to tocilizumab regarding adverse events, including hepatotoxicity, hematologic toxicities, thrombotic risk, gastrointestinal perforation, hospital-acquired infections, and death. Overall, baricitinib was shown to be a safe alternative to tocilizumab, and patients receiving either agent are at increased risk for adverse events.

Disclosures

All Authors: No reported disclosures