bluuebunny/crossref_metadata_2025 huggingface dataset:
440. Detection of COVID-19 Patients Requiring Escalation to ICU Status Using a Naïve Bayes Classifier
Authors: Barnett William R , Jaenke Chad , Holtzapple Zachary , Williams James , Kesireddy Nithin , Khokher Waleed , Assaly Ragheb
Published: December 2021

Background

A naïve Bayes classifier is a popular tool used in assigning variables an equal and independent contribution to a binary decision. With respect to COVID-19 severity, the naïve Bayes classifier can consider different variables, such as age, gender, race/ethnicity, comorbidities, and initial laboratory values to determine the probability a patient may need to be admitted or transferred to an intensive care unit (ICU). The aim of this study was to develop a screening tool to detect COVID-19 patients that may require escalation to ICU status.

Methods

Patients hospitalized with COVID-19 were gathered from the end of March 2020 to the end of May 2020 from four hospitals in our metropolitan area. We began searching for potential variables to include in the classification model using chi-square analysis or calculating the optimal cutpoint to separate ICU and non-ICU status. After identifying significant variables, we began using standard procedures to construct a classifier. The dataset was split 7:3 to create samples for training and testing. To appraise the model’s performance, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC), and the Matthew’s correlation coefficient (MCC) were calculated.

Table 1. Univariate analysis of variables in the COVID-19 dataset dichotomized by ICU status

Results

A total of 574 COVID-19 patients were included in the study. There were 402 patients in the training sample and 172 patients in the testing sample. The naïve Bayes classifier demonstrated an overall accuracy result of 75.6% (95% CI; 68.5% – 81.8%) using the 14 variables listed in Table 1. The model was able to correctly classify 84.9% of ICU status patients (sensitivity), but only 54.7% of non-ICU status patients (specificity). The PPV and the NPV were 80.1% and 61.7%, respectively. The AUC was 0.717 (95% CI; 0.629 – 0.805) and the MCC was 0.410.

Conclusion

Our naïve Bayes classifier operates by recognizing certain aspects of severe COVID-19 cases and looking for the probability of the variables in said patients. We present a classification model that potentially could be used alongside other tools to screen patients with COVID-19 early in their hospital course to identify those needing escalation to ICU level care.

Disclosures

All Authors: No reported disclosures
441. The Effects of Race and Comorbidity Burden on Inflammatory Biomarkers Among Persons Hospitalized with COVID-19
Authors: Fatade Yetunde A , Collins Lauren F , Collins Lauren F , Almuwaqqat Zakaria , Chen ZhenChao , Prasad Mahadev , Quyyumi Arshed , Ofotokun Igho
Published: December 2021

Background

African Americans (AA) and Latinos, compared with Whites, experience disproportionately higher rates of morbidity and mortality in COVID-19. Exuberant inflammatory responses may explain, in part, the differences in disease severity in COVID-19 observed among different demographic groups.

Methods

In a retrospective cohort study, we analyzed data from patients aged ≥18 years hospitalized for COVID-19 (confirmed by positive SARS-CoV-2 PCR) from 3/1/2020 – 12/31/2020 at Emory Healthcare hospitals. Patient demographics, clinical characteristics, and peak levels of high-sensitivity C-reactive protein (hs-CRP) during hospitalization were abstracted from electronic medical record. Comorbidity burden was defined as the number of six total comorbidities assessed per patient. Multivariable logistic regression (adjusted for age, sex, body mass index [BMI], smoking status) assessed the effects of race and comorbidity burden on peak hs-CRP level.

Results

3,860 patients, median age 60 [18-108] years, 51% female, 57% AA, 28% White, 6% Latino and 9% other races were enrolled. Median comorbidity burden per patient was 2 (Q1-Q3, 1-3), with prevalent comorbidities distributed as follows: 68% had hypertension, 43% renal disease, 42% diabetes, 16% cardiovascular disease, 12% lung disease, and 5% cancer. Unadjusted peak hs-CRP (mg/L) levels were highest among Latino patients (144.9) followed by other races (137), AA (130.3), and Whites (122.2). In adjusted models (including race), the mean difference in peak hs-CRP (mg/L) compared with patients who had no comorbidities was 18.7 (p=0.108), 56.7 (p< 0.001), and 78.2 mg/L (p< 0.001) for 1, 2, and ≥3 comorbidities, respectively. In adjusted models (including comorbidity burden), the mean level of peak hs-CRP, compared with Whites, was 34.2 (p< 0.001), 38.4 (p=0.003), and 36.0 mg/L (p=0.06) higher in AA, Latinos, and other races, respectively.

Conclusion

Among patients hospitalized with COVID-19, non-White race and comorbidity burden were associated with significantly higher levels of inflammation. These findings suggest that exuberant inflammatory responses may be driving, in part, the differences in COVID-19 disease severity observed across different demographic groups.

Disclosures

Lauren F. Collins, MD, MSc, Nothing to disclose
442. Sex-Related Differences in Mortality from COVID-19: Survival Analysis of Patients from an Urban Hospital
Authors: Sharma Mamta , Szpunar Susan M , Bhargava Ashish , Johnson Leonard B , Saravolatz Louis
Published: December 2021

Background

Mortality from COVID-19 is associated with male sex, older age, black race, and comorbidities including obesity. Our study identified risk factors for in-hospital mortality from COVID-19 using survival analysis at an urban center in Detroit, MI.

Methods

This was a single-center historical cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (the COVID-19 virus) on qualitative polymerase-chain-reaction assay, who were admitted between 3/8-6/14/20. We assessed risk factors for mortality using Kaplan-Meier analysis and Cox proportional hazards models.

Results

We included 565 patients with mean age (standard deviation) 64.4 (16.2) years, 52.0% male (294) and 77.2% (436) black/African American. The overall mean body mass index (BMI) was 32.0 (9.02) kg/m2. At least one comorbidity was present in 95.2% (538) of patients. The overall case-fatality rate was 30.4% (172/565). The unadjusted mortality rate among males was 33.7% compared to 26.9% in females (p=0.08); the median time to death (range) for males was 16.8 (0.3, 33.9) compared to 14.2 (0.32, 47.7) days for females (p=0.04). Univariable survival analysis with Cox proportional hazards models revealed that age (p=< 0.0001), admission from a facility (p=0.002), public insurance (p< 0.0001), respiratory rate ≥ 22 bpm (p=0.02), lymphocytopenia (p=0.07) and serum albumin (p=0.007) were additional risk factors for mortality (Table 1). From multivariable Cox proportional hazards modeling (Table 2), after controlling for age, Charlson score and qSofa, males were 40% more likely to die than females (p=0.03).

Table 1. Univariate analysis with Cox proportional hazards model on factors associated with mortality in patients with COVID-19

Abbreviations: HR: Hazard ratio, CI: Confidence interval

Table 2. Multivariable analysis with Cox proportional hazards model on factors associated with mortality in patients with COVID-19

Abbreviations: HR: Hazard ratio, CI: Confidence interval, CWIC: Charlson weighted index of comorbidity, qSOFA: Quick sepsis related organ failure assessment

Conclusion

After controlling for risk factors for mortality including age, comorbidity and sepsis-related organ failure assessment, males continued to have a higher hazard of death. These demographic and clinical factors may help healthcare providers identify risk factors from COVID-19.

Disclosures

All Authors: No reported disclosures
445. COVID-19 Pharmacotherapy Was Not Associated with Mortality in a Community Teaching System
Authors: Urnoski Eric , Butler Thomas
Published: December 2021

Background

During the COVID-19 pandemic, a task force was assembled to collect data on patient characteristics and treatment exposures to assess what factors may contribute to patient outcomes, and to help develop institutional treatment guidelines.

Methods

A retrospective study was performed on COVID-19 inpatient admissions within a four-hospital community health system over a six-month period from April-October 2020. Positive COVID-19 immunology results and/in conjunction with an inpatient admission was criteria for inclusion. Covariates for age, gender, race were added apriori. Covariates of interest included baseline comorbidities, admission level-of-care, vital signs, mortality outcomes, need for intubation, and specific pharmacological treatment exposures. Logistic regression was performed on our final model and reported as OR +/- 95% CI.

Results

A total of 349 patients met inclusion criteria. Pharmacotherapies were not associated with a difference in mortality in a four-hospital system. Corticosteroids (p = 0.99); Remdesivir (p = 0.79); hyrdroxychloroquine (p = 0.32); tocilizumab (p = 0.91); were not associated with mortality. ACE-inhibitor or angiotensin II receptor blockers OR 0.29 (0.09-0.93) (p = 0.03); convalescent plasma OR 7.85 (1.47-42.1) (p = 0.02); neuromuscular blocking agents (NMBA) OR 5.51 (1.28-23.8) (p = 0.02); vasopressors OR 17.6 (5.62-54.9) (p = 0.00) were associated with in-hospital mortality. Covariates that were associated with a difference in mortality were: age > 60 years OR 2.73 (1.04-7.14) (p = 0.04); structural lung disease OR 3.02 (1.28-7.10) (p = 0.01). Covariates not associated with mortality included African American race (p = 0.30); critical care admission (p = 0.19); obesity (p = 0.06); cardiovascular disease (p = 0.89); diabetes (p = 0.28).

Conclusion

The use of corticosteroids, remdesivir, tocilizumab, and hydroxychloroquine, and admission to a critical care bed was not associated with a difference of in-hospital mortality. Patients who required vasopressors or NMBA were associated with in-hospital mortality. Despite national trends reporting increased mortality in patients with obesity, diabetes, cardiovascular disease, and of African American race, this was not observed in our health system safety net hospitals.

Disclosures

All Authors: No reported disclosures
446. Prognostic Value of Absolute Lymphocyte Count for Disease Severity and Clinical Outcomes in Adult COVID-19 Inpatients
Authors: Niu Jianli , Sareli Candice , Deane Maria , Sareli Aharon E
Published: December 2021

Background

Lymphopenia has been reported as a relatively frequent finding in patients with coronavirus disease 2019 (COVID-19). This study aimed to assess the use of absolute lymphocyte count (ALC) as a prognostic biomarker for disease severity and clinical outcomes.

Methods

A cohort of adult patients with COVID-19 admitted to Memorial Healthcare System, Hollywood, Florida from March 7, 2020 to January 18, 2021 was retrospectively analyzed. An absolute lymphocyte count (ALC) < 1.1 × 109/L was used as cutoff point to define lymphopenia. Correlations of ALC upon admission with age and serum levels of C-reactive protein, interleukin-6, lactate dehydrogenase, and creatinine were analyzed. Univariate and multivariate regression models were developed to assess the association of lymphopenia with the risk of ICU admission and clinical outcomes.

Results

4,485 hospitalized patients were included in the final analyses. Median age was 61 (interquartile range, 47-73) years and 2,311 (51.5%) were men. Lymphopenia was more frequent in patients admitted to the ICU compared to those that were not admitted to the ICU, with an odds ratio of 2.14 (95% conﬁdence interval [CI], 1.78-2.56, p < .0001) (Figure 1). The actual value of the ALC was negatively correlated with age and serum levels of C-reactive protein, interleukin-6, lactate dehydrogenase, and creatinine (all p < 0.005). Patients with lymphopenia (n=2,409) compared to those without lymphopenia (n=2,076) had multivariable-adjusted odds ratios of 1.85 (95% CI, 1.53-2.24) for ICU admission, 2.08 (95% CI, 1.67-2.58) for intubation, 1.98 (95% CI, 1.31-3.00) for development of acute kidney failure, and 2.23 (95% CI, 1.79-2.79) for in-hospital mortality (Table 1). Analyses were adjusted for age, gender, race, hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, malignancy, obesity, and smoking.

Conclusion

Lymphopenia in adult COVID -19 hospitalized patients was associated with increased risk of disease severity (as evidenced by need for ICU admission) and poor clinical outcomes. Absolute lymphocyte count may help with prognostication in individuals hospitalized with COVID-19.

Disclosures

All Authors: No reported disclosures
448. COVID-19 Acute Care at Home: A Substitution for Hospitalization in Patients with Mild Symptoms
Authors: Kammeyer Joel A , Perkins Brian , Seegert Sara , Caris Dave E , Hollingshead Caitlyn M , Brochin Evan D , Russell Benjamin H
Published: December 2021

Background

Constraints on resources require healthcare systems to implement alternative and innovative means for delivering care. The COVID-19 pandemic amplified this issue throughout the world, leading to shortages of ventilators, hospital beds, and healthcare personnel. We report the results of an Acute Care at Home Program (ACHP) response to COVID-19, providing in-home hospital-level care to patients with mild symptoms, preserving in-hospital beds for more serious illness.

Methods

Patients with COVID-19 were selected for ACHP after undergoing risk stratification for severe disease, including oxygen evaluation, time course of illness, and evaluation of comorbidities. Patients admitted to ACH met inpatient criteria, required oxygen supplementation of ≤4 liters, and received insurance approval. Services were provided consistent with best practice of inpatient care, including 24/7 provider availability via TeleMedicine, bedside care provided by paramedics and nurses, respiratory therapy, radiology and laboratory services, pulse oximetry monitoring, and administration of medications. Protocols existed for patient transfer to hospital in the event of clinical deterioration.

Results

Our initial cohort included 62 patients enrolled October 1, 2020 – May 31, 2021. Of these, 57 patients were discharged successfully from ACHP. Patients presented with initial oxygen requirements of 0-4 liters. Average length-of-stay in ACHP was 5.4 days. Five patients required hospitalization after enrollment in ACHP; one subsequently expired, two were discharged home, one returned to ACHP after inpatient hospitalization, and one remains hospitalized. One additional patient that was successfully discharged home from ACHP was later readmitted and expired in a subsequent hospitalization. The patients that expired had significant immunocompromising conditions that may have contributed to their outcomes.

Conclusion

ACHP can provide care equivalent to hospitalization for select COVID-19 patients. Immunocompromised hosts with COVID-19 may represent a subset of patients in which in-house hospitalization must be carefully considered, even with mild oxygen requirements. Health systems should consider ACHP as a substitution for hospitalization for COVID-19 patients with mild symptoms.

Disclosures

All Authors: No reported disclosures
451. Is Antibody to Nucleocapsid More Prevalent in Individuals with Severe COVID-19?
Authors: Patel Hemang , Bhargava Ashish , Lebovic Daniel , Scarabelli Tiziano , Coyle Meredith M , Salaytah Natali , Saravolatz Louis
Published: December 2021

Background

Virus-specific antibodies help to understand the prevalence of infections and the course of the immune response. Humans produce antibodies against the spike and nucleocapsid proteins of SARS-COV-2 virus. Patients with COVID-19 who recover from the infections have higher levels of antibodies to spike proteins. Our study aimed to find the levels of antibodies to spike and nucleocapsid proteins in severe COVID-19.

Methods

A single center prospective study was done at Ascension St John Hospital, Detroit, MI. We included COVID-19 cases diagnosed by reverse-transcriptase polymerase-chain-reaction (RT-PCR). Quantitative measurements of plasma or serum antibodies to nucleocapsid and spike proteins were done in hospitalized patients with acute COVID-19. Using the electronic medical record, we collected data on demographic and clinical information.

Results

A total 24 patients were studied. Of which, 15 patients were suffering from severe and critical COVID 19 and 9 patients were suffering from mild to moderate COVID 19. The mean age (standard deviation) of our cohort was 69 ± 10 years and 60% were males. Common comorbid conditions were hypertension, obesity, and type 2 diabetes. We also noted that severe to critical COVID 19 expressed higher level of antibody to nucleocapsid.

Conclusion

These results display the seroconversion in COVID 19 patients. Our study shows antibody level remain high in severe COVID 19 patients but those are against nucleocapsid protein instead of spike protein.

Disclosures

All Authors: No reported disclosures
453. Neutralizing Antibody Responses to SARS-CoV-2 in Professional Soccer Players
Authors: Pagura Jorge , de Cunha Clovis Arns , Nishimura Roberto , Wey Sergio , Pedrinelli André , Cimerman Sergio , Picanço Andreia , Freire Sérgio , Guerreiro André , Thiele Edilson , Starling Carlos , Couto Bráulio R G M
Published: December 2021

Background

The Brazilian Football Confederation (CBF) protocol to control the spread of COVID-19 among professional soccer players is based on four cornerstone measures: (1) Tracing all symptomatic and asymptomatic COVID-19 cases by clinical monitoring and nasal swab SARS-CoV-2 RT-PCR testing up to 3 days before the soccer games; (2) Respiratory isolation of all SARS-CoV-2 positive players for at least 10 days, regardless symptoms; (3) All player with clinical suspicion of COVID-19 were immediately quarantined; (4) If a player became SARS-CoV-2 positive after the game, the other players were allowed to play the next game, if they remained asymptomatic and SARS-CoV-2 RT-PCR negative. Understanding how antibody responses to SARS-CoV-2 evolve can provide insights into therapeutic and testing approaches for COVID-19. In the present study we profile the antibody responses of players up to nine months from a SARS-CoV-2 positive RT-PCR test.

Methods

Serum samples were obtained from 955 soccer players, and analyzed at the same laboratory in São Paulo city, in the Hospital Israelita Albert Einstein. It was used the cPas Technology, the sVNT kit for detecting and measuring circulating neutralizing antibodies against the SARS-CoV-2 virus.

Results

Neutralizing antibody was positive for 416 samples (416/955=44%; C.I. 95%= [40%; 47%]). From the 955 soccer players, 454 had RT-PCR+ previously, up to nine months until the neutralizing antibody tests. From this 454 players, 172 (38%) had neutralizing antibody below 20% (C.I. 95% = [34%; 42%]), 30 (7%) between 20% and 30% (C.I. 95% = [5%; 9%]), and e 252 (56%) above 30% (C.I. 95% =[51%; 60%]). Antibody responses to SARS-CoV-2 were significantly higher in individuals RT-PCR+ (Table 1). There was no difference between the neutralizing antibody responses status to SARS-CoV-2 and the time between the RT-PCR+ and the neutralizing antibody test (p-value = 0.423; Figures 1 and 2, Table 2).

Table 1. Neutralizing antibody responses to SARS-CoV-2.

Figure 1. Scatter plot with Time between RT-PCR+ and neutralizing antibody (days) versus Neutralizing antibody levels.

Table 2. Time between RT-PCR+ and neutralizing antibody (days) versus Neutralizing antibody levels.

Conclusion

This study found neutralizing activity of infection against SARS-CoV-2 in 63% RT-PCR+ individuals, but only in 26% in RT-PCR(-) players. Level of neutralizing antibody responses maintained stable until up to nine months after a RT-PCR+.

Figure 2. Percentage of soccer players at each antibody level (below 20%, between 20% and 30%, and above 30%) versus time between the positive RT-PCR test and neutralizing antibody test (days).

Disclosures

All Authors: No reported disclosures
454. Impact of Covid-19 on Infectious Disease Fellows in the United States: A National Survey to Identify Targets for Intervention
Authors: Balan Shuba , Anjan Shweta , Ohringer Alison , Gonzales-Zamora Jose , Weiss Deborah Jones , Morris Michele I , Alcaide Maria L , Lichtenberger Paola , Lichtenberger Paola
Published: December 2021

Background

The Coronavirus disease of 2019 (COVID-19) global health crisis has resulted in an unprecedented strain on healthcare systems, reorganization of medical training programs and disruption in professional and personal lives of medical trainees. The impact of COVID-19 on infectious disease (ID) fellows, who are frontline healthcare professionals, has not been assessed.

Methods

We conducted a national survey of adult and pediatric ID fellows to assess impact on educational activities, availability of personal protective equipment (PPE), well-being, and career prospects. Anxiety and burnout were assessed by 7-item generalized anxiety disorder scale and abbreviated Maslach burnout inventory respectively. Invitations to participate in the survey were sent via email to all ID fellows through Accreditation Council for Graduate Medical Education (ACGME) fellowship directors. Survey responses collected from August 1 to September 30, 2020 have been reported.

Results

136 fellows completed the survey (Table 1). 84% reported their institution had provided evidence-based didactics for management of COVID-19 and 53% indicated their general ID didactics were affected by the pandemic. 86% of fellows were involved in care of patients with COVID-19, and 31% reported a shortage of PPE affecting their clinical duties. Those living in highly impacted states (CA, FL, NY, TX) at the time of the survey were 1.70 times as likely to experience moderate to severe anxiety (vs. minimal to moderate) than those in other states; similarly, those who saw ≥11 COVID-19 patients weekly and reported PPE shortages were 2.5 and 2.0 times as likely, respectively, to experience moderate to severe anxiety compared to their peers who took care of 10 or fewer COVID-19 patients and did not experience PPE shortages. Burnout scores were not significant (Table 2).

Table 1. Demographics, Responses to Personal Exposure, Educational Activities and Career Prospects

Table 2. Stress, Burnout, Anxiety , Sleep and Quality of Life Among Survey Participants.

Conclusion

It is imperative that ID fellows feel adequately protected and supported during this pandemic. Pandemic preparedness should be included in the ID fellowship curriculum. Interventions for anxiety and burnout reduction should be implemented. ID fellowship programs should continue to accept feedback from fellows to ensure their ongoing safety, well-being, and education as we navigate this pandemic.

Disclosures

All Authors: No reported disclosures
455. Diagnostic Value of Hematological Parameters in Different Stages of the Disease in Covid-19 Patients
Authors: Ali Ruhma , Patel Aditya , Chan Kok Hoe , Slim Jihad
Published: December 2021

Background

COVID-19 infection is associated in some individuals with a rapid onset of systemic proinflammatory state leading to cytokine storm followed by multisystem organ failure. We are interested in studying the prognostic value of complete blood count parameters in different stages of the diseases based on the serology.

Methods

This is a retrospective cohort study of patients with confirmed COVID-19 admitted to our hospital between 10/1/2020 to 2/28/2021. Study individuals had complete CBC profile and COVID-19 serology with well-defined clinical outcome (discharged alive or expired). They were divided in 3 groups based on serology results: group 1 (early disease) had no antibodies, group 2 (immune phase) had + IgM, and group 3 (late phase) had only + IgG. Demographic, clinical and laboratory data were reviewed. Simple t-test was used for continuous variables and chi-square test was used for categorical variables. Anova test was used to compare the difference across multiple groups. GraphPad PRISM was used for all analysis.

Results

A total of 202 confirmed covid 19 cases were included in the study. There was no difference between the 3 groups in terms of age, gender, and body mass index (BMI). We did observe an increase in incidence in Latinx (group 1, 34%; group 2, 51%; group 3, 38%). Hypertension and diabetes were major co-morbidities in these patients. Absolute neutrophil count (ANC) and platelet count (PC) showed significant changes across the 3 groups: mean ANC for group 1, 4.868 (SD 3.117); group 2, mean 6.951 (SD 3.843); and group 3 mean 5.59 (SD 3.236). PC in group 1 mean 193.2 (SD 90.25); group 2 mean 271.1 (SD 143.4); and group 3 mean 228.6 (SD 75.33) p-value 0.0008. The difference can be seen in the derived monocyte platelet rationMPR, neutrophil lymphocyte ratio NLR, platelet lymphocyte ratio PLR and aggregate index of systemic inflammation AISI values and they tend to be higher in group 2 (MPR p-value 0.0067, NLR p-value 0.0123, PLR p-value 0.0294, AISI p-value of 0.0190).

Baseline characteristic

CBC parameters

Conclusion

The study demonstrates that MPR, NLR, PLR and AISI have a potential role in categorizing the disease stage based on only CBC profiling.Properly designed prospective studies with a larger sample size should be performed to confirm the disease stratification ability of derived CBC indices like MPR, NLR, PLR and AISI.

Disclosures

All Authors: No reported disclosures
456. The Racial Divide: A Follow Up Study on Racial Disparity Amongst COVID-19 Survivors in an Urban Community in New Jersey
Authors: Millet Christopher , Jimenez Humberto , Racoosin Emily , Horani George , Shamoon Yezin , Narvaneni Spandana , Roman Sherif , Chaudhry Arslan , Chaudhry Sohail , Farokhian Alisa , Aron Polina , Kmiecik Christina , Faheem Beenish , Ashkar Hamdallah , Shafeek Fady , Michael Patrick , Suh Jin
Published: December 2021

Background

We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in Paterson, New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups.

Methods

This was a prospective cohort study consisting of patients who had COVID-19 in the months of March and April of 2020. This was a single institutional study conducted at St. Joseph’s Hospital in Paterson, NJ from March to April of 2021. Patients included were either male or female aged 18 years or older. Patients were contacted by telephone to participate to completed the survey. Chi-square testing and multivariable logistic regression analysis were utilized for statistical analysis.

Results

Of the 170 patients enrolled in the study, the most common ethnicity was Hispanic (79/170 [46.47%]), followed by African American (46/170 [27.05%]). 83 patients were male (83/170 [48.82%]). Caucasians were the most willing to receive a COVID-19 vaccine (28/30 [93.3%]), followed by Asians (13/14 [92.8%]), Hispanics (63/78 [80.7%]) and African Americans (29/46 [63.0%]). Hispanics had the highest rate of job loss (31/79 [39.24%]), followed by African Americans (16/46 [34.7%]). Hispanics were found to be in the most financial distress (31/79 [39.2%]), followed by African Americans (17/46 [36.9%]). Hispanics and African Americans were more likely to refuse COVID-19 vaccination (p: 0.02). Hispanics were more likely to lose their jobs compared to Caucasians (odds ratio,4.456; 95% CI, 1.387 to 14.312; p: 0.0121). African Americans were also more likely to lose their jobs when compared to Caucasians (odds ratio, 4.465; 95% CI, 1.266 to 15.747; p: 0.0200).

Willingness amongst COVID-19 survivors to get vaccinated based on ethnicity

COVID-19 survivors who lost their jobs following diagnosis with COVID-19 based on ethnicity

COVID-19 survivors who are experiencing financial distress following diagnosis with COVID-19 based on ethnicity

Conclusion

Hispanics reported the most financial distress and with nearly 40% losing their jobs, the highest in our study group. 37% of African Americans experienced job loss and financial distress following their diagnosis with COVID-19. Only 63% of African Americans and 80.7% of Hispanics were willing to get vaccinated, mostly due to lack of trust in the vaccine. Statistical analysis showed Hispanics and African Americans were more likely to lose their jobs and refuse COVID-19 vaccination following diagnosis with COVID-19.

Disclosures

All Authors: No reported disclosures
459. COVID-19 Hospitalization and 30-Day Readmission: A Cohort Study of U.S. Hospitals
Authors: Mozaffari Essy , Liang Shuting , Stewart Henry Morgan , Thrun Mark , Hodgkins Paul , Haubrich Richard
Published: December 2021

Background

Evidence on outcomes after COVID-19 hospitalization is limited. This study aimed to characterize 30-day readmission beyond the initial COVID-19 hospitalization.

Methods

This descriptive retrospective cohort study included adult patients admitted between 07/01/2020 and 01/31/2021 with a discharge diagnosis of COVID-19 (ICD-10-CM: U07.1), using a large hospital inpatient chargemaster with a linked open claims dataset. The first COVID-19 hospitalization was considered index hospitalization; baseline was defined as first 2 days of index hospitalization; readmission was assessed within 30 days of discharge from index hospitalization. We describe the demographics, treatments and outcomes of the index hospitalization and readmission.

Results

For index hospitalization, we identified 111,624 COVID-19 patients from 327 hospitals across US. Mean age was 63 and 54% were male. Over the study period, use of remdesivir (RDV) increased from 11% to 50% while use of steroids (66% -73%) and anticoagulants (32% - 35%) remained relatively stable (Figure 1). Overall, 21% required ICU or CCU admission, 13% died, and median length of stay (LOS) was 7 days (range 4 -11 days). Among 61,182 (55%) with ≥ 30-day follow-up post discharge, all-cause 30-day readmission was 16% and remained stable (15% - 17%) over the study period; median days to readmission was 6 days (range 1-30). All-cause readmission (13 % vs 17%) was lower in patients treated with RDV during index hospitalization over time (Figure 2), particularly in those requiring high flow oxygen (17% vs 18%), low flow oxygen (13% vs 16%) or no oxygen (12% vs 17%), but not in ECMO or invasive ventilation (33% vs 29%). Compared to non-readmitted, readmitted patients were older (60 vs 65), had more comorbidities such as COPD (24% vs 37%) (see Table 1) and LOS (6 vs 7 days) in index hospitalization. Overall, the most frequent diagnoses of readmission were COVID-19 (63%), other viral pneumonia (36%), and acute respiratory failure with hypoxia (34%).

Conclusion

In a large, geographically diverse cohort of hospitalized COVID-19 patients, 16% required readmission, especially in those with greater age and comorbidities. Over the study period, all-cause readmission remained stable and was lower in RDV treated patients.

Disclosures

Essy Mozaffari, PharmD, MPH, MBA, Gilead Sciences (Employee, Shareholder) Shuting Liang, MPH, Gilead Sciences (Employee) Henry Morgan Stewart, PhD, IQVIA (Employee) Mark Thrun, MD, Gilead Sciences (Employee, Shareholder) Paul Hodgkins, PhD, MSc, Gilead Sciences (Employee, Shareholder) Richard Haubrich, MD, Gilead Sciences (Employee, Shareholder)
460. Disproportionalities in COVID-19 Clinical Drug Trials in the United States: A Systematic Literature Review
Authors: Chastain Daniel B , Patel Vishwa S , Jefferson Alexandria M , Osae Sharmon P , Chastain Joeanna S , Martínez Andrés F Henao , Franco-Paredes Carlos , Young Henry N
Published: December 2021

Background

To combat higher rates of COVID-19 infection, hospitalization, and death among minorities, it is crucial to identify safe, efficacious, and generalizable treatments. Therefore, the purpose of this systematic literature review was to assess the demographic characteristics of COVID-19 clinical trial participants.

Methods

A literature search was performed according to the PRISMA checklist using PubMed from December 1, 2019 to November 24, 2020 with the following search terms: 2019-nCoV, COVID-19, SARS-CoV-2, clinical trial, randomized controlled trial, observational study, and veterinary. To capture additional results, keyword searches were performed using various versions and plural endings with the title/abstract field tag. Randomized controlled trials evaluating a pharmacologic treatment for COVID-19 patients from one or more U.S site written in the English language were eligible for inclusion. Descriptive statistics were calculated to characterize age, gender, race, and ethnicity of patients enrolled in the included COVID-19 clinical trials, as well as for comparison with national COVID-19 data.

Results

A total of 4472 records were identified, of which 16 were included. Most were placebo-controlled (69%) and included hospitalized patients with COVID-19 (69%). Demographic data were reported for each study arm in 81% of studies. Median number of participants was higher in studies of nonhospitalized patients (n=452 [range 20-1062] vs n=243 [range 152-2795]). Nine (56%) studies reported mean or median ages of 50 years or older amongst all study arms. Males comprised more than half of the study cohort in 50% of studies. Race and ethnicity were reported separately in five (31%) studies, reported in combination in four (25%), while six (38%) reported only race or ethnicity. White or Caucasian patients made up most participants across all arms in 75% of studies. Based on national COVID-19 data, hospitalizations were similar between White persons and African American persons, but higher than other race or ethnic groups, and evenly distributed among males and females.

Conclusion

Lack of heterogeneously reporting demographic characteristics of COVID-19 clinical trial participants limits the ability to assess the generalizability of pharmacologic treatments for COVID-19.

Disclosures

All Authors: No reported disclosures
461. Classical Antigen Presenting Cell Activation Correlates with T Cell Immunity and COVID-19 Severity
Authors: Lu Zhongyan , Pena-DaMata Jarina , Pohida Katherine , Lake Camille , Epsi Nusrat J , Richard Stephanie A , Agan Brian , Pollett Simon , Simons Mark P , Dalgard Clifton , Blair Paul W , Chenoweth Josh , Snow Andrew L , Burgess Timothy , Malloy Allison M
Published: December 2021

Background

The initial response of immune cells against respiratory viruses often determines the severity and duration of disease. The early trajectory of the immune response during infection with SARS-CoV-2 remains poorly understood. Dysregulation of innate immune factors that facilitate viral clearance and the adaptive response, such as type I interferons, have been implicated in severe COVID-19. However, collection of biological samples during the first seven days post-symptom onset has posed a logistical challenge, limiting our knowledge surrounding the immune responses that drive protection versus immunopathology.

Methods

From March 2020, Military Health System beneficiaries presenting with a positive SARS-CoV-2 test, a COVID-19 like illness, or a high-risk SARS-CoV-2 exposure at nine military medical treatment facilities across the United States were eligible for enrollment in our longitudinal cohort study, which included collection of respiratory sample, sera, plasma, and peripheral blood mononuclear cells (PBMCs). Twenty-five SARS-CoV-2 infected study participants provided samples with in the first seven days of symptom onset, fifteen of whom were hospitalized with COVID-19. We employed multiparameter spectral flow cytometry to comprehensively analyze the early trajectory of the innate and adaptive immune responses.

Results

We discovered that early activation of critical antigen presenting cell subsets was impaired upon comparing inpatients with outpatients, correlating with decreased antigen-experienced T cell responses. Specifically, we noted reduced expression of key costimulatory molecules, CD80 and CD86, on conventional dendritic cells that are required for viral antigen-specific T cell priming. Reduction in CD38, a marker of activation was also observed on inpatient dendritic cell subsets.

Conclusion

Reduced antigen presenting cell activation and expression of ligands that facilitate T cell engagement may impede the efficient clearance of SARS-CoV-2, coinciding with more severe disease in our cohort. Further analysis of the functional activation of early innate immune responses triggered by SARS-CoV-2 may unveil new immune biomarkers and therapeutic targets to predict and prevent severe disease associated with inadequate T cell immunity.

Disclosures

Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))
462. Differences in the Humoral Response to SARS-CoV-2 Infection in Children vs. Adult
Authors: Mentor Girlande , Drouin Olivier , Valois Silvie , Taillefer Suzanne , Renaud Christian , Kakkar Fatima
Published: December 2021

Background

One of the most striking observations of the COVID-19 pandemic has been the difference in infection among children vs. adults. Overall, children with SARS-CoV-2 infection generally had milder disease compared to adults, though the cause is not clear.

The objective of this study was to compare the humoral response to infection in children vs. adults of a same family.

Methods

We performed a prospective cohort study at Sainte-Justine University Health Center in Montreal, Canada from July 2020 to March 2021. Children with a positive SARS-CoV-2 PCR were recruited from the COVID-19 clinic (index case), enrollment was offered to all household members. Serum IgG against SARS-CoV-2 native S1/S2 spike proteins was measured using the Diasorin (Liaison XL) assay, 4-6 months following a positive PCR. A mean antibody threshold of 15 Arbitrary unit per ml (AU/ml) was considered seropositive, with 94.4% positive agreement to plaque reduction neutralization tests (PRNT90) at a 1:40 ratio. Antibody titer was compared between children and adults.

Results

111 participants (52 adults and 59 children) were recruited from 50 separate families. Characteristic of participants and their clinical symptoms are described in Table 1. Among all participants, 76.3% children were SARS-CoV-2 seropositive vs. 51.9% of adults (p=0.007). Median antibody titer was significantly higher in children vs. adults (82.8 AU, [IQR: 18.4-130], vs 17.0 AU, [IQR: 6.8-77.8], p=0.006); findings were similar among SARS-CoV-2 PCR positive participants only. Overall, 13 participants were PCR positive but seronegative, 7 were PCR negative and seropositive, while 61 were both PCR positive and seropositive. Older participants and those with any comorbidity. Among the PCR positive group, the seropositive participants were younger (median age 31±17 vs 19±17 years, p=0.003) and more likely to have comorbidity (69% vs 29%, p=0.007).

Conclusion

These results suggest that children have a stronger antibody response to SARS-CoV-2 infection than adults, and that older age and presence of comorbidity are associated with a less robust humoral response. Further work on the differences in response between children and adults may help elucidate mechanisms underlying the severity of disease

Disclosures

Olivier Drouin, MDCM MsC MPH, Covis Pharma (Research Grant or Support)
464. Structural Vulnerability among Patients with HIV and SARS-CoV-2 Coinfection: Descriptive Case Series from the U.S. Midwest
Authors: Hongsermeier-Graves Natasha E , Khazanchi Rohan , Fadul Nada
Published: December 2021

Background

It is well known that the HIV epidemic and COVID-19 pandemic have both disproportionately harmed marginalized minority and immigrant communities in the United States. The risk factors associated with disease incidence and outcomes reaffirm that structural vulnerabilities—sociopolitically imposed risk factors like discrimination, legal status, poverty, and beyond which impact a patient’s opportunity to achieve optimal health—play a key role in facilitating the inequitable harms of COVID-19 and HIV alike. This study explores the role of structural forces in increasing the risk of SARS-CoV-2 coinfection among people with HIV (PWH).

Methods

We performed a retrospective chart review of PWH receiving care at the University of Nebraska Medical Center HIV clinic in Omaha, Nebraska, to collect patient demographics, comorbidities, HIV outcomes, and COVID-19 outcomes for 37 patients with HIV and SARS-CoV-2 coinfection as of August 27, 2020. As a comparison group, we obtained demographic data from a registry of all patients seen at the HIV clinic. We used R Statistical Software to perform descriptive statistical analysis.

Results

Relative to our overall HIV clinic population, over twice as many Hispanic patients (35.1% vs. 16.0%), three times as many undocumented patients (13.5% vs. 4.2%), and four times as many refugee patients (16.2% vs. 4.0%) had COVID-19. The majority (67.6%) of coinfected patients reported working in “essential” jobs during the pandemic. Thirty-four of the 37 people with HIV and COVID-19 (PWHC) had at least one comorbidity, including increased BMI (83.7%), hypertension (64.9%), or hyperlipidemia (48.6%). All 37 PWHC remained alive as of October 4, 2020.

Demographics and HIV Disease Progression of People with HIV and SARS-CoV-2 Coinfection vs. Overall HIV Clinic Registry

Demographics and HIV Disease Progression of People with HIV and SARS-CoV-2 Coinfection vs. Overall HIV Clinic Registry (continued)

Conclusion

The disproportionate burden of SARS-CoV-2 coinfection on Hispanic, undocumented, and refugee PWH may be a product of structural vulnerabilities contributing to greater risk of exposure. Although all 37 PWHC had well-controlled HIV and relatively mild COVID-19 courses, the broader theme of disproportionate COVID-19 incidence among vulnerable sub-populations of people with HIV reaffirms the importance of structural interventions to mitigate current and downstream harms.

Disclosures

All Authors: No reported disclosures
465. Mental Health Treatment Disparities During the COVID-19 Pandemic
Authors: Kricorian Katherine , Kricorian Karin
Published: December 2021

Background

The COVID-19 pandemic has been associated with a decline in mental health status in the US, as well as reduced ability to seek mental health treatment. This study analyzed undertreatment of mental health during the pandemic to identify possible disparities and assess the need for interventions.

Methods

Data were collected from Wave 3 (January 6-February 15, 2021) of the US Census COVID-19 Household Pulse online survey, designed to measure the ongoing impact of the pandemic. Microdata files were downloaded from the Census website and included N=185,201 respondents. Data was collected in both English and Spanish and consisted of a representative sample of US residents. Data were analyzed using χ 2 tests, with z-tests for more granular between-group comparisons.

Results

When asked if they needed and received therapy due to mental health concerns, 81% of respondents did not need therapy and did not receive it. Some (2%) reported receiving therapy but needing more. However, 9% reported needing therapy but not receiving it. A similar proportion, 9%, reported having received adequate therapy from a mental health professional. Those who needed therapy but did not receive it were more likely than adequately treated respondents to express debilitating worry, anxiety, depression, and lack of interest/pleasure in doing things (all p< .05). These respondents were also more likely (vs. adequately treated respondents) to be younger, lower-income, racial/ethnic minorities, without health insurance, and food-insecure (all p< .05).

Conclusion

Inadequate mental health treatment is a critical challenge, especially in the wake of COVID-19; Just as many respondents reported adequate mental health treatment as did needing additional mental health treatment. Respondents reporting undertreated mental health issues in this study were more likely to be vulnerable populations, many of whom have already been disproportionately impacted by the pandemic. Methods to expand accessible counseling capacity in economically feasible ways to limit these disparities should be further explored.

Disclosures

All Authors: No reported disclosures
466. Symptom Profile of Hospitalized, Adult Patients with COVID-19 – Findings From COVID-Net Database
Authors: Siu Chun T , Joshi Amogh
Published: December 2021

Background

According to the Center for Disease Control and Prevention (CDC), there is a disproportional number of COVID-19 deaths in hospitalized patients that increases based on age. Among COVID-19 related deaths in hospitalized patients, 8 of 10 patients are age 65 years and older. By looking at the latest data, the objective of this retrospective analysis is to evaluate the symptom profile in patients hospitalized with COVID-19 and determine if certain symptoms are seen more in older patients.

Methods

We performed a retrospective analysis using the COVID-Net database. This database contains information involving COVID-19 laboratory-confirmed hospitalization across 14 states. Medical history, signs, and symptoms at admission were collected by COVID-NET surveillance officers and reported during the period of March 1st to May 31st. For our analysis, we only included adults patients age 18 and above. Further descriptive statistics were stratified by age into two groups: age 18-64, and age ≥ 65.

Results

We identified 60,363 patients age 18 and above with COVID-19 confirmed hospitalizations. Cough, shortness of breath, and fevers/chills were the most common symptoms at respectively 67%, 66%, and 65%. Patients age ≥ 65, when compared to patients age 18-64, were less likely to have cough (56.7% vs 73.8%), shortness of breath (58.1% vs 72.1%), fever/chills (54.7% vs 71.%), dysgeusia (2.3% vs 7%), and anosmia (1.2% vs 6%). The only presentation that was more common in patients age 65+, than in patients age 18-64, was altered mental status (26.9% vs 5.2%). Overall inpatient mortality was higher in the age ≥ 65 group (8.9% vs 2%). Among the 2,922 COVID-19 decedents, 75.3% were age ≥65.

Conclusion

Published in April 2020, preliminary data from COVID-Net on approximately 180 patient reported that only 8.2% of patients age ≥ 65 had altered mental status2. Since then, our analysis noted that altered mental status is more commonly seen in the age group ≥ 65 than previously reported. The percentage of decedents age ≥ 65 in this analysis is similar to the 74.8% (N= 10,647) reported in a large study that focused specifically on COVID-19-related deaths3. Our analysis highlights that altered mental status is a common neurologic manifestation in elderly patients hospitalized with COVID-19.

Disclosures

All Authors: No reported disclosures