bluuebunny/crossref_metadata_2025_split huggingface dataset:
532. COVID-19 Pneumonia in Patients with Hematologic Malignancies – A Report from the US Epicenter
Authors: Plate Markus , Kodiyanplakkal Rosy Priya , Satlin Michael J , Soave Rosemary , Drelick Alexander Christian , Orfali Nina , Helfgott David , Niesvizky Ruben , Roboz Gail J , Shore Tsiporah B , Van Besien Koen , Small Catherine B , Walsh Thomas J 
Published: January 2021

Abstract

Background
Limited data are available for risk assessment and outcome of COVID-19 in patients with hematologic malignancies (HM). We present a single center study of COVID-19 pneumonia in a cohort of 31 patients with HM.

Methods
Data were abstracted from electronic medical records for patients admitted to NYPH between 3/5/20 and 4/17/20 and entered into a REDCap database.

Results
Twenty (64.5%) were male; median age was 71 years. There were 8 patients with Multiple Myeloma (MM), 8 with Chronic Lymphocytic Leukemia (CLL), 6 (19.4%) had AML, 5 (16.1%) NHL, 2 (3.2%) ALL; CML, MDS and Polycythemia Vera occurred in 1 patient each. Twenty-four (77.4%) had active HM; 6 (19.4%) were in remission; and 1 relapsed. Nineteen patients (61.3%) received recent chemotherapy and 11 (35.5%) immunosuppressive therapies. There were 7 (22.6%) hematopoietic stem cell transplant (HSCT) recipients (4 allogeneic and 3 autologous). Comorbidities were evenly distributed among all malignancies: 18 (58.1%) had hypertension, 9 (38.7%) obesity, 7 (22.6%) diabetes mellitus, and 11 (35.5%) were former smokers. The most common symptoms included cough (90.3%), fever (83.9%) and dyspnea (61.3%); 7 (22.6%) had nausea and vomiting; 7 (22.6%) had diarrhea. On presentation, hypoxia (O2 sat ≤94% on room air) occurred in 64.5%; median ALC was 330/ml; 23 (74.2%) had ALC&lt; 1000/ml; median CRP was 15.9 mg/dl (2.5–40.4), ferritin 1162 ng/ml (264 - &gt; 16500), and D-dimers 456 ng/ml (&lt; 150–2418). Thirteen patients (41.9%) required ICU admission and were intubated; among those 9 (69.2%) had either MM or CLL. Co-infections were uncommon; two patients developed HSV1 pneumonitis and one of these also had CMV pneumonitis. Twenty-eight (90.3%) were treated with hydroxychloroquine, 5 (16.1%) remdesivir, 2 (6.5%) tocilizumab, 1 (3.2%) sarilumab, and 4 (12.9%) with methylprednisolone 0.5mg/kg Q12h. Seventeen patients (54.8%) recovered and were discharged, 12 (38.7%) died; 2 (6.5%) were still hospitalized but left the ICU.

Conclusion
In our cohort, there were predominantly more patients with MM and CLL and 56% of these were intubated; larger cohort studies will further define the risk and outcome for COVID-19 in patients with HM.

Disclosures
Michael J. Satlin, MD, MS, Achaogen (Consultant)Allergan (Grant/Research Support)Merck (Grant/Research Support)Shionogi Inc. (Consultant)
536. HIV Patients with COVID-19 in the Bronx: A Retrospective Cohort Study
Authors: Lee Philip J , Sirichand Surksha , Gutierrez Nataly Rios , Corro Luis Gonzalez , Cruz Carlos , Grossberg Robert , Bernardo Raffaele 
Published: January 2021

Abstract

Background
Since the start of the pandemic there has been limited data on mortality in people living with HIV (PLWH) who have Coronavirus Disease 2019 (COVID-19) in the United States (US). We conducted a retrospective review to investigate potential risk factors associated with survival and need for medical ventilation for PLWH and COVID-19.

Methods
This is a retrospective observational cohort from a large academic center across three campuses, conducted from January 1, 2020 to April 30, 2020. Thirty day readmissions were observed from January 1, 2020 to May 31, 2020. Our patients were identified by an ICD-10 code (B20) corresponding to HIV and positive SARS-CoV-2 PCR test. As a primary endpoint, we compared survivors vs. non-survivors. As a secondary endpoint, we compared patients who needed mechanical ventilator (MV) vs. those who did not need MV.

Results
Seventy two PLWH (28 female patients (39%), median [IQR] age was 62 [-/+16] years) had positive SARS-CoV-2 PCR tests during this retrospective review. Median CD4+ count was 235 cells/ul and 11 (15%) had an HIV viral load &gt;200 copies/mL. The median length of stay was 5 days and 6 patients were directly discharged from the emergency department. Ten patients were readmitted within 30 days with SARS-CoV-2 – like symptoms and 2 are still inpatient. Twenty patients (27.8%) have expired. All non-survivors that expired had an undetectable HIV viral load (0%, p=0.02). The 11 patients with unsuppressed HIV viral loads at the start of the study period all survived, p=0.02. Non-survivors were more likely to have chronic kidney disease CKD (p&lt; 0.01) acute kidney injury (p&lt; 0.01), higher absolute neutrophils (p&lt; 0.01), and elevated IL-6 levels (p&lt; 0.01) compared to survivors. Fifteen patients (20.8%) required mechanical ventilation (MV), 3 (4.1%) of those patients survived. Patients that required MV were more likely to be male (p=0.01) obese (p&lt; 0.01) and had higher absolute neutrophil counts (p=0.01) versus those that did not need MV. Patients with lower CD4 counts (&lt; 200 cells/uL) did not require more mechanical ventilation (p=0.04).
Table 1: Demographics, Primary and Secondary Outcome Results

Conclusion
PLWH who had COVID-19 had a high mortality rate. Since all the patients who died had an undetectable HIV viral load across CD4 counts, our study suggests that patients with uncontrolled HIV are not at an increased risk of mortality.

Disclosures
All Authors: No reported disclosures
537. Outpatient Parenteral Antimicrobial Therapy Readmissions from Post-Acute Care Facilities due to Coronavirus Disease 2019
Authors: Burnett Yvonne , Hamad Yasir 
Published: January 2021

Abstract

Background
Risk factors for morbidity and mortality in coronavirus disease 2019 (COVID-19) include older age, and cardiac and pulmonary comorbidities. In addition, nursing home residents have been one of the most heavily affected populations during this pandemic. Due to insurance reasons, patients requiring outpatient parenteral antimicrobial therapy (OPAT) may be discharged to a post-acute care facility (PACF) for the sole purpose of receiving intravenous antibiotics, placing these patients at higher risk of COVID-19 infection. This study evaluated hospital readmissions due to COVID-19 in OPAT patients.

Methods
Adult patients who received OPAT between March 16 and May 31, 2020 were included. Patients were identified via an OPAT database and reason for readmission was reviewed via the electronic medical record. Patients with ongoing courses of OPAT as of May 31, 2020 were excluded. The primary outcome was readmission due to COVID while receiving OPAT. Results were analyzed using descriptive statistics.

Results
During the study period, 266 OPAT patients were identified, with 88 (31%) patients discharged to PACFs. There were 49 (18%) total readmissions, with 3 (6%) readmitted due to COVID-19. All 3 patients were readmitted from unique PACFs. This resulted in 3/16 (19%) readmissions due to COVID-19 in patients discharged to PACFs as compared to none for OPAT patients discharged to home.

Conclusion
Patients discharged to PACFs are at increased risk of COVID-19 infection. Efforts should be made to increase availability of home OPAT services for patients who have no need for skilled care other than intravenous antimicrobials.

Disclosures
All Authors: No reported disclosures
541. Rapid Migration to Telemedicine in a Boston Community Health Center is Associated with Maintenance of Effective Engagement in HIV Care
Authors: Mayer Kenneth H , Levine Kenneth , Grasso Chris , Multani Ami , Gonzalez Alex , Biello Katie 
Published: January 2021

Abstract

Background
The COVID-19 pandemic has disrupted many health care activities. The impact of the pandemic on HIV primary care in a Boston community health center (CHC) that has specialized HIV, sexual and gender minority care is analyzed here.

Methods
The CHC has used the Centricity Practice SolutionTM electronic medical record (EMR) system since 1997. The current analyses used data abstracted from the EMR, testing for significant differences in HIV care utilization using the Student t-test for means and chi-square tests for proportions.

Results
There were 2,016 HIV+ patients among 25,606 patients (7.9%) engaged in primary care in 2019. In 2019, HIV+ patients had between 563 and 689 in-person visits per month. On average, monthly visits for HIV care increased (p&lt; 0.0001) in the first two months of 2020 (mean=626, sd=60.1) compared to 2019 (mean=617, sd=40.6), but dropped to 370 and 36 in person visits by HIV+ patients in March and April 2020 respectively
(mean=203, sd=236.2; p&lt; 0.0001), when statewide stay-at-home policies were recommended. There were 263 telemedicine visits by HIV+ patients in March and 751 in April, 2020. When telemedicine and in-person visits were combined, mean number of visits per month by HIV+ patients were higher compared to the same two-month period in 2019 (p&lt; .0001). The mean number of plasma HIV RNA viral load (VL) tests performed each month was 279 in 2019 (range 257–312, sd=18.3), versus 219 in March and 274 in April 2020 (mean=246.5, sd=38.9; p&lt; 0.0001). Among those tested, monthly rates of virological suppression ranged from 71–81% in 2019, with 11–20% having VL &lt; 100 copies/ml. Eighty percent had an undetectable VL as their last measurement in 2019; an additional 14% had last VL detectable but &lt; 100 copies/ml. In March and April, 2020, the rates of VL suppression were 77% and 74% and 14% and 18% had VL detectable but &lt; 100 copies/ml, respectively (p=0.209).

Conclusion
The COVID-19 pandemic has led to a significant decrease in in-person visits by HIV+ and other patients at a Boston CHC, but with a rapid migration to the use of telemedicine, patient engagement, as expressed by visits and VL suppression does not appear to be adversely affected

Disclosures
All Authors: No reported disclosures
544. Severe COVID-19 in Children and Young Adults in the Washington DC Metropolitan Region
Authors: DeBiasi Roberta L , Song Xiaoyan , Ansusinha Emily , Smith Karen L , Bell Michael , Pershad Jay , Hahn Andrea , Hamdy Rana , Hanisch Benjamin , Harik Nada , Jantausch Barbara A , Koay Adeline , Campos Joseph M , Delaney Meghan , Simpson Joelle , Cora-Bramble Denice , Wessel David 
Published: January 2021

Abstract

Background
Children and young adults were initially reported as largely spared from severe complications of SARS-CoV-2 infection, but the impact to this population has been significant.

Methods
This observational retrospective cohort study includes 420 symptomatic children and young adults with lab confirmed SARS-CoV-2 infection treated between March 15 and June 16, 2020 at Children’s National Hospital in Washington DC. We identified and compared cohorts of non-hospitalized (N=324) and hospitalized (N=96) patients, including non-critically ill (N=64) and critically ill hospitalized (N=32) patients. Clinical and demographic data were extracted from medical records

Results
Of 420 SARS-CoV-2-infected symptomatic patients, 23% required hospitalization, of which 67% were non-critically ill and 33% were critically ill. All age groups were represented in the symptomatic cohort, with a median age of 8.6 years. Patients &gt; 15 years of age represented 44% of critical care admissions. Males and females were equally represented in all cohorts. Underlying medical conditions were present in 36%, but more common in hospitalized (59 %) and critically ill (66 %) patients. The most frequent underlying diagnosis overall was asthma (16 %), but also included neurologic (6 %), diabetes (3 %), obesity (3 %), cardiac (3 %), hematologic (3 %) and oncologic (1 %) conditions. The majority (66 %) of SARS-CoV-2 infected patients presented with respiratory symptoms with or without fever. Other symptoms were also present, including diarrhea/vomiting (21 %), myalgia (11 %), chest pain (8 %) and loss of sense of smell or taste (7%). Hospitalized patients required varying levels of respiratory support, including mechanical ventilation, BiPAP, RAM cannula and HFNC. Additional presentations included diabetic hyperglycemia, sickle cell vaso-occlusive crisis, vascular complications, and multisystem inflammation. Treatment included remdesivir, convalescent plasma, tocilizumab and other therapies.

Conclusion
Although children/young adults have been less affected than elderly adults, the impact of SARS-CoV2 on this population has been significant in Washington DC and informs other regions anticipating their surge.

Disclosures
Andrea Hahn, MD, MS, Johnson and Johnson (Consultant)
545. The Impact of COVID-19 on African Americans’ Health Attitudes and Information Seeking Behavior
Authors: Kricorian Katherine , Equils Ozlem , Kricorian Karin , Rochebrun Brianna 
Published: January 2021

Abstract

Background
African-Americans suffer a disproportionate impact from COVID-19, comprising about 24% of deaths while representing 13% of the US population. We conducted a study to understand COVID-19’s impact on African-Americans’ health attitudes.

Methods
In April 2020, we surveyed online a national sample of US adults on their health attitudes and behaviors before and after the COVID-19 outbreak. Comparisons were analyzed using chi-squared tests.

Results
A total of 2,544 individuals completed the survey: 473 African-Americans, 282 Hispanics and 1,799 Caucasians responded. The mean ages of each group were 41.4 ± 11 years, 38.0 ± 11 years and 45.7 ± 13 years, respectively. Before COVID-19, African-Americans were least likely to report they had trust in science (53% vs. 68% for Hispanics and 77% for Caucasians; p&lt; .01) and government (16% vs. 27% and 28%; p&lt; .01). After COVID-19, the percentage of African-Americans who had trust in science and government fell further to 44% (p&lt; .01) and 9% (p&lt; .01), respectively, and remained significantly lower than the other two groups. Twice as many African-Americans vs. Caucasians stopped following science and health news after COVID-19 (9% vs. 4%, p&lt; .01). The percentage of African-Americans who reported anxiety about their health rose from 30% pre-COVID to 53% after the outbreak (p&lt; .01), and the percentage who reported anxiety about their family members’ health rose from 35% to 61% (p&lt; .01). Only 25% of African-Americans surveyed agreed that if they contracted COVID-19, they were confident they would get the healthcare needed.

Conclusion
After COVID-19, African-Americans’ trust in science and government fell and a meaningful percentage stopped following science and health news, possibly reducing access to important health information. The percentage of African-Americans reporting anxiety about the future, about their health and about their family members’ health all increased significantly after COVID-19. Only a minority of African-Americans agreed they would get the needed healthcare if they contracted COVID-19. These findings have implications for the mental health and behavioral impacts of COVID-19 on African-Americans and for the development of health communications to high-disease-incidence populations.

Disclosures
All Authors: No reported disclosures
550. Clinical impact of Tocilizumab therapy in SARS-CoV-2 respiratory infections in ICU and non-ICU patients
Authors: Vyas Nikunj M , Hou Cindy , Levin Todd P , Fussa Mark , DeRose Joseph , Condoluci Mark , Williams James , Ghayad Zeina , Barnish Michael , Ali Shereef N , Kerr Kathryn H , Scheiblein Scott W , Fryckberg Anthony J , Chauhan Gauri 
Published: January 2021

Abstract

Background
Tocilizumab (TCZ) is a monoclonal antibody against the interleuikin-6 receptor which is potentially beneficial in COVID-19 induced cytokine release syndrome (CRS). However, there are limited studies showing anti-inflammatory effect and clinical benefit of TCZ in COVID-19 patients. This retrospective study examines treatment responses of criteria based TCZ therapy for SARS-CoV-2 respiratory infection for ICU vs. non-ICU patients.

Methods
We established institutional criteria to identify patients at risk of CRS from COVID-19. Patients were included if they received at least 1 dose of TCZ and were admitted for at least 72 hours. Primary endpoint was to assess clinical improvement (CI) at the end of admission. CI was defined by extubation, downgrade from ICU, discharged or improvement in Clinical Ordinal Scale by 2. Secondary endpoint of the study was to assess inpatient mortality (IM) and risk factors associated with IM. Subgroup analysis included impact of early (&lt; 96 hours) vs late (≥ 96 hours) TCZ therapy on IM.

Results
Between March 25 to May 6, 2020, 170 patients met criteria and received TCZ. There were 83 non-ICU patients and 87 in the ICU. Forty five patients needed invasive mechanical ventilation (IMV). ICU patients tended to be obese, receive 2 doses of TCZ and have longer length of stay. Overall CI was seen in 71% of patients. CI was higher in non-ICU vs ICU patients (85.5% vs 57.5%, P=0.002). Overall IM was 18.8%; however, IM was lower in non-ICU vs ICU patients (8.4% vs 28.7%, P=0.0014). IM was higher in patients on IMV vs. non-IMV (30% vs 15.4%, P=0.03). Risk factors of ICU admission, BMI ≥ 30 kg/m2 and AKI were associated with higher risk of IM. Many IM patients were made comfort care. No differences were observed in early vs late TCZ therapy on inpatient mortality, but there was a trend toward lower mortality with early TCZ.
COS Review of Tocilizumab Patients

Conclusion
TCZ is an effective treatment option in patients with SARS-CoV-2 patients at risk of CRS. Patients receiving TCZ in non-ICU setting had a better response to treatment compared to ICU patients. Obesity and AKI were associated with higher risk of mortality, but there was no statistical difference in early vs late therapy. Further studies with control group and larger sample size are warranted.

Disclosures
All Authors: No reported disclosures
554. Early Clinical Outcomes with Tocilizumab for Covid-19: A Two-Center Retrospective Study
Authors: Smoke Steven , Raja Karan , Hilden Patrick , Daniel Nicole 
Published: January 2021

Abstract

Background
Severe Covid-19 is associated with elevated inflammatory markers, consistent with cytokine release syndrome (CRS). Tocilizumab is an IL-6 inhibitor, effective in treating CRS secondary to CAR-T cell therapy. The efficacy of tocilizumab in treating Covid-19 is unknown.

Methods
This was a retrospective cohort study conducted at two hospitals in northern New Jersey. All patients treated with tocilizumab for confirmed or suspected Covid-19 between the dates of 3/10/20 and 4/9/20 at the study sites were included. The primary endpoint was clinical improvement on day 7 after treatment as assessed by respiratory status. Univariate analysis compared data between those who improved and those who did not.

Results
Forty five severe and critically ill patients treated with tocilizumab for Covid-19 were evaluated. Eleven (24%), 22 (49%) and 12 (27%) patients improved, had no change and worsened by day 7 after treatment, respectively. Lower WBC and LDH at the time of drug administration as well as shorter time from supplemental oxygen initiation to dose were significantly associated with clinical improvement in the univariate analysis.

Conclusion
Tocilizumab administration was associated with a low rate of clinical improvement within 7 days in this cohort of severe and critically ill patients with Covid-19.

Disclosures
All Authors: No reported disclosures
556. Evaluation of Hydroxychloroquine-based Combination Therapies for the Treatment of COVID-19
Authors: Berti Andrew David , Kale-Pradhan Pramodini , Giuliano Christopher , Aprilliano Bianca , Miller Christopher R , Alyashae Basma , Bhargava Ashish , Johnson Leonard B 
Published: January 2021

Abstract

Background
During the early COVID-19 pandemic a large number of investigational agents were utilized due to lack of therapeutic options. We evaluate the utility of commonly-used investigational agents combined with hydroxychloroquine (HCQ).

Methods
This multicenter observational cohort study included patients admitted with COVID-19 between March - May 2020 in Detroit, Michigan who received at least 2 doses of HCQ. Our primary outcome was the change in Sequential Organ Failure Assessment (SOFA) score from presentation to day 5 of HCQ therapy with a secondary outcome of in-hospital mortality. Data collected included demographics, Charlson Comorbidity index (CCI), daily SOFA score, laboratory data and COVID-directed therapies. Multiple linear regressions were performed to control for potential confounders between different therapies and change in SOFA score.

Results
Three hundred thirty-five patients receiving HCQ were included. Patients were 62 ± 14.8 years of age, male (54%) and African-American (82%) with a mean CCI of 1.7 ± 1.9. In our cohort, 32% were admitted to the intensive care unit and 35% expired. Therapies received by more than 20% of patients in addition to HCQ included azithromycin (80%), zinc (76%) and vitamin D (29%). In our unadjusted analysis, a significant improvement in SOFA score was observed with zinc (0.76) while no significant change was observed with azithromycin (-0.46) or vitamin D (0.05). However, there was no significant change in SOFA score after adjusting for confounders for azithromycin, zinc and vitamin D. No difference in mortality was observed between the groups.

Conclusion
Overall, no benefit in end-organ damage or mortality was observed with the addition of azithromycin, zinc or vitamin D to HCQ. Further studies are needed to confirm this observation.

Disclosures
All Authors: No reported disclosures
560. Repurposing Eravacycline for the Treatment of SARS-CoV-2 Infections
Authors: Reig Núria , Shin Dong-Hae 
Published: January 2021

Abstract

Background
The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is seriously impacting health and economies all over the world. With more than 8 million diagnosed cases and close to 450.000 deaths worldwide by mid-June 2020, the need of safe and effective treatments is extremely urgent. Drug repurposing is a suitable approach to bring new treatments to the clinics in a very fast and cost-effective way.

Methods
We have applied an artificial intelligence screening technology based on molecular fields to find drugs that could inhibit the SARS-CoV-2 3-chymotrypsin-like cysteine protease (3CLpro) among a library of compounds with clinical experience, approved drugs and drugs in clinical development. The results were refined by covalent docking at the catalytic domain of the protein and thirty compounds were chosen for experimental validation on a protease assay with recombinant SARS-CoV-2 3CLpro. The compounds were also tested for their inhibition of SARS-CoV and MERS-CoV 3CLpro. Positive hits were further tested in a VeroE6 cell infection assay with pathogenic SARS-CoV-2 using nucleocapsid protein staining at 24h post infection as a readout.

Results
Eravacycline was identified at the top positions of the screening and its potent inhibitory activity was demonstrated in vitro against recombinant SARS-CoV-2, SARS-CoV and MERS-CoV 3CL proteases, with IC50 of 1.65, 10.04 and 16.36 µM respectively. In addition, eravacycline inhibited infection of VeroE6 cells by pathogenic strains of SARS-CoV-2, with an IC50 of 30.61 µM in the absence of drug induced cell toxicity.

Conclusion
Eravacycline is an FDA and EMA-approved antibiotic that was launched in the US in 2018. It is a safe drug that is known to accumulate in the lungs at concentrations that are compatible with its in vitro activity against SARS-CoV-2. This, together with its known antibacterial activity that could help prevent secondary infections in hospitalized COVID-19 patients, and the known anti-inflammatory actions of tetracyclines, warrant further research on the potential role of eravacycline for the treatment of patients with COVID-19 or infected with SARS-CoV-2 but with milder symptoms.

Disclosures
Núria Reig, PhD, SOM Biotech (Employee) Dong-Hae Shin, PhD full professor, SOM Biotech (Scientific Research Study Investigator)