bluuebunny/crossref_metadata_2025_split huggingface dataset:
386. Long-term Complications Associated with COVID-19 Infection
Authors: Gudipati Smitha , Ranger Judith L , Vahia Amit T , Acosta Tommy J Parraga , Hanna Zachary W , Nair Sashi N , Yared Nicholas F , Suleyman Geehan , Brar Indira 
Published: January 2021

Abstract

Background
In Michigan, 44,964 (68%) of the 66,269 COVID-19 patients have recovered. However, there is concern that COVID-19 infection may lead to long-term sequelae, including pulmonary defects, cardiac complications, blood clots, and neurocognitive impairment. This study describes the 30-day outcomes of patients who had recovered.

Methods
From 3/16/2020 to 5/19/2020, a follow-up was attempted for patients who were discharged alive from Henry Ford Hospital in Detroit and had recovered. Recovery was defined as being alive 30 days post symptom-onset. A telephone survey was conducted 30 days post-index admission and recorded in electronic medical records. Oxygen (O2) requirements, symptoms, readmissions and the need for antibiotics for secondary bacterial infections were evaluated.

Results
585 patients met inclusion criteria and were contacted by phone; 303 answered their phone (Table 1), but only 266 (45%) completed a full telephone encounter and were included in the final analysis (Table 2). The majority were female (53%), black (80%), and discharged to home (84%). The clinical characteristics of those who completed the survey were as follows: 11% presented with O2 saturation &lt; 90%, 16% had underlying lung pathology, and 57% had a BMI above 30. Patients’ average age was 61 ± 14.3 years. At 30 days post-index admission, 49% were still symptomatic. Of the symptomatic patients, 86% had dyspnea on exertion and 15% required O2 supplementation. 18% of patients were readmitted within 30 days, and 9% developed a secondary infection prior to the phone encounter. No statistically significant differences in demographics or comorbidities were found between symptomatic and asymptomatic cohorts (Tables 1, 2).

Conclusion
In our study, almost half of the discharged patients remained symptomatic after 30 days with a substantial proportion experiencing pulmonary symptoms. A better understanding of the long-term pulmonary sequelae following COVID-19 infection is needed to design interventions to reduce post-infectious morbidity.

Disclosures
Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)
387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter
Authors: Chan Kok Hoe , Patel Bhavik , Farouji Iyad , Suleiman Addi , Slim Jihad 
Published: January 2021

Abstract

Background
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter).

Methods
A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter

Results
The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%).
New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired.
In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93).

Conclusion
This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter.

Disclosures
Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
389. Neutrophil-lymphocyte index, platelet-lymphocyte index and systemic inflammation-immunity index in patients with Covid-19 pneumonia in Veracruz, Mexico
Authors: Del Carpio-Orantes Luis , García-Méndez Sergio , Hernández-Hernández Sara Nohemi , Rosas-Lozano Ada Lili , Munguia-Sereno Alvaro Efren , Guerrero-Mancinas Zeltzin Olivia , Aparicio-Sánchez Elisa Estefanía , Segura-Rodríguez Orlando Israel , García-Hernández Omar , Escobar-Huerta Alejandro 
Published: January 2021

Abstract

Background
Different indices have been devised that attempt to correlate the severity of the symptoms and predict mortality mainly in septic states and inflammation, with important results that validate their usefulness. In the present pandemic, to date, no indices have been used in severe cases of Covid- 19 that can predict the outcome.
Result of the measurement of demographic and clinical variables

Comparative analysis of the variables studied stratified by hospital outcome

Methods
It includes a cohort of patients with pneumonia confirmed by Sars Cov 2 PCR-RT, treated at the Veracruz Norte branch of the Instituto Mexicano del Seguro Social from April to May 2020, analyzing the neutrophil-lymphocyte, platelet-lymphocyte and immunity-systemic inflammation indices.
Correlation analysis of severity hematological variables with hospital outcome

Results
We included 100 patients, 54 (54%) women and 46 (46%) men, with a mean age of 49.4 ± 19.3 years. The mean of leukocytes was 10,103.0 ± 4,289.0 cel / mm3, neutrophils 8,509.3 ± 4,216.0 cel / mm3 and lymphocytes of 1,112.7 ± 585.4 cel / mm3; Regarding the hematological indices used to measure severity, we found that the mean of the INL was 10.7 ± 10.9, that of the IPL was 290.1 ± 229.2 and that of the IIIS was 2.6 ± 3.4 x 109. Regarding the type of pneumonia, 54 (54%) had mild pneumonia and 46 (46%) had severe pneumonia. Regarding hospital outcomes, 75 (75%) of the patients were discharged due to clinical improvement and 25 (25%) of the patients died during the hospital stay. The mean age was significantly higher in the group of patients who died during the hospital stay (45.9 ± 18.6 VS 60.0 ± 17.5 years, p = 0.001), the proportion of women who died was higher and tended to be statistically significant. The mean INL was 20.4 ± 16.9 in patients who died VS 7.5 ± 4.9 in patients who improved (p = 0.001). The mean IPL was 417.1 ± 379.7 in patients who died VS 247.7 ± 127.4 in patients who had improvement; p = 0.038. Finally, the mean IIIS was significantly higher in patients who died VS patients who had clinical improvement (4.8 ± 6.1 VS 1.9 ± 1.2; p = 0.030, respectively). In the correlation analysis, high and significant r were found in the three indices.

Conclusion
Neutrophil-lymphocyte, platelet-lymphocyte and systemic immunity-inflammation indices in patients with Covid-19 pneumonia can be used as predictors of severity and predict hospital outcome.

Disclosures
All Authors: No reported disclosures
390. Non-invasive Detection of Co-infections in Hospitalized Patients with COVID-19 using the Karius Test, A Plasma-based Next-Generation Sequencing Test for Microbial Cell-free DNA
Authors: Via William V La , Dalai Sudeb , de Vries Christiaan R , Macintyre Ann , Ahmed Asim A 
Published: January 2021

Abstract

Background
Patients hospitalized with SARS-CoV2 infections (Covid-19) are frequently febrile and can become critically ill quickly often leading to intervention with antimicrobial therapy. An etiologic diagnosis of superinfections can be difficult to obtain through the usual invasive procedures because of patient instability and the desire to avoid them because they may not be tolerated by the patient. Providers may also be hesitant to embark on such interventions in order to avoid healthcare personnel (HCP) exposure to aerosols.

Methods
Karius Test (KT) results are presented from 30 patients who presented with Covid-19. The KT is a CLIA certified/CAP-accredited next-generation sequencing (NGS) plasma test that detects pathogen cell free DNA (cfDNA). After cfDNA is extracted and NGS performed, human reads are removed and remaining sequences are aligned to a curated database of &gt; 1400 organisms. Organisms present above a statistical threshold are reported.

Results
The KT detected pathogens in the majority of patients (n=20) with COVID-19. The most common infections were herpesviruses in 60% of patients. The most common bacterial pathogen was E. coli seen in 25% of patients. 15 out of 20 patients had more than one pathogen detected. 15% of patients had fungal pathogens, including one detection of Lichtheimia ramosa, in an immunocompromised patient. The results are summarized in the table.
Co-infections detected by the Karius Test in patients hospitalized with COVID-19

Conclusion
Open-ended, plasma-based NGS for mcfDNA provides a non-invasive method to assess for co-infections in critically ill patients with COVID-19. This report highlights the potential to increase diagnostic yield as well as to decrease the need for invasive procedures – and their attendant risks to patients and HCP – to obtain etiologic diagnoses to better inform antimicrobial therapy for superinfection. It also serves to highlight the variety of pathogens affecting these patients during the COVID-19 pandemic.

Disclosures
William V. La Via, MD, Karius (Employee) Sudeb Dalai, MD, Karius (Employee) Christiaan R. de Vries, MD, PhD, Karius (Consultant, Independent Contractor)Stanford University (Employee) Ann Macintyre, DO, Karius (Employee) Asim A. Ahmed, MD, Karius (Employee)
391. Outcomes of Empiric Antimicrobial Therapy in COVID-19 Positive Patients
Authors: Medler Corey J , Jakupovic Lejla , Weinmann Allison J , Kenney Rachel , Davis Susan L , Davis Susan L 
Published: January 2021

Abstract

Background
The COVID-19 pandemic has revealed new challenges for antimicrobial stewardship. Optimal medical treatment is not completely understood at this time. The epidemiology and outcomes of bacterial co-infections are not well-established; however, empiric antibiotic (abx) use is anecdotally common. The purpose of this study is to characterize empiric antimicrobial drug selection and timing in COVID-19 and evaluate the impact on patient outcomes.

Methods
Cross-sectional cohort study for COVID-19 positive inpatients from March 1, 2020 to June 1, 2020 at an academic medical center and 4 community hospitals. Inclusion: patients with a documented positive COVID-19 PCR nasopharyngeal swab. Exclusion: patients less than 18 years; deceased or transitioned to hospice within 24 hours of admission. Primary endpoint: empiric abx drug, initiation, duration and indication. Additional data collected: severity of illness, co-infection diagnosis, microbiology, and adverse drug effects (ADE). Clinical outcomes included time to recovery by COVID-19 ordinal outcome, clinical status at day 15, and readmission.

Results
400 patients were included with 27% from the ICU. COVID symptom category included mild (23.8%), moderate (53%), severe (15%), and critical (8.3%). 322 (80.5%) received abx at any time during hospital stay, 301 (93.5%) started within 1 day of admission. Most common documented indication community-acquired pneumonia (69%). Identified 43 (10.8%) microbiologically confirmed co-infections, including 5 MRSA and 7 Pseudomonas. Median duration of initial abx 4 days. 54/322 (16.8%) had abx restarted after discontinuation. Median days to recovery without abx was 10 days (7 – 14) and 14 days (9 – 20) with abx. Patient characteristics and outcomes described in table 1. 74 abx related ADE were identified: gastrointestinal 37 and renal 22.

Conclusion
It’s difficult to distinguish bacterial and Covid-19 in coinfections in patients ill enough to be hospitalized. Longer courses of empiric abx therapy were prevalent as the severity of illness increased. However, the low frequency of microbiologically confirmed bacterial co-infections results in potentially unnecessary abx exposure. This exposure increases risk of abx ADE and may not improve clinical outcome.

Disclosures
All Authors: No reported disclosures
392. Predictors of Mortality in Hospitalized Patients with COVID-19; A Single Centered Retrospective Analysis
Authors: Harmouch Farah N , Shah Kashyap , Goel Harsh 
Published: January 2021

Abstract

Background
The Coronavirus disease-2019 (COVID-19) has been responsible for the death of over 400,000 people with a continuous rise in prevalence and mortality globally. Identifying hospitalized patients at high mortality risk is critical for triage and health-care resource management regionally, nationally, and globally. We present a retrospective analysis of predictors of mortality in hospitalized COVID-19 patients.

Methods
Electronic health records (EHR) of patients admitted between March 1 and April 18, 2020 to St. Luke’s University Hospital with a primary diagnosis of COVID-19 were reviewed for medical co-morbidities and initial biochemical/inflammatory markers. Survivors vs non-survivors were compared using χ 2 test, Student’s t-test, and Mann-Whitney U-test as appropriate. Univariate logistic regression was used to identify candidate variables for multivariate analysis, which were then included in stepwise backward logistic regression. Statistical analyses were done on SPSS v26 software (IBM, Armonk, NY).

Results
Clinical characteristics, biochemical abnormalities and results of univariate regression in our cohort of 560 patients are noted in table 1. Multivariate regression revealed age, congestive heart failure (CHF), and creatinine≥ 1.5 mg/dl as significant predictors of mortality while race (Caucasian), vascular disease, lymphopenia, and elevated ferritin approached significance (Table 2).
Table 1: Baseline clinical characteristics, overall and by mortality. Continuous variables are presented as median (25th-75th percentile), and categorical variables as n (%) Significance of difference between subgroups (survivors versus non-survivors) *p≤0.05, **p≤0.01, ***p≤0.001

Table 2: Results of stepwise backward conditional logistic regression for predicting mortality among hospitalized COVID-19 patients. (n=334, 287 survivors and 47 non-survivors). ALC – Absolute lymphocyte count, S.E. – Standard error of B.

Conclusion
We present one of the largest cohorts to date of hospitalized COVID-19 patients. Age, CHF, and renal disease were significant independent predictors of mortality. Though several inflammatory markers (d-dimer, CRP, procalcitonin) initially predicted mortality, they failed in multivariate analysis, questioning their role in risk-stratifying COVID-19 hospitalized patients. Interestingly, IL-6 used in those severely ill patients to assess candidacy for IL-6 inhibitor therapy (Tocilizumab) failed to predict mortality in our study. Our analysis was limited due to its retrospective nature and unfortunately large amounts of data were missing for some variables (ESR, BNP, IL-6 levels). The missing data was due to rapidly evolving institutional protocols early during the pandemic, leading to non-uniform assessment of these markers.

Disclosures
All Authors: No reported disclosures
393. Prevalence of HIV in Patients Hospitalized for COVID-19 and Associated Mortality Outcomes: A Systematic Review and Meta-analysis
Authors: Ssentongo Paddy , Ssentongo Anna E , Heilbrunn Emily S , Du Ping 
Published: January 2021

Abstract

Background
As of June 3rd, 2020, the number of confirmed cases of novel SARS-CoV-2, the causative agent of COVID-19, was approximately 6,538,456, with 386,503 deaths globally. Individuals with pre-existing conditions are particularly susceptible to and more likely to die from Covid-19. However, individuals with human immunodeficiency virus (HIV) are unique due to their use of antiretroviral therapy, including protease inhibitors, which have been used to treat COVID-19. We aimed to conduct a systematic review and meta-analysis exploring the prevalence and prevalence of HIV in patients hospitalized for COVID-19 and delineating the mortality rates.

Methods
MEDLINE, SCOPUS, and Cochrane Library databases and medrxiv.org were searched from January 1st, 2020, to June 15th, 2020. Studies reporting on the prevalence of HIV among hospitalized COVID-19 patients among and outcome of mortality were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified.

Results
A total of 144,795 hospitalized COVID-19 patients were identified from 14 studies (United States 8, Spain 3, China 1, Italy1, and Germany 1). The pooled prevalence of HIV in COVID-19 patients was 1.22 % [95% confidence interval (CI): 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI: 0.48%-0.89%. When we stratified the analysis by country, pooled HIV prevalence among COVID-19 patients in United States (1.43%, 95% CI: 0.98% -2.07%) was significantly higher compared to Spain (0.26%, 95% CI: 0.23%-0.29%) but not different from China (0.99 %, 95% CI: 0.25 %-3.85%). The pooled mortality rates in HIV-positive patients hospitalized for COVID-19 was 14.1 % 95% CI: 5.78%-30.50% and was substantially higher in the United States compared to other countries.

Conclusion
The prevalence of HIV among COVID-19 patients may be higher compared to the general population, suggesting higher susceptibility to COVID-19. The mortality rates are high but vary significantly across countries.

Disclosures
All Authors: No reported disclosures
396. Relationship Between Patient Characteristics and Critical Illness in Patients Admitted for CoVID-19
Authors: Windham Samuel L , Wilson Melissa P , Fling Connor , Sheneman David W , Wand Taylor , Babcock Lyndsey , Delson Samantha , Erlandson Kristine M 
Published: January 2021

Abstract

Background
While several studies have explored hospitalization risk factors with the novel coronavirus (COVID-19) infection, the risk of poor outcomes during hospitalization has primarily relied upon laboratory or hospital-acquired data. Our goal was to identify clinical characteristics associated with intubation or death within 7 days of admission.

Methods
The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed CoVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median height for patients’ sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction.

Results
Participants had a mean(SD) age 55(17), BMI 30.9(8.2), 55% were male and 80% were ethnic/racial minorities. Unadjusted comparisons by outcome are shown (Table 1). Male sex (aOR: 1.60, 95% CI (1.02, 2.54)), increasing age (aOR: 1.25(1.08, 1.47); per 10 years), higher BMI (aOR 1.03(1.00, 1.06) and poorly controlled diabetes (hemoglobin A1C ≥8) (aOR 2.33(1.27, 4.27) were significantly (p&lt; 0.05) associated with greater odds of intubation or death. Minority status tended to be associated with higher odds (aOR:1.8(1.01,3.36); p=0.052). Surprisingly, need for hospital interpreter was associated with decreased odds (OR: 0.58(0.35, 0.95)) of intubation/death. Our final MCP model included indicators of A1C≥8, age &gt;65, sex and minority status, but predicted intubation/death only slightly better than random chance (AUC= 0.61(0.56, 0.67)).
Table 1. Patient Characteristics Stratified by Intubation and/or Death Within One Week of Admission (n=436)

Conclusion
In a hospitalized patient cohort with COVID-19, male sex, poorly controlled diabetes, increasing age and BMI were significantly associated with early intubation or death. These results complement larger cohort studies, and highlight risk differences across metropolitan areas with varying COVID-19 prevalence, demographics, and comorbid disease burden. Notably, our predictive model had limited success, which may suggest unmeasured factors also contribute to disease severity differences.

Disclosures
All Authors: No reported disclosures
397. Respiratory Coinfections with COVID-19 in Veterans Health Administration (VA), 2020
Authors: Schirmer Patricia , Lucero-Obusan Cynthia , Sharma Aditya , Sohoni Pooja , Oda Gina , Holodniy Mark 
Published: January 2021

Abstract

Background
The first US cases occurred in the COVID-19 pandemic in Jan. 2020. Initially, some states required patients be screened for other respiratory pathogens before COVID-19. Information on COVID-19 coinfections with other respiratory pathogens is limited. We investigated prevalence of COVID-19 coinfections with other respiratory pathogens in VA.

Methods
Molecular and viral culture test results from 9/29/2019-5/31/2020 for respiratory pathogens (Adenovirus, Bordetella pertussis/parapertussis, Chlamydia pneumoniae, COVID-19 and other Coronaviruses, Influenza, human Metapneumovirus (hMPV), human parainfluenza viruses (HPIV), Mycoplasma pneumoniae, Rhino-Enterovirus, and Respiratory Syncytial Virus (RSV)) were identified from VA data sources. COVID-19 tested patients were evaluated within 7 days for respiratory pathogen coinfections from 2/1/2020–5/31/2020. Patient demographics were obtained for patients with coinfections.

Results
A total of 825,282 respiratory pathogen tests (including COVID-19) were performed from Sept. 2019 with percent positive shown in Figure 1. Of these, 617,541 tests were performed starting in Feb. 2020 (Table 1). There were 14,839 (6.5%) positive COVID-19 tests (10,223 unique patients) of 227,111 tests performed (174,747 unique patients). 30,066/174,747 (17%) of patients with COVID-19 were tested for another respiratory pathogen. Fifty-six (0.55%) unique COVID-19 patients were detected with coinfection including 3 COVID-19 positive patients with &gt; 1 other respiratory pathogen (2 with Coronavirus and Adenovirus and 1 with Coronavirus and Rhino-Enterovirus). Other coinfections included 18 Rhino-Enterovirus, 15 Influenza, 10 with another Coronavirus, 4 RSV, 3 hMPV, 2 HPIV, and 1 C. pneumoniae. Demographics of coinfected patients are shown in Table 2.
Figure 1: Percent Positive of Respiratory Pathogens in VA, 9/29/2020–5/31/2020

Table 1: Respiratory Pathogens in VA, 2/1/2020–5/31/2020

Table 2: Co-infection patients with COVID-19 and other Respiratory Pathogens, 2/1/2020–5/31/2020

Conclusion
In VA, coinfection with COVID-19 and other respiratory pathogens was rare. Detection was limited since not all COVID-19 patients were tested for other respiratory pathogens and respiratory pathogens were declining when COVID-19 emerged. Coinfections were detected with different respiratory pathogens. Further comparisons of coinfected vs. non-coinfected patients to assess outcome or actionable results will be important as we enter the next influenza season.

Disclosures
All Authors: No reported disclosures