bluuebunny/crossref_metadata_2025_split huggingface dataset:
515. Risk Factors for Death, Intubation and Cardiac Arrest among COVID-19 Patients Hospitalized in Eastern North Carolina
Authors: Pona Adrian , Mao Yuxuan , Jiwani Rahim A , Afriyie Felix , Labbe Jonathan , Younes Ahmed , Badr Mai , Fang Xiangming , Zomorodian Laila , Lee Elisabeth , Cook Paul P 
Published: January 2021

Abstract

Background
Although majority of coronavirus disease 2019 (COVID-19) cases demonstrate mild to asymptomatic disease, COVID-19 can cause serious complications and death. However, risk factors for development of such complications are not well understood. The purpose of this study was to identify risk factors for intubation, cardiac arrest, and death in COVID-19 patients.

Methods
A retrospective chart review of COVID-19 subjects was conducted of the first 185 patients for whom we had complete data sets. Subjects were adult inpatients with a confirmed COVID-19 diagnosis who were hospitalized between March and May 2020 at Vidant Medical Center in Greenville, NC. Data including demographics, comorbidities, laboratory results, treatments, and outcomes were collected. Data were analyzed using logistic regression models and receiver operating characteristic curves in SAS 9.4.

Results
Of the first 185 subjects hospitalized for COVID-19, 26% of patients were intubated, 9% experienced cardiac arrest, and 17% died. Subjects who required intubation were more likely to exhibit elevated triglycerides, sepsis, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), elevated troponin levels, altered mental status, leukocytosis, lymphopenia and elevated ferritin (P&lt; 0.05) (Table 1). Troponin elevation, ARDS, AKI and thrombocytopenia were risks for cardiac arrest (P&lt; 0.05) (Table 2). Risk of death was increased in those presenting with advanced age, critical or severe disease, lymphopenia or thrombocytopenia, and in those with history of coronary artery disease (CAD) (P&lt; 0.05) (Table 3). Patients presenting with AKI, elevated Troponin, ARDS, pressor requirements, critical disease, and sepsis were at increased risk of intubation, cardiac arrest, and death (P&lt; 0.05) (Tables 1–3).
Table 1: Top non-ICU related risk factors for intubation ordered by AUC.

Table 2: Top risk factors for cardiac arrest ordered by AUC.

Table 3: Top risk factors for death ordered by AUC.

Conclusion
In this rapidly evolving pandemic, clinician awareness of risk factors for clinically significant outcomes such as intubation and mortality is essential. Assessment of risk factors like those highlighted in this study can aid in clinical decision-making and predicting patient outcomes. As more data becomes available we aim to develop a validated scoring system to assist clinicians in patient care.

Disclosures
Paul P. Cook, MD, Contrafect (Grant/Research Support, Scientific Research Study Investigator)Gilead (Grant/Research Support, Scientific Research Study Investigator)Leonard-Meron (Grant/Research Support, Scientific Research Study Investigator)Lilly (Grant/Research Support, Scientific Research Study Investigator)
517. Association of the predictive risk scores of CALL points and COVID-GRAM with IL-6, duration of oxygen therapy, D-dimer among patients with COVID-19
Authors: Yoshihara Hanako , Kurihara Ibuki , Fukuchi Takahiko , Sugawara Hitoshi 
Published: January 2021

Abstract

Background
The coronavirus disease 2019 (COVID-19) outbreak has caused a global pandemic. Critically ill patients with COVID-19 can develop acute respiratory distress syndrome (ARDS) and thrombosis. Angiotensin-converting enzyme 2 is a functional receptor for severe acute respiratory syndrome coronavirus 2 to gain entry in cells. This receptor is widely expressed in some hematopoietic cells, including monocytes and macrophages. Infection of these cells results in secretion of interleukin (IL)-6 and other inflammatory cytokines. IL-6 and other inflammatory cytokines can cause ARDS and thrombosis. Elevated IL-6 levels are expected to cause more severe cytokine release syndrome. In this study we investigated the association of the predictive risk scores with the IL-6 level, duration of oxygen therapy (DOT), and D-dimer level.

Methods
We enrolled 20 consecutive patients diagnosed with COVID-19 from April 3, 2020, to April 30, 2020, and determined the predictive risk scores of CALL points (Dong J et al. CID 2020) and COVID-GRAM (Liang W et al. JAMA Int. Med2020) on admission. We statically analyzed the regressions between these two scores and the values of IL-6 and D-dimer and DOT.

Results
The regression lines between CALL points and the values of IL-6, D-dimer, DOT were Y=-2.09 + 0.618X (r=0.821), Y=-0.783 + 0.213X (r=0.510), and Y=-5.32 + 1.26X (r=0.744), respectively. The regression lines between COVID-GRAM and the values of IL-6, D-dimer, and DOT were Y=-0.820 + 0.0344X (r=0.935), Y=-2.70 + 0.0205X (r=0.774), and Y=-1.92 + 0.0491X (r=0.765), respectively. These correlation coefficients were statistically significant. The correlation coefficients of CALL points were in the descending order of IL-6, DOT, and D-dimer. The correlation coefficients of COVID-GRAM were in the descending order of IL-6, D-dimer, and DOT. The coefficient between COVID-GRAM and IL-6 was the highest.

Conclusion
These predictive risk scores of CALL points and COVID-GRAM can be surrogate markers for the IL-6 level in patients with COVID-19. Further research is required to understand the prediction of severity in patients with COVID-19.

Disclosures
All Authors: No reported disclosures
518. Factors Associated with Severe COVID-19 among Patients Hospitalized in Rhode Island
Authors: Pandita Aakriti , Gillani Fizza S , Shi Yiyun , hardesty Anna , Aridi Jad , McCarthy Meghan , Chiang Silvia , Beckwith Curt 
Published: January 2021

Abstract

Background
To better understand patient factors that impact clinical outcomes in COVID-19, we performed a retrospective cohort study of patients hospitalized with COVID-19 in Rhode Island to identify patient and clinical characteristics associated with severe disease.

Methods
We analyzed 259 patients admitted to our academic medical center during a three month period with confirmed COVID-19. Clinical data was extracted via chart review and lab results within the first 24 hours of admission were extracted directly from electronic medical records. Patients were divided in two groups based upon the highest level of supplemental oxygen (O2) required during hospitalization: severe COVID-19 (high flow O2, non-invasive, or invasive mechanical ventilation) and non-severe COVID-19 (low flow O2 or no supplemental O2). SAS 9.4 (Cary, NC) was used for statistical analyses. Chi-square or Fisher’s exact tests for categorical variables and the Student’s t-test for continuous variables were used to compare demographics, baseline comorbidities, and clinical data between the severe and non-severe groups.
Table 1: Demographics

Results
Of 259 patients, 166 (64%) had non-severe disease, and 93 (36%) severe disease; median age [IQR] was 62 [51,73]. There were 138(53%) males and 75 (29%) Hispanics. Among non-Hispanics,124(48%) were White, 48(19%) African Americans, and 12(5%) other races. Sixty (23%) were admitted from a nursing facility and the in-hospital mortality rate was 15% (38/259). Severe COVID-19 was associated with older age (p=0.02), admission from nursing facility (p=0.009), increased BMI (p=0.03), diabetes mellitus (p=0.0002), and COPD (p=0.03). At the time of presentation, severe COVID-19 was associated with tachypnea, hypoxia, hypotension (all p&lt; 0.0001), elevated BUN (p=0.002) and AST (p=0.001), and acute or chronic kidney injury (p=0.01). Median hospital stay [IQR] was 11 days [7,18] in the severe vs. 6 days [3,11] in the non-severe group. In the severe group, 72% required ICU admission and 39% died.
Table 2: Medical comorbidities

Table 3: Presenting symptoms and signs in the first 48 hours of admission

Table 4: Basic labs in the first 24 hours

Conclusion
In this cohort of patients with COVID-19, specific comorbidities, and vital signs at presentation were associated with severe COVID-19. These findings help clinicians with early identification and triage of high risk patients.

Disclosures
All Authors: No reported disclosures
523. COVID-19 Preparedness in Hospice and Palliative Care
Authors: Pogorzelska-Maziarz Monika , Kates Jeannette , Shang Jingjing , Gerolamo Angela M 
Published: January 2021

Abstract

Background
Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown.

Methods
An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7–28, 2020. Summary statistics were computed.

Results
We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit.
More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19; of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19.

Conclusion
Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate.

Disclosures
All Authors: No reported disclosures
525. Characteristics of HIV SARS-COV-2 Coinfection in a Highly HIV Seropositive Population in New York City
Authors: Willner Debra M , Bengualid Victoria , Bisono-Garcia Bismarck , Trigueros Ricardo , Berger Judith 
Published: January 2021

Abstract

Background
The HIV and COVID-19 co-infection prevalence has not been described extensively. Given the high prevalence of HIV positive patients in our population-our Designated AIDS Center (DAC) caters to approximately 600 patients-of which 68% are virally suppressed, this relationship is of great interest. The objectives of this analysis are to report the characteristics of HIV and COVID-19 patients, and to evaluate for any associations of HIV with COVID-19 outcomes.

Methods
Retrospective chart review of all patients admitted with both HIV and confirmed COVID-19. Collected demographics, past medical history, HIV history including therapy, compliance, viral loads, and CD4 counts, and COVID-19 disease course. Evaluate baseline clinical status utilizing the World Health Organization’s Ordinal Scale for Clinical Improvement, and note disease outcomes. Analyzed mortality and disease severity as compared to the general COVID-19 patient population.

Results
39 patients were identified with HIV and COVID-19 from March 15th –June 18th 2020. Baseline characteristics of these patients are listed in Figure 1. Of the available labs, 60% of patients were virally suppressed, and 87% had CD4+ counts above 200/µL. On admission, most patients either did not require oxygen support, or received support through noninvasive methods. In Figure 2 we see the final outcome of the patients, with 77% of the patients discharged, and a mortality rate of 18%. Of note, the only baseline characteristic that had a significant correlation with mortality among our patients was age &gt; 60 (p = 0.03).
Baseline Characteristics of HIV COVID-19 Patients and Pertinent COVID-19 Admission Statistics

COVID-19 Outcomes

Conclusion
Mortality in our HIV COVID-19 population was 18%, significantly lower than the 33% in COVID-19 patients overall at our institution. 39 patients with HIV were admitted for confirmed COVID-19 infections, which only amounts to 6.5% of the DAC population, although it is possible that our patients were admitted to other facilities for COVID-19. In our patients, compliance, viral suppression, and CD4+ counts did not correlate with outcomes. Although our mortality was significantly lower than the overall hospital mortality, larger studies are needed to fully evaluate the mortality relationship and determine the protective effects of antiviral therapy and/or decreased immune response in HIV patients with COVID-19.

Disclosures
All Authors: No reported disclosures
526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit
Authors: Ang Jocelyn Y , Kannikeswaran Nirupama , Asmar Basim 
Published: January 2021

Abstract

Background
There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution.

Methods
We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19.

Results
SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia).
Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children

Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy

Figure 1: Severity of Ill ness in the study cohort

Conclusion
Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children.

Disclosures
All Authors: No reported disclosures
528. Coronavirus Disease 2019 in Children Cared for at Texas Children’s Hospital: Implications of Repeat Testing on Infection Control Strategies
Authors: Foster Catherine , Marquez Lucila , Koy Tjin , Singh Ila , Campbell Judith 
Published: January 2021

Abstract

Background
Accurate diagnosis of coronavirus disease 2019 (COVID-19) is key for source control and interrupting disease transmission. To better understand the length of viral shedding in children and potential infection control implications, we describe 51 children with COVID-19 who underwent repeat testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at Texas Children’s Hospital (TCH).

Methods
We performed a retrospective chart review of all pediatric patients (&lt; 21 years of age) with ≥ 2 nasopharyngeal specimens tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (rt-PCR) and at least one positive result between 3/13/2020 and 6/7/2020 through the TCH Molecular Microbiology Laboratory.

Results
Fifty-one patients met inclusion criteria. The median age was 8.6 years (0.02–19.2 years). Sixteen (31%) children were hospitalized. Fourteen (27%) patients underwent testing for surveillance purposes (including 3 admitted patients). Two SARS-CoV-2 tests were performed in 25 (49%) children; while 12 (24%) children had 3 tests, 4 (8%) children had 4 tests, and 10 (20%) children had ≥ 5 tests (including 1 patient with underlying malignancy who had 9 SARS-CoV-2 PCRs performed). SARS-CoV-2 testing timeline for 9 hospitalized children is shown (Fig 1). The median time between collection of tests 1 and 2 was 14 days (n=51, range 1, 53 days). For children with conversion (first detected to first not-detected sample), the median time was 15 days (n=31, range 1, 45 days). For patients with consecutive positive SARS-CoV-2 PCRs, the median time of positivity was 10 days (n=19, range 2, 31). One patient with malignancy had 5 tests over 6 weeks in the outpatient setting and each time alternated between detected and not-detected. Following diagnosis with COVID-19, one patient with sickle cell disease likely had re-infection and had a positive test after having 2 consecutive negative tests; his last SARS-CoV-2 rt-PCR was positive 68 days after initial positive.
Fig 1. Timing of Repeat SARS-CoV-2 PCRs in Select Hospitalized Children with COVID-19

Conclusion
We observed variation in the duration of SARS-CoV-2 rt-PCR positivity in children with COVID-19. For children with COVID-19, a single negative molecular assay for SARS-CoV-2 may not be predictive of sustained negativity.

Disclosures
All Authors: No reported disclosures
530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study
Authors: Hardesty Anna , Pandita Aakriti , Shi Yiyun , Vieira Kendra , Rogers Ralph , Merhi Basma , Osband Adena , Bayliss George , Gohh Reginald , Morrissey Paul , Beckwith Curt , Farmakiotis Dimitrios 
Published: January 2021

Abstract

Background
Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date.

Methods
We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died.

Results
16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted &gt;10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were &gt;1,000 (normal: &lt; 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were &gt;10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2).
Table 1

Table 2

Conclusion
Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway.

Disclosures
All Authors: No reported disclosures
534. Halting a SARS-COV2 Outbreak in a Veterans Affairs Nursing Home
Authors: Psevdos George , Papamanoli Aikaterini , Barrett Nancy , Bailey Lisa , Thorne Monique , Ford Florence M , Lobo Zeena 
Published: January 2021

Abstract

Background
Health care systems have been significantly overwhelmed during the SARS-CoV-2 (SC2) pandemic. Cases in the USA have exceeded 1.9 million with over 40% of deaths occurring in nursing homes and assisting living facilities. We describe our experience in controlling an outbreak in our community living centers (CLC)

Methods
We retrospectively reviewed the charts of Veterans with positive nasopharyngeal (NP) RT-PCR for SC2 from March 24 to April 18, 2020 in 2 neighboring CLC units (80 bed capacity), at Northport Affairs Medical Center.

Results
Twenty five Veterans (24 men) tested positive for SC2. Of these, 5 remained asymptomatic, 9 got hospitalized, 6 died. No coinfection with influenza or other respiratory viruses identified. 11 health care workers (HCW) tested positive. Figure 1 shows test results by date. Table 1 summarizes the demographic characteristics, medical history, and laboratory findings. The median age was 74 years, with no difference in age between recovered and deceased, 73 vs. 77, P:0.105. Simplified acute physiology score (SAPS) II score was higher in the deceased group (P=0.001) and so were D-dimer (admission and peak levels), CRP, LDH, and peak ferritin/procalcitonin levels. There was no ICU admission. Figure 2 illustrates the CLC 1 and 2 outline of beds depicting positive cases in sequence of detection. Initial spread of the virus was fast, affecting residents and HCW. CLC visits were prohibited, floating of staff minimized, internal group activities halted, infection control measures and education on proper use of personal protective equipment provided. A SC2 (or “COVID”) unit was created in CLC1 and all patients and staff got tested. Withdrawal of isolation precautions required resolution of symptoms, and two sequential negative NP PCR tests which were obtained after 14 days from diagnosis. If the PCR was positive, a repeat test was obtained in 72 hours. 13 patients had persistent positive PCR for average 32 days (19 to 52) since diagnosis. 7/13 got tested and all were positive for SC2 IgG antibody.
SARS-CoV -2 Outbreak in VA Nursing Home, Dates of Tests

Bed Outline of CLCs Depicting the Location And Numerical Sequence of Positive Tests

Comparison Between Recovered vs Deceased Nursing Home Veterans with COVID-19

Conclusion
Controlling SARS-CoV-2 outbreaks in nursing homes is a unique challenge as the virus can spread quickly among residents and staff. Mortality rate in our cohort was 24%. Prompt, effective isolation and broad testing was instrumental in halting the SC2 (COVID-19) outbreak.

Disclosures
All Authors: No reported disclosures