bluuebunny/crossref_metadata_2025_split huggingface dataset:
345. Dermatological Manifestations in Patients with COVID-19 Pneumonia in Veracruz, Mexico
Authors: Del Carpio-Orantes Luis , García-Méndez Sergio , Sánchez-Díaz Jesús Salvador , aguilar-silva Andrés , Aparicio-Sánchez Elisa Estefania , Cruz-Albarrán Sonia , Denis-Bravo Jorge Luis , Esparza-Mora Iván , Samantha González-Medel Karem , Hernández-Zaleta Nelyda Verania , López-Cruz Edgar Alberto , Montano-Montiel Laura Guadalupe , Morgado-Hernández Jennifer Ivonne , Muñoz-Aguilar José Alberto , Priego-Parra Edson Irving , Reich-Sierra Reynaldo , Sánchez-Jiménez Noel Jhosimar , Tress-Uc María Fernanda , Velázquez-Orozco Paola 
Published: December 2021

Abstract

Background
A large number of viral infections are characterized by the presence of cutaneous manifestations. Multiple dermatological manifestations have been observed in patients with COVID-19. Dermatological lesions in patients infected by SARS-CoV-2 such as livedo reticularis, rash and vascular lesions may represent manifestations of secondary phenomena such as paraviral rashes or by participation of the innate or adaptive immune system that cause vasodilation, vascular leakage or procoagulant effects

Methods
Descriptive and observational study, adult patients with COVID-19 pneumonia were selected, confirmed by RT-PCR and chest CT. General symptoms, hematic cytometry results, pneumonia severity, prognosis as well as dermatological manifestations are characterized.

Results
100 patients were entered into the study, with an average age of 49.4 years, 54% male. The general symptoms with the highest incidence were: fever, cough and dyspnea characteristic of SARS-CoV-2 infection, followed by chest pain, headache, anosmia and dysgeusia. The main alteration of the hemogram was lymphopenia, no leukopenia or plaquetopenia was demonstrated. 54% of those affected had mild pneumonia, the rest severe pneumonia. 75% progressed towards improvement and 25% died. Among the dermatological manifestations identified, all occurred in cases with severe pneumonia, the one with the highest incidence was the morbilliform viral exanthema in 18%, the presence of diffuse partial alopecia in 7% as well as manifestations of lividity and maceration in 1%. Regarding alopecia, in 6% it was reversible androgenetic alopecia, having manifested during the acute stage of pneumonia (all men), in 1% it presented alopecia areata (male) that has been persistent beyond the acute phase and in frank recovery
Demographic and clinical variables

Clinical manifestations

Conclusion
The incidence of dermatological manifestations is low in this study population, the most frequent being the morbilliform viral exanthema expected in a virus, however they present manifestations of low incidence such as reversible androgenetic alopecia associated with severity of the disease, a finding that has been documented recently as a manifestation associated with COVID-19

Disclosures
All Authors: No reported disclosures
350. Joint Modeling of EHR and CXR Data to Predict COVID-19 Deterioration
Authors: Mu Emily , Jabbour Sarah , Sjoding Michael , Guttag John , Wiens Jenna , Dalca Adrian 
Published: December 2021

Abstract

Background
Infectious respiratory-track pathogens are a common trigger of healthcare capacity strain, e.g. the COVID19 pandemic. Patient risk stratification models to identify low-risk patients can help improve patient care processes and allocate limited resources. Many existing deterioration indices are based entirely on structured data from the Electronic Health Record (EHR) and ignore important information from other data sources. However, chest radiographs have been demonstrated to be helpful in predicting the progress of respiratory diseases. We developed a joint EHR and chest x-ray (CXR) model method and applied it to identify low-risk COVID19+ patients within the first 48 hours of hospital admission.

Methods
All COVID19+ patients admitted to a large urban hospital between March 2020 and February 2021 were included. We trained an image model using large public chest radiograph datasets and fine-tuned this model to predict acute dyspnea using a cohort from the same hospital. We then combined this image model with two existing EHR deterioration indices to predict the risk of a COVID19+ patient being intubated, receiving a nasal cannula, or being treated with a vasopressor. We evaluated models’ ability to identify low-risk patients by using the positive predictive value (PPV).

Results
The image-augmented deterioration index was able to identify 12% of 716 COVID-19+ patients as low risk with 0.95 positive predictive value in the first 48 hours of admission. In contrast, when used individually, the EHR and CXR models each identified roughly 3% of the patients with a PPV of 0.95.
Predicting Low Risk Patients

Aggregated predictions for COVID19 positive patients within the first 48 hours of admission, shown with exponential weight moving average and 95% CIs. Each plot shows the number of patients flagged as low-risk by lowest aggregated prediction and the resulting accuracy for that fraction of patients. The bottom plot compares the MCURES fused model to the MCURES model. The top plot compares the EDI fused model to the EDI model.

Conclusion
Our multi-modal models were able to identify far more patients at low-risk of COVID19 deterioration than models trained on either modality alone. This indicates the importance of combining structured data with chest X-rays when creating a deterioration index performance for infectious respiratory-track diseases.

Disclosures
All Authors: No reported disclosures
358. Early Cardiac Marker of Mortality in COVID-19
Authors: Salguero Douglas , Ferri-Guerra Juliana , Porras Angel , Donatelle Marissa , Rogers Everett , Seiffer Lee , Porudominsky Ruben , Ujueta francisco , Olayiwola Ayoola , Tuda Claudio 
Published: December 2021

Abstract

Background
Epicardial adipose tissue (EAT) is a highly inflammatory depot of fat, with high concentrations of IL-6 and macrophages, which can directly reach the myo-pericardium via the vasa vasorum or paracrine pathways. TNF-α and IL-6 diminish cardiac inotropic function, making EAT inflammation a potential cause of cardiac dysfunction.

Methods
A retrospective cohort study assessing EAT Thickness and Density from CT scans, without contrast, from adult patients during index admission for COVID-19 infection at Mount Sinai Medical Center from March 2020 to January 2021. A total of 1,644 patients were screened, of which 148 patients were included. Follow-up completed until death or discharge. The descriptive analysis was applied to the general population, parametric test of normality for comparisons between groups. Kaplan survival analysis was conducted after survival distribution was confirmed significant. It was followed by the assumption of normality by Q-Q Plot, prior to performing a multiple regression analysis in the vulnerable group using a K-Matrix input for cofounders. A log-rank test was conducted to determine differences in the survival distributions for the different ranges of EAT thickness.

Results
A total of 148 Participants were assigned to two groups based on epicardial adipose tissue in order to classify them as increased or decreased risk of cardiovascular risk: &gt;5mm (n = 99), &lt; 5mm (n = 49). The survival percentage was higher in the group with no EAT inflammation compared to the group with EAT inflammation (95.0% and 65%, respectively). Participants with EAT &gt;5mm had a median day of hospital stay of 18 (95% CI, 16.86 to 29.92). The survival distributions for the two categories were statistically significantly different, χ2(2) = 6.9, p &lt; 0.01. A Bonferroni correction was made with statistical significance accepted at the p &lt; 0.025 level. There was a statistically significant difference in survival distributions for the EAT &gt;5 mm vs EAT &lt; 5 mm, χ2(1) =6.953, p = 0.008.

EAT Thickness Survival Analysis 2020-2021 COVID-19 MSMC

Scatter Plot Length of Stay by EAT Thickness

Conclusion
There was an association with increased EAT thickness and increased mortality. These findings suggest that EAT thickness can be used as a prognostic factor and as a risk factor for increased mortality in patients with COVID-19

Disclosures
All Authors: No reported disclosures
359. Clinical implications of SARS-CoV-2 PCR presumptive positive results
Authors: Yamamoto Takeru , Mizusawa Masako 
Published: December 2021

Abstract

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase (RT) polymerase chain reaction (PCR) testing is a cornerstone of coronavirus disease 2019 (COVID-19) diagnostics. A number of RT-PCR tests are currently available with different combinations of target genes including the pan-Sarbecovirus E gene target. When the E gene target is positive and the SARS-CoV-2 specific target is negative, the result is reported as presumptive positive which may indicate 1) a sample at concentrations near or below the limit of detection, 2) a mutation in the SARS-CoV-2 specific target, 3) infection with some other Sarbecovirus or 4) other factors. However, what the presumptive positive results mean clinically and whether they should be treated in the same way as the positive results are unknown.

Methods
We conducted a retrospective review of electronic health records for patients who had the presumptive positive results by Xpert Xpress SARS-CoV-2 (Cepheid, Sunnyvale, CA) or Cobas SARS-CoV-2 (Roche Molecular Systems, Branchburg, NJ) at Truman Medical Center from April 13, 2020 to December 31, 2021. Demographics, comorbidities, symptoms, laboratory data, radiographic data, clinical course and COVID-19 related complications were recorded and analyzed.

Results
During the study period, 85,267 SARS-CoV-2 RT-PCR tests were performed and 253 (0.3%) presumptive positive results were reported for 243 patients. Symptom information were available for 178 patients and 70% of them were symptomatic at the time of testing. Only 2 patients were admitted for COVID-19 pneumonia with the presumptive positive results. Both of them had low oxygen requirement during hospitalization and were discharged with stable conditions.

Conclusion
Symptomatic COVID-19 patients who presented with presumptive positive results by Xpert Xpress SARS-CoV-2 or Cobas SARS-CoV-2 had generally mild disease and rarely required hospitalization for COVID-19.

Disclosures
All Authors: No reported disclosures
369. Alternative Workflow for SARS-CoV-2 Testing Using a Heat Lysis Protocol for Respiratory Specimens
Authors: Yadav Meghna , Martinez Tiffany , Regoli Isabel , Hernandez Osvaldo , Le Phuong , Carolan Heather , Brown Brad , Menge Karen 
Published: December 2021

Abstract

Background
The SARS-CoV-2 pandemic has demonstrated the need for streamlined workflows in high-throughput testing. In extraction-based testing, limited extraction reagents and required proprietary instrumentation may pose a bottleneck for labs. As a solution, ChromaCode developed a Direct Extraction protocol for the HDPCR™ SARS-CoV-2 Assay, distributed in accordance with the guidance on Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency, Section IV.C., which allows for the processing of specimens without an extraction system. In lieu of an extraction system, the Direct Extraction protocol uses a thermal cycler to lyse and inactivate specimens which are directly added to the Polymerase Chain Reaction (PCR).

Methods
The Limit of Detection (LoD), Clinical Performance, and effect of Interfering Substances was determined for the Direct Extraction protocol. The LoD was established on 6 PCR platforms with dilutions of inactivated SARS-CoV-2 virus spiked into residual, negative nasopharyngeal swab (NPS) matrix. Clinical performance was assessed with 48 positive and 50 negative frozen retrospective samples using the Direct Extraction protocol compared to an external Emergency Use Authorized (EUA) comparator assays (cobas® Liat® SARS-CoV-2 & Influenza A/B assay and the Hologic Panther Fusion® SARS-CoV-2 Assay respectively) on three PCR platforms. The Direct Extraction protocol was evaluated for performance in the presence of 13 potentially interfering substances that can be present in a respiratory specimen.

Results
The LoD of the Direct Extraction protocol ranges from 1000 – 3000 genomic equivalents (GE)/mL. The clinical performance of the assay was 95.8% positive agreement (95% CI of 84.6% - 99.3%) and 100% negative agreement (95% CI of 90.9% - 100% or 91.1% – 100%) across all three PCR platforms tested. The viral target was detected at 3X LoD for all interferents tested.

Conclusion
The Direct Extraction protocol of ChromaCode’s SARS-CoV-2 Assay is a sensitive test that eliminates the need for sample extraction and performs very well against traditional extraction-based workflows. The inclusion of this protocol can reduce costs, reliance on extraction systems, and time associated with extraction-based protocols.

Disclosures
Meghna Yadav, Ph.D. Molecular Biology, ChromaCode Inc. (Employee, Shareholder) Tiffany Martinez, n/a, ChromaCode (Employee, Shareholder) Isabel Regoli, MS, Bioinformatics, ChromaCode (Employee, Shareholder) Osvaldo Hernandez, B.S., Molecular Biology, ChromaCode (Employee, Shareholder) Phuong Le, B.S., Biochemistry, ChromaCode (Employee, Shareholder) Heather Carolan, Masters, Computational Molecular Biology, ChromaCode (Employee, Shareholder) Brad Brown, Ph.D Biomedical Sciences, ChromaCode (Employee, Shareholder) Karen Menge, Ph.D. Biochemistry, ChromaCode (Employee, Shareholder)ChromaCode (Employee, Shareholder)
396. Disparities in SARS-CoV-2 Antibody Prevalence: Findings from a Citywide Serosurvey in Holyoke, Massachusetts, November 2020–January 2021
Authors: Matias Wilfredo , Fulcher Isabel , Nolan Cody , Guillaume Yodeline , Zhu Jack , Molano Francisco , Uceta Elizabeth , Collins Shannon , Slater Damien , Sanchez Vanessa , Moheed Serina , Harris Jason , Charles Richelle , Paxton Ryan , Gonsalves Sean , Franke Molly , Ivers Louise 
Published: December 2021

Abstract

Background
Seroprevalence studies are important tools to estimate the prevalence of prior or recent SARS-CoV-2 infections. This information is critical for identifying hotspots and high-risk groups and informing public health responses to the COVID-19 pandemic. We conducted a city-level seroprevalence study in Holyoke, Massachusetts to estimate the seroprevalence of SARS-CoV-2 antibodies and risk factors for seropositivity.

Methods
We invited inhabitants of 2,000 randomly sampled addresses to participate between November 5 and December 31, 2020. Participants completed questionnaires measuring sociodemographic and health characteristics, and COVID-19 exposure history, and provided dried blood spots for measurement of SARS-CoV-2 IgG and IgM antibodies. To calculate total and group seroprevalence estimates, inverse probability of response weights were constructed based on age, gender, race/ethnicity and census tract to ensure estimates represented the city’s population.

Results
We enrolled 280 households including 472 individuals. 328 underwent antibody testing. The citywide weighted seroprevalence of SARS-CoV-2 IgG or IgM was 13.9% (95%CI 7.8 - 21.8) compared to 9.8% based on publicly reported case counts. Seroprevalence was 16.8% (95%CI 5.7 – 28.0) among individuals identifying as Hispanic compared to 8.9% (95%CI 3.0 - 14.7) among those identifying as White. Seroprevalence was 20.7% (95%CI 2.2 – 39.2) for ages 0-19; 13.8% (95%CI 5.6 – 22) for ages 20 – 44; 9.6% (95%CI 0 – 20.5) for ages 45 – 59; 4.8% (95%CI 0 – 10.2) for ages 60 – 84; and 42.9% (95%CI 0 – 100) for ages &gt;85.
Table 1. Seroprevalence by antibody positivity profile

Table 2. Unweighted and weighted seroprevalence by sociodemographic characteristics

Figure 1. Seroprevalence by Medical, Symptom, Testing and Exposure History.

Conclusion
The measured SARS-CoV-2 seroprevalence in Holyoke was only 13.9% during the second surge of SARS-CoV-2 in this region, far from accepted thresholds for “herd immunity” and highlighting the need for expanding vaccination. Individuals identifying as Hispanic were at high risk of prior infection. Subsequent community-level serosurveys are necessary to guide local responses to the SARS-CoV-2 pandemic.

Disclosures
All Authors: No reported disclosures
398. Multicenter Evaluation of Outcomes of SARS-CoV-2 Positive Patients Treated at Rural vs Urban Hospitals in the United States
Authors: Bauer Karri A , Yu Kalvin , Gupta Vikas , Puzniak Laura A 
Published: December 2021

Abstract

Background
The SARS-CoV-2 pandemic has revealed socioeconomic and healthcare inequities in the US. With approximately 20% of the population living in rural areas, there are limitations to healthcare access due to economic constraints, geographical distances, and provider shortages. There is limited data evaluating outcomes associated with SARS-CoV-2 positive patients treated at rural vs. urban hospitals. The aim of the study was to evaluate characteristics and outcomes of SARS-CoV-2 positive patients treated at rural vs. urban hospitals in the US.

Methods
This was a multicenter, retrospective cohort analysis of adult (≥ 18 years) hospitalized patients from 241 US acute care facilities with &gt;1 day inpatient admission with a discharge or death between 3/6/20-5/15/21 (BD Insights Research Database [Becton, Dickinson & Company, Franklin Lakes, NJ]), which includes both small and large hospitals in rural and urban areas. SARS-CoV-2 infection was identified by a positive PCR or antigen during or &lt; 7 days prior to hospital admission. Descriptive statistics were completed. P value of ≤0.05 was considered statistically significant.

Results
Overall, 42 (17.4%) and 199 (82.6%) of hospitals were classified as rural and urban, respectively. A total of 304,073 patients were admitted to a rural hospital with 12,644 (4.2%) SARS-CoV-2 positive. In comparison, a total of 2,844,100 patients were treated at an urban hospital with 132,678 (4.7%) SARS-CoV-2 positive. Patients admitted to rural hospitals were older compared to those treated at an urban hospital (65.2 ± 17.3 vs. 61.5 ± 18.7, P=0.001) (Table 1). Patients treated at an urban facility had significantly higher rates of ICU admission, severe sepsis, and mechanical ventilation. ICU length of stay was significantly longer for patients admitted to an urban hospital compared to a rural hospital (8.1 ± 9.9 vs. 6.1 ±7.2 days, P=0.001) (Table 2). No difference in mortality was observed.
Table 1. Characteristics of SARS-CoV-2 positive patients treated at rural vs. urban hospitals.

Table 2. Outcomes of SARS-CoV-2 patients treated at rural vs. urban hospitals. *Patients with available data.

Conclusion
In this large multicenter evaluation of hospitalized patients positive for SARS-CoV-2, there were significant differences in patient characteristics. There was no observed difference in mortality. These findings are important in evaluating the pandemic’s impact on patients in rural and urban healthcare settings.

Disclosures
Karri A. Bauer, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee)
406. Incidence of Community and Hospital Acquired Infections in Critically Ill COVID-19 Patients in the Dominican Republic
Authors: Rojas-Fermin Rita Alexandra , Guzman Anel E , Sanchez Ann , Germosen Edwin , Matos Cesar , Mena Lora Alfredo J 
Published: December 2021

Abstract

Background
The disease caused by SARS-CoV-2, COVID-19, has caused a global public health crisis. COVID-19 causes lower respiratory tract infection (LRTI) and hypoxia. There is a paucity of data on bacterial and fungal coinfection rates in patients with COVID-19 at low and middle income countries (LMICs). Our objective is to describe the clinical characteristics of critically ill patients with COVID-19 in the Dominican Republic (DR)

Methods
We performed a retrospective review of patients admitted to the ICU with COVID-19 from March 14th to December 31st 2020, at a 296-bed tertiary care level and teaching Hospital in the Dominican Republic. Demographic and clinical information was collected and tabulated. Laboratory confirmed bacterial and fungal infections were defined as community acquired infections (CAI) if diagnosed within 48 hours of admission and hospital acquired infections (HAI) when beyond 48 hours. Microbiologic data was tabulated by source and attribution.

Results
Our cohort had 382 COVID-19 patients. Median age was 64 and most were male (64.3%) and 119 (31.1%) were mechanically ventilated and 200 (52%) had central venous catheters. A total of 28 (7%) laboratory confirmed community acquired infections and 55 (14%) HAIs occurred. Community acquired infections included 13 (46%) bloodstream infections (BSIs), 11 (39%) urinary tract infections (UTI) and 6 (21%) LRTIs. HAIs included 39 (70%) BSIs, 11 (20%) UTIs and 6 (11%) ventilator associated pneumonias (VAP). Causal organisms of community and hospital acquired BSI and UTI are in Figure 1 and Figure 2 respecively. All-cause mortality was 35.3% (135/382) in our cohort, and 100% mortality (76) in those with coinfections.
Figure 1. Community acquired and hospital acquired bloodstream infections in COVID-19 patients admitted to the ICU

Figure 2. Community acquired and hospital acquired urinary tract infections in COVID-19 patients admitted to the ICU

Conclusion
Community and hospital acquired infections were common and in the ICU and likely contributed to patient outcomes. More than two thirds of HAIs in the ICU were BSIs. Central venous catheter device utlization and maintenance may play a role in BSIs, along with immunosuppression from COVID-19 therapeutics and translocation from mucosal barrier injury. Mortality in patients with coinfections was higher than those without. Infection prevention strategies to reduce device utilization during COIVD-19 in LMICs may have an impact on HAIs.

Disclosures
All Authors: No reported disclosures