bluuebunny/crossref_metadata_2025_split huggingface dataset:
441. The Effects of Race and Comorbidity Burden on Inflammatory Biomarkers Among Persons Hospitalized with COVID-19
Authors: Fatade Yetunde A , Collins Lauren F , Collins Lauren F , Almuwaqqat Zakaria , Chen ZhenChao , Prasad Mahadev , Quyyumi Arshed , Ofotokun Igho 
Published: December 2021

Abstract

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

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

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

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

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

Abstract

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

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

Results
We included 565 patients with mean age (standard deviation) 64.4 (16.2) years, 52.0% male (294) and 77.2% (436) black/African American. The overall mean body mass index (BMI) was 32.0 (9.02) kg/m2. At least one comorbidity was present in 95.2% (538) of patients. The overall case-fatality rate was 30.4% (172/565). The unadjusted mortality rate among males was 33.7% compared to 26.9% in females (p=0.08); the median time to death (range) for males was 16.8 (0.3, 33.9) compared to 14.2 (0.32, 47.7) days for females (p=0.04). Univariable survival analysis with Cox proportional hazards models revealed that age (p=&lt; 0.0001), admission from a facility (p=0.002), public insurance (p&lt; 0.0001), respiratory rate ≥ 22 bpm (p=0.02), lymphocytopenia (p=0.07) and serum albumin (p=0.007) were additional risk factors for mortality (Table 1). From multivariable Cox proportional hazards modeling (Table 2), after controlling for age, Charlson score and qSofa, males were 40% more likely to die than females (p=0.03).
Table 1. Univariate analysis with Cox proportional hazards model on factors associated with mortality in patients with COVID-19

Abbreviations: HR: Hazard ratio, CI: Confidence interval
Table 2. Multivariable analysis with Cox proportional hazards model on factors associated with mortality in patients with COVID-19

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Conclusion
This study found neutralizing activity of infection against SARS-CoV-2 in 63% RT-PCR+ individuals, but only in 26% in RT-PCR(-) players. Level of neutralizing antibody responses maintained stable until up to nine months after a RT-PCR+.
Figure 2. Percentage of soccer players at each antibody level (below 20%, between 20% and 30%, and above 30%) versus time between the positive RT-PCR test and neutralizing antibody test (days).

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

CBC parameters

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

Disclosures
All Authors: No reported disclosures