bluuebunny/crossref_metadata_2025_split huggingface dataset:
293. Lung Cancer and Hematologic Malignancy ( HM) Patients Are Associated with the Highest Risk of Progressing to Severe Disease and Mortality in Cancer Patients with COVID-19
Authors: Chaftari Anne-Marie , Malek Alexandre , Dagher Hiba , Jiang Ying , Bayle Arnaud , Bhinder Arvinder , Cruz Ana Fernandez , Siddiqui Bilal , Somer Robert , Datoguia Tarcila , Slavin Monica , Dragvich Tomislav , Gorak Edward , Mori Nobuyoshi , Hachem Ray Y , Raad Issam I 
Published: December 2021

Abstract

Background
Several studies have shown that underlying cancer is a risk factor for progression of COVID-19 to severe illness and fatal outcome but there is very little data that specifies which underlying cancer puts this patient population at the highest risk.

Methods
We retrospectively collected de-identified data on 1115 cancer patients diagnosed with COVID-19 between January and November 2020, at 12 centers in Asia, Australia, Europe, North America, and South America. Patient characteristics including age, type of malignancy (hematologic malignancy [HM], lung cancer, and non-lung cancer were determined in association with severe illness as well as all-cause mortality within 30 days after COVID-19 diagnosis.

Results
By multivariable logistic regression analysis, independent risk factors for 30-day mortality in cancer patients included age &gt; 65 (OR 6.64; 95% CI 3.351to 12.55; p&lt; 0.0001), ALC &lt; 0.5 K/microliter (OR 2.10; 95% CI 1.16 to 3.79; p=0.014), and anemia at &lt; 10g/dl (OR 2.41; 95% CI 1.30 to 4.44; p=0.005). Among cancer patients, the 30-day mortality rate was significantly higher in patients with lung cancer than in patients with non-lung cancer solid tumors, including those with lung metastases (22% vs 9%; p=0.001). Patients with HM tended to have higher 30-day mortality than patients with non-lung cancer solid tumors (13% vs 9% p=0.07) and tended to have a lower mortality rate than patients with lung cancer (p=0.07). Furthermore, HM patients were more likely to be lymphopenic and anemic at diagnosis as well as progress to LRTI and be placed on ventilatory support compared to non-lung cancer solid tumor patients ( p= or &lt; 0.01). In addition, lung cancer and HM patients were more likely to develop hypoxia and require hospital admission than non-lung cancer solid tumor patients ( p=0.01).

Conclusion
Lung cancer and HM patients are associated with the highest risk of progressing to severe disease and mortality in cancer patients with COVID-19. Hence, cancer patient population should be given the highest priority as far as prevention [vaccination with boosters if needed] as well as preemptive early therapy with monoclonal antibodies right after the onset of COVID-19.

Disclosures
Monica Slavin, MBBS,MD, F2G (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Pfizer (Advisor or Review Panel member)
295. SARS-CoV-2 Infection in a Referral Cancer Center in Mexico City During the First Year of the COVID-19 Pandemic
Authors: Vilar-Compte Diana , De La Rosa Martinez Daniel , Martín-Onraet Alexandra , Pérez-Jiménez Carolina , Islas-Muñoz Beda , Alatorre-Fernández Pamela , Cornejo-Juarez Patricia , Aranda-Audelo Mercedes , Zinser-Peniche Paola , Nuñez-Luna Luis , Ruíz-García Erika 
Published: December 2021

Abstract

Background
Literature on SARS-CoV-2 infection in cancer patients is scarce in Latin America. This population seems to have a higher risk for adverse outcomes. This study aims to correlate clinical characteristics with outcomes in patients with cancer in a referral center in Mexico.

Methods
We included patients with cancer and confirmed SARS-CoV-2 infection, from April, 19 to December 30, 2020, at the Instituto Nacional de Cancerología, Mexico. Clinical information was obtained from medical and epidemiological records. We conducted a descriptive analysis. For the association between variables with hospitalization, invasive mechanical ventilation (IMV), and mortality; univariate and multivariate logistic regression was performed; odds ratios and 95% confidence intervals were calculated.

Results
Four hundred thirty-three patients were included; 268 (62%) were female, the median age was 55 years. One hundred thirty-five (31%), 130 (30%), and 93 (21%) patients had obesity, hypertension, and diabetes mellitus (DM), respectively. Three hundred forty-one (79%) had solid cancer; 82 (19%) hematological malignancy (HM), and 10 (2%) were under evaluation for cancer diagnosis. One hundred seventy (39%) had advanced or metastatic cancer. One hundred ninety-eight (46%) patients were hospitalized. Risk factors were: age (p= 0.001); woman (p=0.019); HM (p=0.050) and advanced or metastatic cancer (p= 0.041). Fourty-five (10%) patients required IMV. Age (p=0.018); DM (p=0.041); C-Reactive Protein (p= 0.002), and LDH (p= 0.033) were associated with invasive mechanical ventilation. Mortality within 30-days after diagnosis was 19% (82 cases). Associated characteristics were: age (p=0.041); lymphocytes (p=0.049); creatinine (p=0.005) and albumin (p=0.001).

Conclusion
In this study, patients with cancer showed higher mortality, need of hospitalization, and invasive mechanical ventilation compared with groups of patients without cancer. We did not find an increased risk in mortality for hematological malignancies. Although our cohort was younger than others previously reported, age was a strong predictor of adverse outcomes. Variables associated with IMV and death were similar to those previously described in cancer patients with COVID-19.

Disclosures
All Authors: No reported disclosures
297. Infectious Complications Associated with Tocilizumab Use in Patients Infected with SARS-CoV-2 at a Mid-Atlantic Hospital Consortium
Authors: Kent Kristen R , Darling Nellie , Geng Xue , Clark Gavin , Kazanas Marybeth , Kumar Princy N , Timpone Joseph G 
Published: December 2021

Abstract

Background
The IL-6 inhibitor Tocilizumab (TOCI) has been associated with infections in 5-8% of patients with Rheumatoid Arthritis. TOCI has now been recommended as a treatment option for select patients with COVID-19; however, the risk of infection in this patient population is yet to be determined.

Methods
We performed a retrospective chart review of patients diagnosed with COVID-19 and admitted to MedStar hospitals within the D.C./Baltimore corridor from 03/01/2020 to 12/31/2020. We identified patients who had positive culture data within 30 days of administration of TOCI-based regimens and analyzed clinical characteristics and outcomes. Univariate analyses (Wilcoxon, T-test, Chi-Square, Fisher’s Exact) were used to compare these outcome variables between patients who had post-treatment infections and those who did not.

Results
A total of 220 patients received TOCI-based regimens; 16% (N=36) of patients developed positive cultures within 30 days of treatment. Of the 99 cultures, 50% were gram positive (N=49), 38% were gram negative (N=38), 10% were Candida spp. (N=10), and 2% were anaerobic organisms (N=2). Only 9% (8/87) of the gram positive and gram negative organisms were MDROs. Bloodstream infections were the most common and accounted for 58.4% of all infections. Length of stay (LOS) was approximately twice as long in those with post-treatment infections (26 days) compared to those without infections (14 days, p&lt; 0.001). Although the mortality rate was higher in patients with infections after TOCI-based treatment compared to patients with no post-treatment infection (47% vs 31% respectively), this did not reach statistical significance (p=0.09). Moreover, there was no significant difference in the infection rate of patients treated with TOCI alone compared to TOCI and Dexamethasone (16.6% vs. 13.3%, p=0.99). No cases of invasive Aspergillosis were observed.

Conclusion
Tocilizumab treatment in patients with COVID-19 may predispose patients to an increased risk of infection which is associated with a prolonged LOS and possibly higher mortality. We observed a two-fold increase in infections in COVID-19 patients compared to other patient groups receiving this treatment.

Disclosures
Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)
298. Examining the Relationship Between Excess Weight and In-Hospital Mortality in COVID-19 Patients in Southwest Georgia, U.S
Authors: Dykes Austin C , Chastain Daniel B , Thomas Geren , Young Henry N , Martínez Andrés F Henao , Franco-Paredes Carlos , Osae Sharmon P 
Published: December 2021

Abstract

Background
There are multiple mechanisms for the interconnection between obesity and adverse outcomes in COVID-19. Body mass index (BMI) has historically been used to delineate body fatness, but does not include age, which could influence the relationship between body fat and BMI. Ideal body weight (IBW) equations predict a single IBW, which could allow improved recognition of adults with excess weight at increased risk of death from COVID-19. The purpose of our study was to determine whether an association exists between excess weight and in-hospital mortality in COVID-19 patients.

Methods
This was a multicenter, retrospective chart review of hospitalized patients with COVID-19. Patients were separated in two groups based on the difference between actual body weight (ABW) and IBW (ABW/IBW ≤ 120% and ABW/IBW &gt; 120%) to compare rates of in-hospital mortality and length of stay (LOS). A subgroup analysis of patients with ABW/IBW &gt; 120% was conducted to compare in-hospital mortality between patients with ABW/IBW 121-149%, ABW/IBW 150-199%, and ABW/IBW ≥ 200%.

Results
A total of 445 patients were included of which 71% were in the ABW/IBW &gt; 120% group. Patients in the ABW/IBW ≤ 120% group had higher median age (71 [IQR 64-80.5] vs 60 [IQR 50-70] years) compared to those in the ABW/IBW &gt; 120% group. Fewer African Americans and females were in the ABW/IBW ≤ 120% than in the ABW/IBW &gt; 120% group (65% vs 86% and 35% vs 64%, respectively). There was no difference in the rate of in-hospital mortality between patients in the ABW/IBW ≤ 120% and ABW/IBW &gt; 120% group (26% vs 20%, p=0.174). Average LOS was 10.5 days (SD 9.2) for patients in the ABW/IBW ≤ 120% and 9.3 days (SD 9.5) for those in the ABW/IBW &gt; 120% group (p=0.227). Among those in the ABW/IBW &gt; 120% group, in-hospital mortality was 14%, 23%, and 22% in patients with ABW/IBW 121-149%, ABW/IBW 150-199%, and ABW/IBW ≥ 200%, respectively (p=0.192).

Conclusion
In-hospital mortality and LOS were not significantly higher among COVID-19 patients with excess weight, defined by ABW/IBW &gt; 120%, when compared to those with ABW/IBW ≤ 120%. Further research is needed to compare COVID-19 outcomes when BMI and ABW/IBW are used to define excess weight.

Disclosures
All Authors: No reported disclosures
299. D-dimer as an ICU Admission Risk Predictor in COVID-19 Patients, A Prospective Study
Authors: Narváez - Ramírez Oriana , Morales-Cely Lina , Bustos-Moya Ingrid G , Fuentes-Barreiro Yuli Viviana , Lozada-Arciniegas Julian , Ibañez-Prada Elsa Daniela , Bravo-Castelo Laura A , Parra-Tanoux Daniela , Ramirez Paula , Gomez-Duque Salome , Gamboa-Silva Enrique , Caceres Edar , Reyes Luis F 
Published: December 2021

Abstract

Background
Since the onset of the 2019 coronavirus disease 2019 (COVID-19) pandemic, the rapid increase in community-acquired pneumonia (CAP) cases has led to an excessive rate of intensive care units (ICU) admissions, a rate varying between 5-18%, depending on the country. Consequently, the study of serum biomarkers, such as D-dimer, have been utilized to identify patient with severe disease. However, further data is needed to confirm the association between this serum concentration of D-dimer and the risk of ICU admission. Thus, the aim of this study was to determine if serum concentration of D-dimer predict the risk of ICU admission in patients with COVID-19 and CAP.

Methods
A prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years old, hospitalized for COVID-19 or CAP were included. Then, patients were stratified into ICU and non-ICU patients. Plasma samples were collected within the first 24 hours of hospital admission to quantify D-dimer using the PATHFAST system. Concentrations were compared among groups and to assess the biomarker capacity to predict ICU admission risk, ROC curves were used. Finally, a DeLong test was applied to compare their differences.

Results
A total of 240 patients diagnosed with lower respiratory tract infection were included in the study. 88 patients were COVID-19 negative (CAP) and 152 were positive. Plasma concentrations of D-dimer (µg/ml) were significantly higher in COVID-19 patients admitted to the ICU when compared with non-ICU COVID-19 admitted patients (Median [IQR]; 1.54 [0.9-3.25] Vs. 1.13 [0.69-1.69], p=0.005). The area under curve (AUC) ROC to predict ICU admission was 0.62 among COVID-19 patients. DeLong’s test p value was 0.24.
Serum D-dimer an ICU admission

Conclusion
D-dimer seems to be a promising tool to identify COVID-19 patients with disease. However, this predicting capacity was not observed in CAP patients. Further studies are needed to identify the mechanisms underling the elevation of D-dimer in COVID-19 patients.

Disclosures
All Authors: No reported disclosures
300. Long COVID in Cancer Patients: Preponderance of Symptoms in Majority of Patients Over Long Time Period
Authors: Dagher Hiba , Malek Alexandre , Chaftari Anne-Marie , Subbiah Ishwaria M , Jiang Ying , Lamie Peter , Granwehr Bruno , John Teny , Guevara Eduardo Yepez , Borjan Jovan , Reyes Cielito , Flores Mary , Khawaja Fareed , Pande Mala , Ali Norman , Rojo Raniv , Karp Daniel D , Hachem Ray Y , Raad Issam I 
Published: December 2021

Abstract

Background
An increasing number of observational studies have reported the persistence of symptoms following recovery from acute COVID-19 disease. The long-term consequences of COVID-19 are not fully understood and there is no clear consensus on the definition of post-acute sequelae of SARS-CoV-2 infection (PASC). The reported prevalence of PASC widely varies from 10% up to 87%. The purpose of this study is to assess PASC in cancer patients following acute COVID-19 recovery.

Methods
We assessed cancer patients at MD Anderson Cancer Center who were diagnosed with COVID-19 disease between March 1, 2020 and Sept 1, 2020. Using patient questionnaires and medical chart reviews we followed these patients from March 2020 till May 2021. Patient questionnaires were sent out remotely daily for 14 days after COVID-19 diagnosis then weekly for 3 months, and then monthly thereafter. Chart reviews were conducted for each patient hospital re-admission and emergency department visit. These admissions were classified as either COVID-19 related or non-related. The persistence or emergence of new COVID19-related symptoms were captured at each COVID-19 related admission.

Results
We included 312 cancer patients with a median age of 57 years (18-86). The majority of patients had solid tumors (75%). Of the 312 patients, 188 (60%) reported long COVID-19 symptoms with a median duration of 7 months and up to 14 months after COVID-19 diagnosis. The most common symptoms reported included fatigue (82%), sleep disturbances (78%), myalgias (67%) and gastrointestinal symptoms (61%), followed by headache, altered smell or taste, dyspnea (47%) and cough (46%). A higher number of females reported a persistence of symptoms compared to males (63% vs 37%; p=0.036). Cancer type, neutropenia, lymphocytopenia, and hospital admission during acute COVID-19 disease were comparable in both groups and did not seem to contribute to a higher number of long-COVID-19 patients in our study group.

Conclusion
Long-COVID occurs in 60% of cancer patients and may persist up to 14 months after acute illness. The most common symptoms are fatigue, sleep disturbance, myalgia and gastro-intestinal symptoms.

Disclosures
Fareed Khawaja, MBBS, Eurofins Viracor (Research Grant or Support)
302. Using Antiphospholipid Antibody Presence as an Additional Biomarker to Identify COVID-19 Positive Patients with High Risk for Thrombosis
Authors: Hewlett Jennifer R , Du Jing , Lee M Sung , McLeod Gavin , Archer Herbert 
Published: December 2021

Abstract

Background
Patients who are hospitalized with Coronavirus 2019 (COVID-19) are known to have increased risk for thrombosis. Several mechanisms have been proposed for increased thrombogenesis, including antiphospholipid antibodies (APLs). We sought to better understand the relationship between a commonly used marker of thrombosis, D-dimer, and antiphospholipid antibodies in relation to thrombosis in COVID-19.

Methods
This was a single-center prospective cohort study. Participants were adults admitted to the hospital with COVID-19 between March and December of 2020. Included patients required a positive COVID-19 nasopharyngeal nucleic acid amplification testing (NAAT), coagulation studies, and regular assessment of D-dimer levels. Patients who were excluded were pregnant adults, use of oral anticoagulants prior to admission, and absence of a positive COVID-19 nasopharyngeal NAAT. We tested 52 patients for antiphospholipid antibodies (APLs), including lupus anticoagulant (LA), anti-beta-2 glycoprotein antibodies (B2GP), and anti-cardiolipin antibodies (aCL). The endpoint for analysis was hospital discharge or development of a confirmed thrombosis.

Results
Twenty-nine of fifty-two patients (55.7%) with COVID-19 had non-negative APLs. Of these patients, twenty-seven (93.1%) had non-negative aCLs, the majority of which were IgM antibodies. There was a total of 7 thrombotic events in our cohort. The sensitivity of D-dimer alone was 85% and the sensitivity of APLs alone was 71%. In patients with an intermediate D-dimer level (i.e., greater than 2 milligrams per liter (mg/L) but less than 5 mg/L), the addition of non-negative APLs increased the sensitivity of D-dimer to 100%. In patients with a high D-dimer (i.e., greater than 5), the combined sensitivity of D-dimer and APLs was 60%. Out of the 7 thrombotic events in our cohort, two patients had negative APLs, however both patients had a D-dimer of greater than 5 mg/L.

Conclusion
The use of APLs can assist in risk-stratifying patients in an intermediate-risk D-dimer group to consider prophylactic anticoagulation if APLs are negative and to consider therapeutic anticoagulation if APLs are non-negative. In the high-risk group (i.e., a D-dimer greater than 5 mg/dL), a therapeutic anticoagulation approach may be more appropriate.

Disclosures
All Authors: No reported disclosures
303. Evaluation of Antimicrobial Utilization and the Incidence of Bacterial Pneumonia Co-infection in Non-ICU COVID-19 Patients at an Urban Academic Medical Center
Authors: Groome Sara , El-Beyrouty Claudine , Mitchell Meghan 
Published: December 2021

Abstract

Background
The management of COVID-19 poses diagnostic challenges with regard to concomitant bacterial pneumonia. This may result in unnecessary antibiotic therapy. This analysis described the experience of an urban academic medical center’s management of non-ICU patients diagnosed with COVID-19 during the initial months of the pandemic and assessed the rate of concomitant bacterial pneumonia in this population.

Methods
This retrospective analysis evaluated patients 18 years and older admitted to Thomas Jefferson University Hospital (TJUH) between March 1, 2020 and July 31, 2020 who had a positive COVID-19 test, were symptomatic, and received at least one dose of antibiotics. Antibiotic therapy was considered appropriate if there was objective evidence of bacterial pneumonia. Per the TJUH COVID-19 guidelines, objective diagnostic criteria assessed included the following: MRSA nasopharyngeal swab, urine Legionella pneumophilia or Streptococcus pneumoniae antigen test, respiratory pathogen panel, and sputum culture. If patients did not have evidence of bacterial pneumonia, the threshold for appropriate discontinuation of antibiotics was 48 hours.

Results
50 patients were included in the final analysis. Upon admission, 7 (14%) patients had clear chest radiographs, and 9 (25%) of the 36 patients with a procalcitonin drawn had a level ≥ 0.25, indicating a potential bacterial infection. 15 (30%) patients were known to be COVID-19 positive prior to being administered antibiotics. Additionally, 22 (44%) patients had an infectious diseases service consult during their admission. 25 (50%) patients were continued on antibiotics &gt; 48 hours. The mean duration of antibiotic therapy in the entire population was 3.4 days (82 hours). The monthly average duration of antibiotic therapy trended downward as the pandemic progressed. The most common empiric antibiotic regimen was ceftriaxone and azithromycin, received by 28 (56%) patients. Only 2 (4%) patients were diagnosed with bacterial pneumonia.

Conclusion
In a sample of 50 COVID patients the overall rate of concomitant bacterial pneumonia was 4%. Given this finding, it is vital to remain judicious with the use of antibiotics and to employ the assistance of antimicrobial stewardship colleagues when managing patients diagnosed with COVID-19.

Disclosures
Claudine El-Beyrouty, PharmD, BCPS, Astellas (Advisor or Review Panel member)Shionogi (Advisor or Review Panel member)