bluuebunny/crossref_metadata_2025_split huggingface dataset:
391. Patients Hospitalized for Acute Coronary Syndrome with Concomitant COVID-19 have Worse Clinical Outcomes
Authors: Sharath Deepali Boothankad , Khokhlov Leonid , Thapa Usha , Aboelnasr Amr , Pereira Leanne , Improvola Jose , Patel Anar 
Published: November 2023

Abstract

Background
Since the onset of the global pandemic caused by COVID-19, there has been a multitude of studies that demonstrate the association between COVID-19 infection and adverse clinical outcomes. To date, there is a paucity of evidence showing how COVID-19 affects morbidity and mortality among patients admitted with cardiac events in large heterogeneous populations. We aimed to investigate the clinical outcomes in patients hospitalized with acute coronary syndrome (ACS) with co-existing COVID-19 infection using the National Inpatient Sample.

Methods
We queried the Nationwide Inpatient Sample (NIS) database for the year 2020 for adult patients who were hospitalized with ACS with a concomitant diagnosis of COVID-19. The primary outcome was inpatient mortality. The secondary outcomes measured were cardiogenic shock, cardiac arrest, severe sepsis, invasive mechanical ventilation, length of stay (LOS), and total hospital cost. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. The p-value &lt; 0.05 was significant.

Results
There were 582,424 hospitalizations with ACS, of which 6,074 (1.1%) had COVID-19 infection. Patient characteristics are shown in Table 1. Patients with comorbid COVID-19 infection had significantly higher mortality and worse clinical outcomes (Table 2 and Figure 1).

Conclusion
Patients hospitalized with ACS and concomitant COVID-19 infection had a significantly increased risk for adverse clinical outcomes and higher resource utilization. They were younger, female, with more prevalent STEMI, acute myocarditis, PE, DM, AKI, and stroke. COVID-19 infection in the setting of ACS was associated with higher mortality and poor outcomes including cardiogenic shock and cardiac arrest as well as respiratory failure requiring mechanical ventilation. Further research to elucidate the correlation between COVID-19 infection and cardiac events is needed.

Disclosures
All Authors: No reported disclosures
393. Comparison of COVID-19 Associated Complications in Children during the First and Second Omicron Waves in Taiwan
Authors: Chen Jiun-An , Lai Huan-Cheng , Hsu Yu-Lung , Lin Hsiao-Chuan , Lin Chien-Heng , Wei Hsiu-Mei , Low Yan-Yi , Chiu Yu-Ting , Hwang Kao-Pin 
Published: November 2023

Abstract

Background
In early 2022, the Omicron variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Taiwan and caused two waves of COVID-19 outbreaks throughout the year. The emergence of the Omicron variant in Taiwan has led to an increased incidence of COVID-19 associated complications in children. This study aims to compare COVID-19 associated complications in children admitted during the peak of the first wave (late May, 2022, BA.2 predominance) and the second wave (early October, 2022, BA.5 predominance) of the Omicron-driven outbreaks in Taiwan.

Methods
This retrospective, single-center, observational study was conducted at China Medical University Children's Hospital (CMUCH), a tertiary hospital in central Taiwan. The study population included children under 18 years of age who were admitted with a confirmed SARS-CoV-2 infection between May 1 and October 31, 2022. Medical records of these children were collected. The study period was divided into two periods based on the peak of the outbreak: May 1 to June 30, 2022 and September 1 to October 31, 2022. During these periods, the COVID-19 associated complications of hospitalized children were compared.

Results
A total of 228 pediatric patients with SARS-CoV-2 infection were included, with 145 (63.6%) from the first wave and 83 (36.4%) from the second wave. The median age (IQR) was similar between the two waves [18 (6-43) months vs. 16 (5-62) months, p = 0.796]. The proportion of patients with underlying comorbidities was similar between the two waves (7.6% vs. 12.1%, p = 0.262). Patients in the second wave had a lower ICU admission rate (16.6% vs. 9.6%, p = 0.148). The proportion of patients with bacterial coinfection was higher in the second wave (15.9% vs. 24.1%, p = 0.126). The proportion of patients with febrile convulsion (13.8% vs. 16.9%, p = 0.531), myositis (5.5% vs. 2.4%, p = 0.334), and croup (11.0% vs. 16.9%, p = 0.148) were similar between the two waves.

Conclusion
There was no significant difference in the frequency of admission for COVID-19 associated complications between the BA.2 and BA.5 predominance periods. However, it was observed that children admitted during the second wave had a lower rate of ICU admission and a higher rate of bacterial coinfection.

Disclosures
All Authors: No reported disclosures
404. Impact of cross-coronavirus humoral immunity in post-acute sequelae of COVID-19 in systemic autoimmune rheumatic diseases patients
Authors: Herman Jonathan , Atyeo Caroline , Zur Yonatan , Cook Claire , Patel Naomi , Vanni Kathleen , Kowalski Emily , Qian Grace , Srivatsan Shruthi , Shadick Nancy , Rao Deepak , Kellman Benjamin , Mann Colin , Lauffenburger Douglas A , Wallace Zachary , Sparks Jeffrey , Alter Galit 
Published: November 2023

Abstract

Background
Beyond the acute illness caused by SARS-CoV-2, about one-fifth of infections unpredictably result in long-term persistence of symptoms despite the apparent clearance of infection. Insights into the mechanisms that underlie post-acute sequelae of COVID-19 (PASC) will be critical for the prevention and clinical management of long-term complications of COVID-19. Several hypotheses have been proposed that may account for the development of PASC, including persistence of virus or the dysregulation of immunity. Among the immunological changes noted in PASC, alterations in humoral immunity have been observed in some patient subsets.

Methods
To begin to determine whether SARS-CoV-2 or other pathogen specific humoral immune responses evolve uniquely in PASC, we performed comprehensive antibody profiling against SARS-CoV-2, a panel of endemic pathogens, and a panel of routine vaccine antigens using Systems Serology in two independent cohorts of patients with pre-existing systemic autoimmune rheumatic disease (SARD) who either developed or did not develop PASC.

Results
A distinct qualitative shift observed in Fcγ receptor binding was observed in individuals with PASC. Specifically, individuals with PASC harbored weaker Fcγ receptor binding anti-SARS-CoV-2 antibodies and a significantly stronger Fcγ receptor binding antibody response against endemic Coronavirus OC43. Individuals with PASC, further, generated more avid IgM responses and developed an OC43 S2-specific antibody response with stronger Fcγ-receptor binding, linked to cross reactivity across SARS-CoV-2 and common coronaviruses.

Conclusion
These findings from two independent cohorts implicate previous common Coronavirus imprinting as a marker for the development of PASC in individuals with SARDs.

Disclosures
Douglas A. Lauffenburger, PhD, Sanofi: Board Member|Sanofi: Honoraria|Sanofi: Honoraria Zachary Wallace, MD, MSc, Bristol-Myers Squibb: Grant/Research Support|Horizon: Advisor/Consultant|MedPace: Advisor/Consultant|Principia/Sanofi: Grant/Research Support|Sanofi: Advisor/Consultant|Shionogi: Advisor/Consultant|Viela Bio: Advisor/Consultant|Zenas BioPharma: Advisor/Consultant Jeffrey Sparks, MD, AbbVie: Advisor/Consultant|Amgen: Advisor/Consultant|Boehringer Ingelheim: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|Bristol Myers Squibb: Grant/Research Support|Gilead: Advisor/Consultant|Inova Diagnostics: Advisor/Consultant|Janssen: Advisor/Consultant|Optum: Advisor/Consultant|Pfizer: Advisor/Consultant Galit Alter, PhD, Leyden Labs: Ownership Interest|Moderna Therapeutics: Employee|Seromyx Systems: Ownership Interest
422. Impact of Respiratory Virus Co-Infection in Pediatric COVID-19
Authors: Mareboina Manvita , Bakhl Katrina , Fisher James , Jassal Simrat , Ericson Jessica E , Gavigan Patrick 
Published: November 2023

Abstract

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a viral infection that emerged in December 2019, leading to the COVID-19 pandemic. Despite significant research, there are still significant knowledge gaps, particularly with regards to COVID-19 in children and the impact of respiratory virus co-infection.

Methods
A retrospective chart review was conducted at Penn State Children’s Hospital including children who tested positive for SARS-CoV-2 by multiplex polymerase chain reaction from nasopharyngeal swabs between March 2020 and June 2022. Demographics, symptoms, clinical features, and treatments of patients who tested positive for SARS-CoV-2 alone were compared to those who had co-detection of another respiratory virus.

Results
A total of 464 episodes of SARS-CoV-2 detection were included, with 123 (26.5%) involving of co-detection of another respiratory virus. Patients with viral co-detection more commonly presented with upper respiratory tract infection (URI) symptoms and, cough, and were more likely to require any supplemental oxygen therapy. However, there were no differences in rates of mechanical ventilation, intensive care unit admission, mortality, or receipt of SARS-CoV-2 specific antivirals [Table 1]. Co-detections occurred throughout the study period [Figure 1]. Of the 123 episodes of viral co-detection, 99 (80.5%) had one other virus detected. The most commonly co-detected virus was rhino/enterovirus, which was found in 100 (81.3%) of the co-detection episodes.
Outcomes of SARS-CoV-2 and Viral Co-Detection
Numbers of SARS-CoV-2 and Viral Co-Detections

Conclusion
This study provides insight into the impact of respiratory virus co-infections in pediatric COVID-19. Co-infection was more often associated with URI symptoms, but otherwise appeared clinically similar to SARS-CoV-2 mono-detection. Additionally, while children with co-infection more often needed any supplemental oxygen, there were no differences with regard to other markers of clinical severity. As SARS-CoV-2 continues to circulate with other respiratory viruses, ongoing studies will be needed to determine if alternative treatment strategies are needed.

Disclosures
Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant
442. Unveiling Factors Associated with Mortality in Mucormycosis Patients: Insights from Second and Third Waves of COVID-19 Pandemic in India
Authors: Sharma Vagisha , Kriplani Kushal , Tuli Isha Preet 
Published: November 2023

Abstract

Background
Mucormycosis is one of the most aggressive opportunistic fungal infections. Though conventionally limited to the demographics of immunocompromised and those on the diabetes spectrum. It has recently propelled to the frontline in investigations of COVID-19 complications. For patients present in varied stages and severity of Mucormycosis, it's crucial to discuss the presenting factors that impact mortality in order to provide more intensive care and treatment from the beginning to those more at risk of death.

Methods
All patients presenting to a tertiary care hospital in New Delhi, India with clinicopathological confirmed Mucormycosis were enrolled in the study. Detailed history and physical examination were performed, and a questionnaire of patient demographic details and comorbidities was filled out.

Results
There were 75 patients who met the inclusion criteria and were assessed after obtaining informed consent. Of these 75, 64 patients survived. The most common comorbidity in the study population was Diabetes spectrum(89.33%), followed by antecedent COVID-19 infection(64%) and hypertension(12%). Despite a high prevalence, none of these was significantly associated with mortality. The only comorbidity associated with mortality was Coronary Artery Disease(p-value&lt; 0.05). The symptomatology at presentation was also assessed. Most commonly reported symptoms at presentation were Orbital/facial edema(45.33%), nasal discharge(29.33%), nasal block(29.33%) and diminution of vision(26.66%). The presence of proptosis at presentation in the patient was found to be significantly associated with a mortality outcome(p-value&lt; .0.05). The glycemic control at presentation was also measured and compared between the survivors and non-survivors, however, no significant association was found.
Mucormycosis patient with Proptosis

Conclusion
Mucormycosis patients with presenting symptoms of proptosis should be prognosticated early and managed in the intensive care unit from the beginning due to the increased risk of mortality. Also, patients with coronary artery disease should be similarly given special attention and care due to the association with mortality. Other factors like antecedent COVID-19, diabetes, hypertension, tobacco and alcohol use and the extent of hyperglycemia do not impact patient outcome

Disclosures
All Authors: No reported disclosures
445. An Ongoing Battle from a Forgotten War: Long COVID in Mississippi, October 2021 - September 2022
Authors: Staneva Manuela , Dobbs Thomas 
Published: November 2023

Abstract

Background
Due to the lack of a well-established definition, long COVID—unlike its acute counterpart—has been evading statewide surveillance systems. In October 2021, however, the adoption of an ICD-10-CM code for long COVID, created the prerequisite needed for such retrospective state-level surveillance of long COVID. To seize this opportunity and establish baseline information, we used Mississippi’s hospital discharge data to examine hospitalizations associated with long COVID.

Methods
Hospital discharge data are a population-level data source that captures data from all non-federal hospitals in the state and contains information on diagnoses, procedures, and resource utilization. In this cross-sectional study, we utilized the latest available data that incorporates long COVID diagnoses (10/01/2021-09/30/2022). The study included only adult Mississippi residents (≥ 18 years) and the unit of analysis was individual patients. We performed descriptive and inferential (chi-squared tests) statistical analyses.

Results
Among the 1,213 patients hospitalized with post-COVID-19 complications, the majority were white (69.7%), elderly (average age = 66), rural residents (60.3%), and females (53.8%). The most common comorbidities were hypertension (73.6%), diabetes (39.4%), chronic pulmonary disease (28.4%), and congestive heart failure (28.4%). Among long haulers, 22.1% were admitted to ICU, 13.6% needed respiratory support, and 8.5% died in the hospital. The in-hospital mortality proportion among long haulers did not differ by race, residence, or insurance status. In-hospital deaths were more likely to occur, however, among patients ≥ 65 years (68.7% vs. 56.3%, p &lt; .01). Compared to survivors, deceased patients with long COVID had a slightly higher average number of comorbid conditions (2.8 vs. 2.2). For patients with long COVID, the mean length of stay was 11 days and the mean hospital charges were $109,739.

Conclusion
In our study, we identified that hypertension was highly prevalent among long haulers. The severity of illness as measured by ICU care, in-hospital mortality, length of stay, and hospital charges was also high among patients with long COVID. These findings underscore the importance of long-term surveillance of COVID-19 complications.

Disclosures
All Authors: No reported disclosures
454. How Useful is SARS-CoV-2 Antigen Detection in Individuals Admitted to the Hospital With no Respiratory Symptoms?
Authors: Prince Monique A , Aiman Wajeeha , Owolabi Modupeoluwa , Muhanna Alaa , Martin Evans , Hessell Joe , Slim Jihad 
Published: November 2023

Abstract

Background
Clinical findings and laboratory data have been crucial for timely diagnosis and transmission reduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus disease (COVID-19). We have observed an increase in incongruent same day antigen and reverse transcription polymerase chain reaction (RT-PCR) results in all patients presenting to the hospital. This study aims to correlate SARS-CoV-2 test results with the presence of respiratory symptoms and to find the significance of performing the antigen screening test.

Methods
We conducted a single-center retrospective study, using electronic medical records of adults over 18 years of age who were tested routinely for COVID-19 with the Lyra SARS-CoV-2 RT-PCR Assay and the QuickVue SARS Antigen Test on presentation for any complaint from February 2022 to January 2023. We included all the patients who had a positive rapid antigen or RT-PCR test for COVID-19 admitted to the medical, or psychiatry unit. Patients admitted to the intensive care unit (ICU) or cardiac care unit (CCU) or those who returned a negative antigen and RT-PCR test were excluded from our study. We used the R software program to find the relative risk of pneumonia in these patients and performed pooled analysis with the random effects model.

Results
Overall, 178 adults were identified with at least one test positive and were divided into three groups. In patients with positive antigen and negative RT-PCR test 20.8% had respiratory symptoms while 79.1% did not. In patients with negative antigen and positive RT-PCR, 32% had respiratory symptoms and 68% did not. In the group that returned positive for both antigen and RT-PCR tests, only 40% had respiratory symptoms and 60 % did not. Fig. 1 demonstrates the relative risk (RR) of pneumonia (PNA) in all three groups which is less than 1.Figure 1Demonstrates the relative risk of pneumonia in patients who returned a positive COVID-19 testAg-Antigen PCR- Polymerase Chain Reaction Sx-Presence of Respiratory Symptoms Asx- Abscence of Respiratory Symptoms

Conclusion
The relative risk of COVID-19 pneumonia is low in all three groups including those with a positive RT-PCR test, therefore COVID-19 antigen tests are not necessary until patients have severe respiratory symptoms or confirmed exposure. There is an ongoing need for clear guidelines for reliable detection of infection in hospitalized patients.

Disclosures
Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
461. COVID-19 Hospitalizations among Vaccinated and Unvaccinated Immunocompromised Children, 23 States, December 2022 – April 2023
Authors: Campbell Angela P , Zambrano Laura D , Newhams Margaret M , Wu Michael J , Simeone Regina , Orzel Amber , Halasa Natasha B , Fleming-Dutra Katherine E , Randolph Adrienne G 
Published: November 2023

Abstract

Background
Immunocompromised (IC) persons are at increased risk of severe COVID-19 and can have a suboptimal immune response to a primary 2-dose COVID-19 vaccine series; thus, vaccination recommendations for IC persons include additional COVID-19 vaccine doses. We describe outcomes and vaccination status among US IC children hospitalized with laboratory-confirmed COVID-19 during a period of SARS-CoV-2 Omicron circulation.

Methods
Children with and without an IC condition hospitalized for COVID-19 were enrolled as case-patients into a vaccine effectiveness investigation as part of the Overcoming COVID-19 network of 31 hospitals across 23 states. Data on IC conditions abstracted from the medical record included the presence of an “active or prior oncologic disorder” or a “non-oncologic immunosuppressive disorder.” Results for IC case-patients with COVID-19 enrolled from 12/18/2022–4/3/2023 (Omicron period) were analyzed by age group and vaccination status.

Results
Of 239 IC case-patients, 127 (53%) had an oncologic disorder and 112 (47%) non-oncologic; 120 (50%) had &gt; 1 additional underlying medical condition (Table 1). Thirty (13%) IC case-patients were aged 8 months–4 years, 115 (48%) 5–11 years, and 94 (39%) 12–18 years. Life-threatening illness or death occurred in 1 (3%) IC case-patient aged 8 months–4 years, 8 (7%) aged 5–11 years , and 13 (14%) aged 12-18 years (including 2 deaths). Among 209 IC case-patients aged 5–18 years, 26 (23%) of those with oncologic and 27 (28%) with non-oncologic disorders had received 2 doses of a monovalent primary COVID-19 vaccine series; 6 (5%) and 14 (14%) had received &gt; 3 doses, respectively (p=.03; Table 2). A significantly higher proportion of IC case-patients (n=73/209; 35%) had received at least 2 COVID-19 vaccine doses compared with non-IC patients (n=284/1021; 28%; p=0.04; Table 2).

Conclusion
During Omicron, immunocompromised children hospitalized for COVID-19 were more frequently aged &gt; 5 years and &gt; 99% survived. Vaccination coverage was low among all case-patients. A higher proportion of IC children who received &gt;2 vaccine doses were among those case-patients hospitalized for COVID-19 compared with non-IC children. Additional doses to improve protection in IC children are recommended.

Disclosures
Regina Simeone, PhD, Pfizer: Stocks/Bonds Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support
472. The impact of sarcopenia on unfavorable outcomes in lung transplant patients with COVID-19
Authors: Han Min , Lee Jung Ah , Jeong Su Jin , Kim Jung Ho , Ahn Jin Young , Choi Jun Yong , Ku Nam Su , Yeom Joon-sup 
Published: November 2023

Abstract

Background
Coronavirus disease 2019 (COVID-19) in immunocompromised patients has become an important issue owing to the high transmissibility of the Omicron variant of severe acute respiratory syndrome coronavirus 2. Sarcopenia in lung transplant patients is associated with a poor prognosis, and lung transplant patients are more vulnerable to COVID-19. However, the effect of sarcopenia on lung transplant patients with COVID-19 remains unclear. This study aimed to investigate the effect of sarcopenia on lung transplant patients with COVID-19 and the risk factors for sarcopenia following COVID-19 in lung transplant patients.

Methods
We performed a retrospective cohort study of lung transplant patients with COVID-19. Sarcopenia was defined as being within the lower 25% of the thoracic muscle index based on cross-sectional area measurements of the pectoralis, paraspinal, serratus, and latissimus muscles at the fourth vertebral using computed tomography (CT). Multivariable logistic analysis was conducted to identify the factors associated with sarcopenia in lung transplant patients following COVID-19.

Results
Of the 445 patients receiving follow-up care after lung transplantation, 81 were diagnosed with COVID-19. The median age was 59.0 (interquartile range 48.0–64.0) years, and 55 (67.9%) patients were male. Among patients within three years of lung transplantation, the sarcopenic group had a significantly higher rate of hospitalization (100.0% and 46.9%, P = 0.006) and oxygen demand (63.6% and 18.8%, P = 0.016) than the non-sarcopenic group. Multivariable analysis showed that body mass index before COVID-19 [odds ratio (OR), 0.77; confidence interval (CI), 0.58–0.96; P = 0.040] and serum albumin (OR, 0.12; CI, 0.01–0.79; P = 0.047) were associated with sarcopenia after COVID-19.Table 1.Comparing characteristics of lung transplant patients according to pre-COVID-19 sarcopenia statusTable 2.Comparing muscle index and outcome of COVID-19 in lung transplant patients according to pre-COVID-19 sarcopenia status

Conclusion
Sarcopenia was associated with poor outcomes of COVID-19 in patients within three years of lung transplantation. Low albumin levels and body mass index were identified as risk factors for post-COVID-19 sarcopenia. Assessments and interventions for sarcopenia are needed to improve the prognosis of lung transplant patients with COVID-19.

Disclosures
All Authors: No reported disclosures