bluuebunny/crossref_metadata_2025_split huggingface dataset:
1029. Clinical Characteristics and Outcomes of Neuroinvasive West Nile Virus Infection in Immunocompromised and Immunocompetent Individuals
Authors: Mbonde Amir , David Gritsch , Harahsheh Ehab , Kasule Sabirah N , Vikram Holenarasipur R , Hasan Shemonti , Butterfield Richard , Grill Marie 
Published: December 2022

Abstract

Background
Despite the increasing incidence of neuroinvasive West Nile virus (NiWNV) infection in the US, the spectrum of disease characteristics and neuroimaging findings in immunosuppressed (IS) individuals are not adequately described. We aimed to compare the clinical characteristics and outcomes of NiWNV infection in IS and immunocompetent (IC) patients.

Methods
We extracted relevant data from all NiWNV patients hospitalized 7/2003-10/2021 at Mayo Clinic hospitals. Cohort was inclusive of patients from the recent historic WNV outbreak in Arizona in 2021. Chi-Square or Kruskal-Wallis and logistic regression were used to compare relevant variables and determine predictors of mortality respectively.

Results
We included 115 patients (72 IC and 43 IS), mean age 63.5 years; neurologic syndromes included meningoencephalitis (85.2%), encephalomyelitis (8.7%) and myeloradiculitis (6.1%). Presenting symptoms were malaise (72%), fever (66%), altered mentation (64%), gastrointestinal (47%) and myalgia (35.7%). MRI brain was abnormal in 62.8% (49/78), demonstrating T2/FLAIR hyperintensities in 47.4% (brainstem, thalamus, temporal lobes), leptomeningeal enhancement (16.7%) and diffusion restriction (20.5%). Altered mental status (76.7% vs 56.9%), myalgia (44.4% vs. 20.9%), myoclonus (18.6% vs. 4.2%) and thalamic MRI T2 FLAIR abnormalities (11.4% vs 0%) were more common in IS patients. Higher CSF WBC counts were observed in IC vs IS patients (P&lt; 0.05). Immunosuppressed patients were more likely to be treated with intravenous immunoglobulin (44.2% vs 8.3% p=&lt; 0.001) and/or interferon therapy (32.6% vs 6.9%, p=0.0003) and had increased odds of 90-day mortality on multivariable analysis (Adjusted Odds Ratio, AOR 2.22; 95% CI 1.065-4.627, p=0.0334). In the IS subgroup, ICU admission, mechanical ventilation, and Glasgow coma scale of &lt; 8 were associated with reduced overall survival/increased 90-day mortality (p&lt; 0.005).

Conclusion
Individuals presenting in summer/fall months with the aforementioned symptoms and/or MRI abnormalities should be evaluated for NiWNV infection. Compared to the immunocompetent, immunosuppressed patients with NiWNV are at a significantly greater mortality risk. Novel and effective antiviral therapies aimed at improving outcomes are warranted.

Disclosures
All Authors: No reported disclosures.
1038. Assessment of risk factors for coronavirus disease 2019 in healthcare workers: a nested case-control study, Bishkek, Kyrgyzstan, June 2020-May 2021
Authors: Alymkulova Venera , Nabirova Dilyara , Kemelbek kyzy Nasyat , Otorbaeva Dinara , Zhumalieva Chynar , Abamuslimova Nazgul 
Published: December 2022

Abstract

Background
Despite infection control and mitigation measures against coronavirus disease (COVID-19) in Kyrgyzstan hospitals, 3173 healthcare workers (HCW) had been diagnosed with COVID-19 by September 2020 (22 COVID-19 cases/100 HCW). We aimed to identify risks for COVID-19 among HCW exposed to COVID-19 patients in Bishkek.

Methods
We conducted a case-control study in six hospitals with high COVID-19 incidence using incidence-density sampling. Cases were HCW with positive SARS-CoV-2 PCR and negative SARS-CoV-2 IgG results June 2020-May 2021 exposed to COVID-19 patients &lt; 14 days prior to PCR positive test. Controls were randomly selected HCW working with COVID-19 patients at the same time with negative SARS-CoV-2 PCR and IgG results. HCW with COVID-19 contacts outside of the work setting were excluded. We used logistic regression to identify factors associated with COVID-19.

Results
We included 132 cases and 406 controls; 479 (89%) were women, and 256 (48%) were ages &lt; 40 years. HCW wore different types of masks; among these medical respirators (FFP3) were used by 49% of cases vs 28% of controls. Comorbidities were reported in 34% of cases vs 14% of controls; 90% of cases vs 91% of controls stayed in shift-dormitories. Odds of COVID-19 were greater for HCW who used FFP3 vs other types of respirators including N95 (adjusted odds ratio=2.9, 95% confidence interval [CI]: 1.1–3.9), shared a shiftwork dormitory with another HCW diagnosed with COVID-19 vs not (2.9, CI: 1.5–5.5), and had a comorbidity vs not (2.3, CI:1.4–5.0).

Conclusion
HCW can become infected from exposures in a variety of settings. Our findings showed an association of COVID-19 with shared dormitory, comorbidity and FFP3 use. Results are not causal, but they point to the need for increased infection control and mitigation in communal spaces, including dormitories. Additionally, hospitals should ensure quality of respirators and correct training on respirator use.

Disclosures
All Authors: No reported disclosures.
1043. Gastrointestinal manifestations of COVID-19 and their association with disease severity and death in the Dominican Republic
Authors: Roque Yori A , Luna David De , Mena Lora Alfredo J , Santana Ysalda E , Rodriguez Alicia , Ramos Johan , Suarez Mariel 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has strained healthcare systems worldwide. The disease spectrum of COVID-19 is wide, ranging from asymptomatic to respiratory distress and critical illness. A wide range of associated symptoms have been described, including gastrointestinal manifestations. Defining clinical characteristics that can help identify and triage cases towards COVID-19 treatment pathways early in low-and-middle income countries is of priority.

Methods
Single center retrospective review of cases admitted to a tertiary center with COVID-19 and gastrointestinal symptoms between March 2020 and November 2021. Inclusion criteria was defined as molecular diagnosis of SARS-CoV-2 with symptomatic gastrointestinal disease. Demographic and clinical characteristics were tabulated, and statistics of association and mortality were performed.

Results
A total of 95 cases admitted with SARS-COV2 pneumonia met the inclusion criteria. Cases were predominantly male (65.3%). Age distribution was 48.4% &gt;61 years, followed by 51-60 (17.9%), 31-40 (15.8%) and 41-50 years (13.7%). The gastrointestinal findings associated with COVID-19 were transaminitis (48.4%), Nausea and diarrhea (29.5%), anorexia (28.4%) and abdominal pain (13.7%). Patients with abdominal pain had 46% with respiratory decompensation and 23% critical illness (Figure 1) compared to 39% and 17.9% in patients with diarrhea. Transaminitis was associated with highest association with progression to critical illness (30%) and death (55%).
Respiratory decompensation, critical illness and death by gastrointestinal findings

Conclusion
Gastrointestinal symptoms in COVID-19 have a wide range of clinical presentation and can be associated with severity of illness and decompensation. Transaminitis had the highest association with severe disease and death. These associations, if confirmed in larger studies, can help guide triage and prognostication in resource limited settings. Further studies are needed to validate these findings.

Disclosures
All Authors: No reported disclosures.
1059. The Experiences of Healthcare Workers during the Second Wave of COVID-19 Crisis in the South Indian State of Kerala
Authors: Issac Aleena , Kochuparambil Jose J 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has presented an unprecedented crisis and challenge for healthcare professionals globally. This study aims to explore the challenges faced by healthcare professionals during the second wave of COVID-19 in the south Indian state of Kerala.

Methods
An online cross-sectional survey was designed and disseminated through social media and professional organizations to collect the relevant information from the healthcare workers. The questionnaire composed of demographics, and of questions about the employment, work role, and access to personal protective equipment.

Results
Of the 423 responses received, 268 (63.3%) were nurses, followed by pharmacists (7.4%), doctors (14.6%), and allied healthcare professionals (4.4%). Nearly half i.e., 198 (46.8%) of the total responders, expressed concern about work-related risks to themselves and their families. The primary concerns expressed by the participants include higher workload, psychological distress, shortage of quality personal protective equipment (PPE), lack of incentives, and social stigmatization. Just over a third of respondents (35%) perceived that care provided in their workplace was significantly worse than before the pandemic.

Conclusion
The study offers lessons for hospitals in middle-income and low-income countries to ensure a safe working environment for front-line healthcare workers in their fight against COVID-19. This implies the need to support with adequate safety kits, protocols, and support for both physical and mental health of the healthcare professionals.

Disclosures
All Authors: No reported disclosures.
1061. Evaluation of Measures for the Assessment of Covid-19 Signs and Symptoms in Children and Adolescents
Authors: Romano Carla , Mayorga Margaret , Ruiz-Guiñazu Javier , Trudel Géralyn C , Fehnel Sheri , McQuarrie Kelly , Chan Eric K H , Katz Eva G 
Published: December 2022

Abstract

Background
The Symptoms of Infection with Coronavirus-19 (SIC) is a 30-item patient-reported outcome (PRO) measure developed to assess the presence and severity of COVID-19 signs and symptoms in adults. To further facilitate the evaluation of new vaccines and treatments in development, similar tools are needed for use within pediatric populations. The objectives of this study were to support adolescent self-completion and create an adaptation of the measure for caregiver assessment of signs and symptoms in children aged &lt; 12 years (henceforth, the Pediatric SIC [PedSIC]).

Methods
After developing draft versions of the PedSIC and reference materials with definitions to facilitate accurate completion of both measures, iterative rounds of cognitive debriefing interviews were conducted from November 2020 through January 2021 to evaluate understanding of the SIC (in adolescents aged 12-17), and inform refinement of the PedSIC for caregivers of children aged &lt; 12. Recruitment quotas were employed to support sample diversity.

Results
Nine adolescents (mean [SD, range] age, 14 [1.76, 12-17] years, 56% female, 78% white; round 1, n=6; round 2, n=3) and 17 caregivers (mean [SD, range] age, 34 [6.28, 26-41] years, 59% female, 65% white; round 1, n=9; round 2, n=8) completed interviews. All adolescents understood and completed the adult version of the SIC without instrument modification. Ease and accuracy of self-completion was improved through the use of reference materials. Caregiver feedback resulted in modification of the PedSIC to include two sections: observable signs (ages &lt; 12), and symptoms assessed with input from children (ages ≥ 5-&lt; 12). Reference materials provided standardization of item intent.

Conclusion
Results support using the SIC, PedSIC, and their associated reference materials to assess the presence and severity of COVID-19 signs/symptoms in adolescents and children aged &lt; 12 years, respectively, who participate in vaccine and treatment clinical trials. Supported by Janssen Vaccines & Prevention B.V.

Disclosures
Carla Romano, MS, Janssen Pharmaceuticals: Grant/Research Support Margaret Mayorga, MS , MPH, Janssen Pharmaceuticals: Grant/Research Support Javier Ruiz-Guiñazu, MD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Géralyn C. Trudel, PhD, Janssen Pharmaceuticals: Stocks/Bonds Sheri Fehnel, PhD, Janssen Pharmaceuticals: Grant/Research Support Kelly McQuarrie, BSN, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Eric K. H. Chan, PhD, Janssen Global Services, LLC: Employee|Janssen Pharmaceuticals: Stocks/Bonds Eva G. Katz, PhD, MPH, RD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds.
1067. Predicting next 7-day Discharges of Hospitalized COVID-19 Patients Using Ensemble Learning
Authors: Ye Xiangyang , Zhang Mingyuan , Samore Matthew H , Shen Jincheng , Bohman Julia , zhang Yue , Humpherys Jeffrey 
Published: December 2022

Abstract

Background
COVID-19 pandemic, especially during resurgences of cases in hard-hit areas, led to significant shortage of hospital beds. Such shortages may be alleviated through timely and effective forecasting of hospital discharges. The objective of this study is to predict next 7-day discharges of hospitalized COVID-19 patients using daily-based electronic health records (EHR) data.

Methods
Using EHR data of hospitalized COVID-19 patients from 03/2020-08/2021, we employed ensemble learning to predict next 7-day discharges of individual patients. We used both baseline and daily inpatient features for model training, validation, and test. Baseline features include demographic and clinical characteristics, and comorbidities. The daily inpatient features were vital signs, laboratory tests, medications administered, acute physiological scores, use of ventilator, and use of intensive care unit.
1832 hospitalized patients were identified (12,397 hospital days). Samples were randomly split at patient level (7:2:1) into training set (N=1,283 patients with 8,704 hospital days), validation set (N=366 patients with 2,524 days), and test/holdout set (patient N=183, and 1,169 days). Prediction models were trained on the training set and the validation set. We conducted the model training separately on the samples of admission day and the samples of days after admission day.
The predictions were based on the ensemble learning from decision tree, XGBoost, logistic regression, and multilayer perceptron, long short-term memory (LSTM), bi-directional LSTM, and convolutional neural network.
The combination of ensemble learning on the test/holdout set was used for final next 7-day predictions based on ‘hard’ voting (by majority). Where there was a tie, we used ‘soft’ voting (sum of probabilities) to break the tie. Figure 1.Data Processing PipelineFigure 2.Ensemble Model Architecture

Results
The overall average hospital length of stay was 8.7 (SD=10.5) days. The ensemble learning accuracies for admission-day samples and after-admission-day samples were 0.781 and 0.793, and the F1-scores for were 0.761 and 0.789, respectively.

Conclusion
EHR data of hospitalized COVID-19 patients can be used to predict next 7-day hospital discharges. Additional inpatient features and more advanced machine learning techniques are needed for prediction accuracy improvement.

Disclosures
All Authors: No reported disclosures.
1075. The MET Project: Distinguishing Multisystem Inflammatory Syndrome in Children from Typhus Using Artificial Intelligence
Authors: Chun Angela , Bautista Abraham , Weatherly Chad , Osuna Isabella , Nasto Kristiana , Munoz Flor M , Schutze Gordon , Devaraj Sridevi , Muscal Eyal , Tejtel Kristen Sexson , Vogel Tiphanie , Kakadiaris Ioannis 
Published: December 2022

Abstract

Background
Multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection shares features with other inflammatory states, notably Kawasaki Disease. The rickettsial infection murine typhus is also in the differential for MIS-C in endemic areas. As the therapeutic approaches differ, it is essential to distinguish these disorders soon after presentation, well before confirmatory serologic testing results. Our objective was to develop an algorithm to accurately predict MIS-C versus typhus.

Methods
Retrospective review extracted demographic, clinical, and laboratory features available within 6 hours of presentation for 133 MIS-C and 87 typhus patients. 33 features were broken into 44 inputs and passed through an attention module to compute importance. Inputs were then entered into machine learning algorithms as MIS-C or typhus. Patients were divided into training and test cohorts respecting proportions in the dataset. An equation was built to calculate the “MET” (MIS-C versus endemic typhus) score.

Results
MIS-C patients were younger (8.4 v 11.2 years, p&lt; 0.0001) and the majority (71%) presented on day 4-6 of fever; most typhus patients (84%) presented with ≥6 days (mean 4.9 v 7.3 days, p&lt; 0.0001). Typhus patients were more likely to have rash (86% v 51%, p&lt; 0.0001) and MIS-C patients red eyes (71% v 36%, p&lt; 0.0001), other features were similar. MIS-C patients had higher C-reactive protein levels (17.7 v 9.8 mg/dL), procalcitonin (14.0 v 0.48 ng/mL), fibrinogen (558 v 394 mg/dL) and neutrophil-to-lymphocyte ratio (12 v 3.5), all p&lt; 0.0001, other parameters were similar. MIS-C patients were also more likely to have elevated troponin (0.48 v 0.01 ng/mL, p&lt; 0.0001) and require intensive care (66% v 6%, p&lt; 0.0001). A long short term memory network outperformed 6 other models (99% accuracy using all 33 elements). The MET score predicted MIS-C versus typhus with 90% accuracy using only 10 features (sensitivity 90%, specificity 90%).

Conclusion
The clinical and laboratory similarities between typhus and MIS-C present challenges, but they can be reliably distinguished using artificial intelligence with as little as 10 features. Our ongoing interprofessional collaboration aims to make the MET score readily available to clinicians for use in patient encounters.

Disclosures
Flor M. Munoz, MD, MSc, Gilead: Grant/Research Support|Moderna: DSMB|Pfizer: DSMB Tiphanie Vogel, MD, PhD, Moderna: Advisor/Consultant|Novartis: Advisor/Consultant|Pfizer: Advisor/Consultant.
1081. Clinical Characteristics and Predictive Factors for the Development of Hypoxemia in SARS-CoV-2 Infected Women during Pregnancy
Authors: Kim Young Keun , Kim Eui Hyeok , Choi Hee Kyoung 
Published: December 2022

Abstract

Background
There is limited information describing the clinical characteristics and prognosis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and the predictive factors for development of hypoxemia were investigated in SARS-Cov-2 infected women during pregnancy.

Methods
From August 2020 to February 2022, 410 pregnant women were infected with SARS-CoV-2 who admitted to two hospitals, the National Health Insurance Service Ilsan Hospital in Goyang or the Wonju Severance Christian Hospital in Wonju, Korea. The clinical characteristics and prognosis were compared between pregnant women who required oxygen or not during hospitalization.

Results
The mean age of the patients was 33.3 years. The hospitalized pregnant women were categorized into two groups such as no oxygen group and oxygen group. Of 410 patients, 100 (24.4%) required oxygen therapy (81 low-flow, 15 high-flow oxygen and 4 mechanical ventilation including 2 extracorporeal membrane oxygenation). In oxygen group, the symptoms such as fever [163 (52.6%) vs 81 (81.0%), p&lt; 0.001] and cough [172 (56.4%) vs 73 (73.0%), p=0.003] were frequently observed. In oxygen group, the frequency of whom were not vaccinated was more [264 (85.2%) vs 98 (98.0%), p=0.003], however, that of the SARS-CoV-2 omicron variant infected patients was lower [98 (31.6%) vs 18 (18.0%), p=0.009]. The risk for the development of hypoxemic respiratory difficulty was increased if the SARS-CoV-2 infection during third trimester (OR 5.083, 95% CI 1.095-23.593, p=0.038) and elevated C-reactive protein (≥1.0 mg/dL) at admission (OR 5.878, 95% CI 3.099-11.146, p&lt; 0.001) in the SARS-CoV-2 infected pregnant women. However, the risk was decreased with vaccination (OR 0.186, 95% CI 0.041-0.838, p=0.028) and omicron variant infection (OR 0.498, 95% CI 0.258-0.961, p=0.038).

Conclusion
A quarter of SARS-CoV-2 infected women during pregnancy developed hypoxemic respiratory difficulty. The SARS-CoV-2 infection during third trimester and no vaccination increased the risk for the development of hypoxemic respiratory difficulty in pregnant women.

Disclosures
All Authors: No reported disclosures.
1092. Management of Transplant Graft and Role of Immunosuppression in the Outcome of Covid-19 Infection in Solid Organ Transplant Recipients
Authors: Sabunwala Suhel A , Cornelius Tuhina , Aslam Sadaf , Alrabaa Sally , Kumar Ambuj 
Published: December 2022

Abstract

Background
COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Little is known how the immunosuppressive medications impact the mortality rate in Solid Organ Transplant (SOT) recipients. There is also minimal data regarding the incidence of transplanted graft failure or rejection that could be attributed to the COVID-19 infection itself or its complications and management. Our study aims to investigate the management of COVID-19 infection, outcome of the infection, transplant failure and rejection rates in SOT recipients.

Methods
We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. Table 1Characteristics of the Population in the two groups
Table 2 Type of Transplants in the two groups

Results
A total of 135 patients met the inclusion criteria. After the diagnosis of COVID -19 infection, 31% recipients had decrease in the dose of immunosuppressive medications (change group) and 69% had no changes in the dose (no change group). Out of the 73 Kidney Transplant recipients 33% were in the change group compared to 14% of liver, 25% of heart and 27% of lung transplant recipients. Of the total 42 recipients in the change group, 28.6% required Intensive Care Unit (ICU) level care significantly higher compared to 7.5% in the no change group (p-value &lt; 0.005). Mechanical ventilation was required in 14.3% of the patients in the change group and 6.5% in the no change group (p-value &lt; 0.5). Out of the total, 85.7% patients in the change group survived compared to 94.6% in the no change group (p-value &lt; 0.1). Overall, the transplant rejection rate was higher in the change group compared to the no change group (p-value &lt; 0.5). Table 3Comparison of the Outcomes in the two groups
Figure 1 Kaplan – Meier Curve for survival
Figure 2 Kaplan – Meier Curve with Cox Regression for survival

Conclusion
Our study showed a significantly higher ICU admission rate and mortality in SOT recipients who had their immune suppression reduced at the time of COVID-19 diagnosis. The same group also had a higher risk of rejection of transplanted graft. More studies with larger sample size needs to be done to further understand the management of immunosuppressive drugs in the SOT recipients with COIVD-19 infection.

Disclosures
All Authors: No reported disclosures.