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Introduction: Coronavirus disease 2019 (COVID-19) has been associated with high in-hospital mortality. Since the implementation of guidelines and improvement in the quality of cardiopulmonary resuscitation (CPR), the survival rate for non-COVID-19 patients has improved. There is, however, scarce data regarding in-hospital cardiac arrest outcomes in COVID-19 patients. This study aimed to investigate cardiac arrest outcomes in patients hospitalized for COVID-19. Method(s): Retrospective study of the data of 994 adult patients admitted to a single-center high acuity critical care COVID-19 unit between March 2020 and February 2022 with COVID-19 diagnosis. Patients who underwent CPR were identified. Resuscitation registers and demographic information were obtained. The primary outcome was survival to hospital discharge. Secondary assessments were the initial rhythm and duration of CPR. Descriptive statistics were utilized. Result(s): A total of 994 COVID-19 patients were included in the study. 129 (13%) had a cardiac arrest and underwent CPR. Two patients survived hospital discharge (1.6%). Of them, 91(70.5%) were male. Mean age was 68.6 (+/-13.5) years. Median BMI was 29.1 [25.8-35.7] Kg/m2. The most frequent comorbidity was hypertension in 59 patients (46.1%), followed by diabetes type 2 in 30 patients (23.4%), and there were 37 (28.9%) patients with no comorbidities. The median time from admission to cardiac arrest was 12[6-18.5] days, the most common rhythm at the time of cardiac arrest was asystole in 94 (72.9%) patients, followed by pulseless electrical activity in 25 (19.4%);Ventricular dysrhythmias occurred in 7 (5.5%)of the cases. Finally, the median duration of CPR was 20[13.7-29] minutes. Conclusion(s): Survival of COVID-19 patients after in-hospital cardiac arrest was dismal, despite the adequate implementation of resuscitation protocols. Many of these patients were overweight or obese with comorbid conditions. The most common presenting rhythm was a non-shockable rhythm.
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INTRODUCTION: Advanced age is frequently cited as a prognostic indicator in critically ill patients. This study aimed to assess the association between outcomes in three age subgroups of older adults with COVID 19 patients. METHOD(S): Retrospective analysis of 994 adult patients admitted to our hospital between March 2020 and February 2022 with COVID-19. Patients with ages on admission >= 65 years were included and classified as young-old (65- 74 years), middle old (75-84 years), and oldest old (>= 85 years). Primary endpoints were survival, hospital length of stay (LOS), and need for mechanical ventilation. Secondary assessments included code status, ICHIKADO score, and the highest value of IL-6. Descriptive statistics, Pearson Chisquare, and Mann-Whitney-U methods were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 293 patients with age on admission >= 65 years were included in this analysis. 183 (68.5%) were young old patients, 81(27.6%) middle old patients, and 29(9.9%) oldest old patients. The median age for non-survivors was 73[69- 78.2] years vs 72[68-78] years for survivors. 56(30.6%) patients from young old group died, 28 (34.6%) died in middle old group and 10(34.5%) in the oldest old (X2(2) =0.491, p=0.78). 22(12%) of the young old group were do not resuscitate (DNR), 11(13.6%) in the middle old group, and 7(24%) in the oldest old group(X2(2) =3.118, p=0.21). LOS for young old patients was 9[4-15] days, 10[5-16] days for middle old, and 8[5-13] days for oldest-old (H(2)=1.070 p=0.58). A total of 25(13.7%) young old patients required mechanical ventilation, 11(13.6%) middle old patients and 5(17.2%) oldest old patients (X2(2) =0.282, p= 0.86). ICHIKADO score was 160[121-200] in the young old group, 150 [110-230] in the middle old and 145[119.2-176.2] in the oldest old group (H(2) =1.426,p= 0.49). Regarding inflammatory markers, IL-6 wasn't different between the groups. In the young old IL-6 was 40.9[8.9-176.5]pg/ mL, 74.45[12-374.3]pg/mL in the middle old and 51.85 [14.25-812.2]pg/mL in the oldest old group (H(2) =3.336, p=0.189). CONCLUSION(S): Oldest old patients were not found to have increased IL6, worse computed tomography findings, increased risk of death, length of stay, or need for mechanical ventilation than their younger counterparts.
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INTRODUCTION: Coronavirus disease 2019 (COVID-19) infection has been associated with the development of acute kidney injury (AKI) in some patients. The purpose of this study was to assess the mortality rates among different ethnicity of COVID-19 patients who developed AKI. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 from March 2020 to February 2022 was performed. Patients were divided into three groups based increased creatinine levels compared to their baseline creatinine, according to the KDIGO Guidelines for AKI: Stage 1 (S1;1.5 -1.9 times baseline creatinine), Stage 2 (S2;2.0-2.9 times baseline creatinine), and Stage 3 (S3;>3.0 times baseline creatinine). Survival to hospital discharge was assessed for each individual. Descriptive statistics, Chisquare, and Mann-Whitney tests were utilized. A p value <= 0.05 was considered statistically significant. RESULT(S): 192 patients with AKI admitted to our hospital with COVID-19 were included in this study. The median age was 61 [18-95]. 75 (39.1%) were female.101 (52.6%) patients survived. 111 (57.8%) were Hispanic, 22 (11.5%) were African-American, 48 (25.0%) were Caucasian, and 8 (4.2%) had other ethnicities. 45 (23.4%) patients were classified in S1, 52 (27.1%) were in S2, and 95 (49.5%) were in S3. In S1, 15 (33.3%) patients died and 30 (66.7%) survived. In S2, 24 (46.2%) died and 28 (53.8%) survived. In S3, 52 (54.7%) died and 43 (45.3%) survived. There was no correlation between mortality and AKI staging. (chi2(2) = 5.655, p = 0.059). Of 48 Caucasians, 10 (20.8%) had S1 on admission, 14 (29.2%) S2, and 24 (50.0%) S3. Of 111 Hispanics, 25 (22.5%) had S1, 31 (27.9%) S2, and 55 (49.5%) S3. Of 22 African-Americans, 7 (31.8%) had S1, 5 (22.7%) had S2, and 10 (45.5%) S3. Of 8 in other ethnicities, 1 (12.5%) had S1, 2 (25.0%) S2, and 5 (62.5%) S3. There was no statistical significance between AKI staging on admission and race. (chi2(6) = 1.845, p = 0.933). CONCLUSION(S): The development of AKI is not associated with increased mortality for any specific ethnicity.
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INTRODUCTION: Increased mortality due to COVID-19 in the intensive care unit (ICU) raised questions about the best way and time to use invasive mechanical ventilation (IMV). The purpose of this study is to analyze effectiveness of IMV in COVID-19 patients. METHOD(S): We performed a retrospective analysis of adult patients admitted to our hospital with COVID-19 infection from May 2020 to December 2021. We reviewed the need of IMV in patients admitted to the ICU with APACHE II scores higher than 12.5. Outcomes from the IMV-receiving patients were compared to outcomes from patients on non-invasive mechanical ventilation (NIMV). The second analysis of IMV aimed to determine the best initiation time for IMV. Patients were divided into Group1: early intubation (IMV within the first 24hrs of admission) and Group2: late intubation (IMV later than 24hrs after admission). Primary outcomes included mortality and length of stay (LOS) in the ICU. Descriptive statistics, Mann-Whitney-U and Chi-square methods were used. RESULT(S): For the first part of the analysis, 82 patients were included. They were divided into 2 groups (IMV and NIMV) of 41 patients each. Median age in IMV group was 67 [51.5- 75.5] vs 64 [47.5-73.5]. 21 (51.2%) patients died in the IMV group vs 22 (53.7%) X2(1, N=82)=0.049, p=0.5. Median LOS in the IMV group was 10 [6-16] days vs 11 [5-19.5] days U(NIMV group=41, NNIMV group=41)=819, z=-0.2, p=0.84. For the second analysis, 68 patients were included. They were divided into 2 groups (Group1 and 2) of 34 patients each. Median age in group1 was 53.5 [25-90] vs 53.5 [37.75-65.25]. 19 (55.9%) patients in group1 were male vs. 26 (76.5%). The median APACHE II, SOFA and ICHIKADO scores on admission in group1 were 8 [6-10.5], 1.5 [1-2], 120 [110-165] points respectively vs 9.5 [6-16.5], 2 [1-4], 150 [132.5-200] points. 3 (8.8%) patients died in group1 vs 11 (32.4%) X2(1, N=68)=5.76,p=0.033. Median LOS in group1 was 4.5 [3-8.5] days vs 6 [3.75-10.5] days U(NGroup1=34, NGroup2=34)=450, z=-1.59, p=0.113. CONCLUSION(S): In COVID-19 patients admitted to the ICU with APACHE II score higher than 12.5, mortality and LOS were not significantly different in patients that received IMV vs those that received NIMV. Early intubation correlated with improved mortality, but not with length of ICU stay.
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INTRODUCTION: The antiviral efficacy of remdesivir is still controversial. We aimed to evaluate the impact of remdesivir use in patients admitted to our intensive care unit (ICU) with COVID-19. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to September 2021 was performed. Patients were divided into 2 groups;Group1 received remdesivir while Group2 did not. The primary outcomes studied were mortality rate, length of stay (LOS) in the ICU and the need of invasive mechanical ventilation (IMV). Additional outcomes assessed were highest APACHE II during stay and inflammatory markers (Ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)). Descriptive statistics, Mann-Whitney-U and Chisquare methods were used. RESULT(S): 227 patients were included, median age was 57 years [46-68]. 122 (53.7%) were male. 113 patients were in Group1 vs 114 in Group2. Median age in Group1 is 58 years [45.75-68] vs 57 years [46.5-68] in Group2. In Group1, 64 (56.1%) were male vs 58 (51.3%). The median APACHE II score on admission for group1 was 8 [5-12] vs 9 [6-12]. The median SOFA score on admission for group1 was 2 [2-3] vs 2 [1-2.75]. The median ICHIKADO score on admission for group1 was 160 [120-200] vs 140 [110-180]. 24 (21.1%) patients died in group1 vs 21 (18.6%) in group2 x2(1, 227) = 0.218, p = 0.74. The median LOS of group1 was 7 [4-10] vs 7 [5-11] U(NGroup1=114, NGroup2=113)=6400, z=- 0.083, p=0.934. 16 (14%) patients in group1 needed IMV vs 22 (19.5%) in group 2, x2(1, 227) = 0.273, p = 0.291. The median of the highest APACHE II score in group1 was 10 [6- 17.5] vs 11 [7-15] U(NGroup1=114, NGroup2=112)=6163, z=-0.45, p=0.652. In group1, median ferritin, CRP and ESR were 486.6 [246.75-1184.5] ng/ml, 90.35 [39.48-135] mg/L, 85 [60-106.5] mm/hr, respectively vs. 493.3 [174.6- 1025.5] ng/ml, 69.6 [35.25-116.75] mg/L, 77 [47.5-110] mm/hr, U(NGroup1=114, NGroup2=107)=5614.5, z=- 1.022, p=0.307, U(NGroup1=56, NGroup2=34)=854, z=- 0.816, p=0.415, U(NGroup1=113, NGroup2=110)=5644.5, z=-1.185, p=0.236, respectively. CONCLUSION(S): There is no difference in mortality, severity scales nor inflammatory markers in patients that were treated with remdesivir compared to those who were not.
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INTRODUCTION: Thrombocytopenia (TCP) can be caused by Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Coronavirus Disease 2019 (COVID-19). This study aimed to evaluate the degree of TCP in COVID-19 patients with coinfection with EBV and/or CMV. METHOD(S): Retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to February 2022 was conducted. Patients were divided into two groups. Group 1 (G1) had viral co-infection with EBV and/or CMV and group (G2) did not. These groups were analyzed based on the degree of TCP. Thrombocytopenia was classified into mild (100-150x103/uL), moderate (50- 99x103/uL), and severe (< 50x103/uL). Primary outcomes were mortality, need for ventilation (NFV), and length of stay (LOS). Descriptive statistics, crosstabulation, Chi-square, and Mann-Whitney tests were used. RESULT(S): Of 994 patients, 445 with a median age of 57 [45-68] years were tested for viral co-infection. 262 (58.9%) were male and 327 (73.5%) survived. There was a statistically significant association between co-infection and TCP, X2(3)= 22.335, p= <.001. Of 218 patients in G1, 98 (45.0%) had normal platelet count (NPC), 44 (20.2%) had mild TCP, 47 (21.6%) had moderate, and 29 (13.3%) had severe. Of 227 patients in G2, 132 (58.1%) had NPC, 59 (26.0%) had mild TCP, 26 (11.5%) had moderate, and 10 (4.4%) had severe. There was a statistically significant association between coinfection and mortality, X2(1)= 36.682, p= <.001. In G1, 86 (39.4%) died and 132 (60.6%) survived. In G2, 32 (14.1%) died and 195 (85.9%) survived. There was a significant difference in LOS between the groups, [U= 16935.50, p= <.001]. G1 had a median LOS of 12 [6-19] days and G2 had a median of 7 [4-11] days. There was no statistically significant association between co-infection and NFV, X2(1)= .033, p= .856. In G1, 34 (15.6%) patients were mechanically ventilated and 184 (84.4%) were not. In G2, 34 (15.0%) were ventilated and 193 (85.0%) were not. CONCLUSION(S): COVID-19 and viral co-infection with EBV and/or CMV is associated with the presence of thrombocytopenia, mortality, and longer LOS in hospitalized patients. The presence of co-infection is associated with moderate and severe TCP.
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INTRODUCTION: Cardiac abnormalities are frequently found in COVID-19 patients admitted to the intensive care unit. The purpose of this study was to describe echocardiographic findings in COVID-19 patients admitted with elevated troponin levels. METHOD(S): Retrospective study of adult patients admitted to our hospital with COVID-19 from March 2020 to February 2022. Troponin I was obtained on all admitted patients and levels >=0.04 ng/mL were included. Echocardiographic findings were analyzed and past medical history was reviewed. Descriptive statistics Chi-Square, and Kruskal- Wallis H tests were used. RESULT(S): 186 patients were included. Age was 63 [50- 75] years. 70 (37.6%) patients were female. The median Troponin I level was 0.095 ng/mL [0.053-0.329]. 4 (2.2%) patients had a history of myocardial Infarction, 89 (47.8%) patients had chronic hypertension, 10 (5.4%) had a history of congestive heart failure, and 14 (7.6%) patients had chronic kidney disease. 173 (93%) of these patients had echocardiography. Ejection fraction (EF) >50% was found in 135 (72.6%), EF 40-50% in 14 (7.5%), and less than 40% in 24 (12.9%) of the patients. Mortality for the patients that had EF >50% was 61 (45.5%), EF between 40-50% mortality was 6 (42%), and for EF < 40% was 10 (41%). (x2(2) = 0.145, p = 0.93). Patients with EF >50% had a length of stay (LOS) of 9 [5-19] days, patients with EF between 40- 50% 13 [6.2-23] days, and patients with EF < 40% LOS of 8 [5-18.2] days. (H(2) = 1.532, p = 0.46). Other findings reported in echocardiograms were ventricular or atrial enlargement in 73 (39.2%) of cases, 5 (2.7%) endocarditis, 4 (2.2%) myocarditis, 8 (4.3%) pericarditis, 5 (2.7%) findings compatible with pulmonary embolism (PE), 30 (16.1%) had pulmonary hypertension and 21 (11.3%) pleural effusion. CONCLUSION(S): Abnormal ejection fraction findings in patients with COVID-19 are not associated with increased mortality or length of hospitalized stay.
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SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are commonly reactivated in critically ill patients with severe infections. This study aimed to evaluate the proportion of reactivation of EBV and CMV and its impact on length of stay, need for ventilation, and Ichikado CT scores in patients with coronavirus disease 2019 (COVID-19). METHODS: A retrospective study was conducted comprising adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. Patients were divided into groups: virus-free, EBV-only, CMV-only, and EBV and CMV detected. Primary outcomes were length of stay, need for ventilation, and Ichikado CT score. Descriptive statistics, one-way ANOVA, Games-Howell, and Kruskal-Wallis tests were used. RESULTS: 189 patients were included with a median age of 51 years [41 – 66], 80 (42.3%) were female and 109 (57.7%) were male. CD4(+) counts were lower in all viral reactivation groups. EBV-only (157 cell/µl [93 – 279.2] ), CMV-only (82.5 cell/µl [65.5 – 323.7] ), both viruses (62.5 cell/µl [47.5 – 135.5]) and virus-free (221 cell/µl [117 – 318]), (H(3) = 12.029, p = < 0.01). A significant increase in the Ichikado CT score was seen in the viral reactivation groups. EBV 186.5 [43.6], CMV 177.5 [41.6], both-viruses group 204 [50.3] vs. virus-free 161 [45.8],( H(3) = 15.770, p = < 0.01). There was an increase in days of hospitalization when comparing the virus-free and the viral reactivation groups. EBV (9 days [5.5-15.5]), CMV (17 days [3-33]), both viruses (23 days [8-31]) vs. virus-free (5 days [3.5-9]), (H(3) = 15.487, p = < 0.01). Regarding the need for assisted ventilation, there was no difference between groups. 7 (9.1%) patients in the virus-free group, 29 (29.9%) patients in the EBV group, 2 (33.3%) patients in the CMV group, and 2 (22.2%) patients in the both-viruses group needed mechanical ventilation (X2 (3, N=189) = 11.699, p= 0.08). Additionally, a statistically significant decrease in albumin levels on admission was found in the EBV-only patients compared to the virus-free group, (3.4 g/dL [0.44] vs 3.75 g/dL [0.46], F(3,185) = 5.483, p = < 0.01). CONCLUSIONS: Viral reactivation is associated with lower CD4(+) count, an increase in length of stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: EVB and CMV reactivation is associated with low CD4(+) counts and longer hospital stay. DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Severe COVID19 patients present with low CD8(+) T cell counts. A reduced number of T-cells seems to be correlated with high serum IL-6 and IL-10 levels, and a marked inflammatory state. This study aimed to assess if low CD8(+) counts were associated with inflammation markers, length of stay, and Ichikado CT scores in COVID-19 patients. METHODS: A retrospective study of adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. CD8(+) count was obtained, and patients were divided into less than 150 cells/μl and more than 150 cells/μl. Ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), troponin, Lactate dehydrogenase (LDH), and d-Dimer values were also recorded. Primary outcomes were hospital length of stay (LOS), Ichikado CT score, and correlation of CD8(+) count and inflammatory markers. Descriptive statistics, and Mann-Whitney-U methods were utilized. RESULTS: 264 patients were included, median age was 50 years [41-61]. 143 (54.2%) patients were male. There was a statistically significant difference when assessing hospital LOS in patients with CD8(+) counts <150 cells/μl vs > 150 cells/μl (9 days [5-16] vs 5 days [4-9], U=(134, 84)=3742, z=-4.174, p<0.01). The Ichikado CT score was significantly different between groups (190 [150-220] vs [130-190], U=(128,80)=3394, z=-4.094, p<0.01). IL-6 and IL-10 values were higher in those patients with CD8(+) less than 150 μl, when compared to higher CD8(+) counts. IL-10 value was (23.8pg/ml [13.6-43.3] vs (6.6pg/ml [9.4-29.2]), U=(131,78)=3711.5, z=-3.305, p<0.01), and for IL-6 (23.8pg/ml [7.6-88.3] vs (11.9 [4.1-32.1]), U=(125,75)=3473.5, z=-3.064, P<0.01). Ferritin was increased in patients with CD8(+) counts lower than 150 cells/μl compared to more than 150 cells/μl (845.3ng/ml [381.6-1600] vs 480ng/ml [232.6-988.7], U=(133,83)=3939.5, z=-3.550, p=<0.01). Similarly, CRP (83mg/L [46.3-136.7] vs 60.2 mg/L [33.25-100.72], U=(134-82)=4208, z=-2.885, p=<0.01), d-Dimer (1.76mg/L [0.53-7] vs 0.64 mg/L [0.35-1.72], U= (134,84)=3635.5, z=-4.396, p<0.01), and LDH (555IU/L [361-849.2] vs 375.5IU/L [273.2-531.2], U=(122,72)=2740,z=-4.373,p<0.01). Troponin and ESR were not significantly different, median troponin (0.022ng/ml [0.011-0.039] vs 0.012ng/ml [0.007-0.032], U=(111,70)=3218, z=-1.944,P=0.052) and median ESR (78mm/hr [57.2-105] vs 76.5 mm/hr [55-108.7], U=(134,84)=5603, z=-0.055,P=0.95). CONCLUSIONS: CD8(+) counts below 150 cells/μl are associated with increased inflammatory markers, a longer hospital stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: CD8(+) count below 150 cells/μl is other indicator of disease severity in COVID-19 DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Common markers of inflammation in COVID-19 include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and ferritin. We aimed to find an association between creatine Phosphokinase (CPK) and other inflammatory markers and enzymes, and their effect on length of hospital stay, and the Ichikado CT scores. METHODS: Retrospective study of the data of 264 adult patients admitted to our hospital between June and September 2021, with COVID-19. Patients were divided into groups with CPK of greater or less than 200mg/dL. Each was assessed for its association with CRP, ESR, ferritin, and lactate dehydrogenase (LDH), length of hospital stay, and Ichikado CT score. Descriptive statistics, Mann Whitney-U were used to address statistical significance. RESULTS: 264 patients were included, median age was 51.95 years [41-63]. 143(53.2%) were male. The median highest CRP value in patients with CPK of <200 mg/dL was (55 mg/L [24-96.4] vs 97.4 mg/L [50.1-139]) in those with CPK of >200 mg/dL, (U=(131,118) =5097, z=-4.638, p<0.01). The median highest ESR with CPK of <200 mg/dL was (72 mm/hr [51.0-102.5] vs 89 mm/hr [60-109]) in those with CPK of >200 mg/dL, (U= (133,119) =6862.5, z=-1.820, p=0.069). The median highest ferritin value in those with CPK of <200 mg/dL was (388.5 ng/mL [187.1-804.4] vs 1046 ng/mL [462.1-1600]) in those with CPK of >200 mg/dL, (U=(132,118) =4156.5, z=6.3985, p<0.01). The median highest phosphate level in patients with CPK of <200 mg/dL was (3.6 mg/dL [3.3-4.2] vs 3.8 mg/dL [3.4-5.2]) in those with CPK of >200 mg/dL,(U=(133,119) =6487.5, z=-2.471, p=0.013). The median highest LDH level in patients with CPK of <200 mg/dL was (352 IU/L [271.5-459] vs 673.5 IU/L[411.7-980.2]) in those with CPK of >200 mg/dL, (U=(113,106) = 2201, z =-8.084, p<0.01). The median highest Ichikado CT score in patients with CPK of <200 mg/dL was (150[130-190] vs 190[140-222.5]) in those with CPK of >200 mg/dL,(U= (142,209) =5188, z=-4.482, p<0.01). The length of hospital stay in patients with CPK of<200 mg/dL was (5 days [3-8] vs 9 days [5-17]) in those with CPK of >200 mg/dL, (U=(144,120) = 5533, z =-5.049, p<0.01). CONCLUSIONS: CPK has a statistically significant association with CRP and ferritin levels but not ESR. Imaging disease severity at presentation (Ichikado CT score) was associated with higher CPK levels. CLINICAL IMPLICATIONS: CPK is another marker of disease severity in COVID-19. DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Joseph Varon No relevant relationships by Daryelle Varon No relevant relationships by Mohamed Ziad
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: A significant reduction of CD4(+) cells and marked inflammatory activity in moderate and severe COVID-19 cases are seen, both associated with a poor prognosis. This study aimed to assess the association of low CD4(+) counts with inflammatory markers, length of stay, and ICKIKADO scores in COVID-19 patients. METHODS: A retrospective study of adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. CD4(+) count was obtained and patients were divided into two categories: less than 200 cells/μl and more than 200 cells/μl. Ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), troponin, Lactate dehydrogenase (LDH), and d-Dimer values were also recorded. Primary outcomes were hospital length of stay (LOS), Ichikado CT scores, and correlation of CD4(+) count and inflammatory markers. Descriptive statistics, and Mann-Whitney-U methods were used. RESULTS: 264 patients were included, median age was 50 years [41-61]. 143(54.2%) were male. There was a statistically significant difference in LOS for patients with CD4(+) counts <200 cells/μl vs > 200 cells/μl CD4(+) (9 days [5-18]vs 6 days [4-9]), U=(111,107)=4330, z=-3.466, p <0.01). The Ichikado CT score was significantly different between groups (190[150-220]vs 160[128.7-192.5], U=(106,102)=3706.5, z=-3.923, p<0.01). IL-10 values and IL-6 values were higher in those patients with CD4(+) less than 200 cells/μl, as compared to higher CD4(+) counts. median IL-10 was (25.2 pg/ml [17-72.45 ] vs 15.7 pg/ml [9.4-26.8 ], U=(109,100)=3463, z=-4.550, p<0.01), and median IL-6 was (23 pg/ml [10.5-99] vs 12 pg/ml [3.77-39], U=(104, 96)=3444.5, z=-3.785, p<0.01). Ferritin was increased in patients with CD4(+) counts lower than 200 cells/μl when compared to counts more than 200 cells/μl (850.2 ng/mL [373.3-1600] vs 541.5 ng/mL [245.1-1034.6], U=(110,106) =4543.5, z=-2.813, p=<0.01). CRP had a similar pattern (82 mg/L[49.5-138.2] vs 60.8 mg/L[30-114.2]), U=(111,105)=4478, z=-2.940, p=<0.01), d-Dimer (2.2 mg/L[0.55-7.14] vs 0.7mg/L[0.37-1.75], U=(111,107)=3992.5, z=-4.180, p<0.01), LDH (630 IU/L[371-888] vs 381 IU/L[276-520.2], U=(102,92)=2631.5,z=-5.227, p<0.01) and troponin (0.024 ng/mL[0.012-0.048] vs 0.012 ng/mL[0.007-0.027], U=(91,90)=2925, z=-3.321,P<0.01). The only inflammatory marker that was not statistically significant different was ESR (86 mm/hr[60-110] vs 72 mm/hr[50-100], U(111-107)=5113, z=-1.773,P=0.076). CONCLUSIONS: CD4(+) counts below 200 cells/μl are associated with increased inflammatory markers, a longer hospital stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: CD4(+) count below 200 cells/μl is other indicator of disease severity in COVID-19 DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
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BACKGROUND: COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct. PATIENTS AND METHODS: This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations. RESULTS: The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (-46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from -23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded. CONCLUSIONS: Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.
Subject(s)
COVID-19 , Neoplasms , COVID-19/epidemiology , Humans , Medical Oncology , Neoplasms/epidemiology , Neoplasms/therapy , Pandemics , Prospective StudiesABSTRACT
Introduction: Patients with thoracic malignancies are susceptible to severe outcomes from coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the disruption to care of patients with thoracic malignancies during the COVID-19 pandemic. Methods: The COVID-19 and Cancer Outcomes Study (CCOS) is a multicenter prospective cohort study comprised of adult patients with a current or past history of hematological malignancy or invasive solid tumor who had an outpatient medical oncology visit on the index week between March 2 and March 6, 2020 at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, NY (MSSM) or the Dana-Farber Cancer Institute in Boston, MA (DFCI). An electronic data capture platform was used to collect patient-, cancer-, and treatment-related variables during the three months prior to the index week (the baseline period) and the following three months (the pandemic period). Two-by-three contingency tables with Fisher's exact tests were computed. All tests were two-tailed and considered statistically significant for p<0.05. All analyses were done in the R statistical environment (v3.6.1). Results: The overall cohort included 2365 patients, of which 313 had thoracic malignancies, 1578 had other solid tumors, and 474 had hematological malignancies. At a median follow-up of 84 days (95% confidence interval, 82-84), 13 patients with thoracic malignancies (4.1%) had developed COVID-19 (vs. other solid: 63 [4.0%] and hematological: 52 [11.0%];p<0.001). When comparing data from the pandemic period to the baseline period, patients with thoracic malignancies had a decrease in the number of in-person outpatient visits (thoracic: 209 [66.8%] vs. other solid: 749 [47.5%] vs. hematological: 260 [54.9%];p<0.001) and an increase in the number of telehealth visits (thoracic: 126 [40.3%] vs. other solid: 465 [29.5%] vs. hematological: 168 [35.4%];p<0.001). During the pandemic period, 33 (10.5%) patients with thoracic malignancies experienced treatment delays due to the pandemic (vs. other solid: 127 [8.0%] and hematological: 79 [16.7%];p<0.001), and 26 (8.3%) patients with thoracic malignancies experienced delays in cancer imaging or diagnostic procedures (vs. other solid: 63 [4.0%] and hematological: 26 [5.5%];p=0.003). Discussion: In this prospective cohort study, patients with thoracic malignancies were not at increased risk of developing COVID-19 compared to patients with other cancers, but experienced significant cancer care disruption during the COVID-19 pandemic with a higher likelihood of decreased in-person visits and increased telehealth visits compared to patients with other malignancies. Focused efforts to ensure continuity of care for this vulnerable patient population are warranted.
ABSTRACT
Entire world is passing through the corona virus disease (COVID-19) outbreak badly. According to the WHO, corona virus affects respiratory system. This corona virus majorly spreads when someone comes in contact with an infected person and respiratory droplets that generates by coughing or sneezing play major role in spreading the infection. These respiratory droplets can spread infection when inhaled by someone or contaminate hands and surfaces in contact. During the treatment of such infectious disease, the safety of healthcare workers becomes the matter of primary concern as they are directly involved during the process of diagnosis as well as treatment and care of COVID‐19 patients;hence, they are always open to infection, and their chances of getting infected with SARS‐CoV‐2 virus become very high. A lot of challenges hospitals and staff are facing, and few of them need to be addressed technologically. In present work, in this paper, we have proposed a Bluetooth and IOT-based wireless healthcare monitoring system. The proposed system can be utilized to get real-time online physiological conditions of a patient. Doctors can monitor their COVID-19 patients remotely. A robotic trolley could be pressed into service (serve or fulfill the patient need) in hospital in order to remove direct connection and minimize the risk of spreading infection between healthcare workers who are directly involved in treating COVID-19 patients. This system continuously monitors the real-time temperature and pulse rate of the patient and send data remotely to the doctors. A medicine reminder system also reminds the patient about the medicine with date and time through voice system. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
ABSTRACT
Background: The COVID-19 pandemic has rapidly altered cancer care. However, the ways in which it has done so and the associated impact at the individual and societal levels remains poorly defined. Methods: CCOS is a multicenter prospective cohort study designed to define the impact of the pandemic on cancer care delivery and outcomes. The CCOS cohort comprised consecutive outpatients with cancer seen at two US cancer centers from March 2 to March 6, 2020 (index visit). Data was collected at baseline, retrospectively from the preceding 3 months, and prospectively at 3-month follow up. Per patient changes in numbers of visits were compared using Wilcoxon signed rank tests. Correlates of increases in telehealth visits and decreases in in-person visits were evaluated using multivariable logistic regression models. Adjusted Odds ratios [aOR] and 95% confidence intervals (CI) were reported. Results: Of 2365 included patients, 1219 (51.6%) had a decrease in in-person visit frequency during the pandemic period relative to the preceding 3 months. Conversely, 760 (32.2%) had an increased frequency of telehealth visits (decrease in in-person and increase in telehealth visits;both p<0.01). 128 (5.4%) patients developed COVID-19. Compared to White patients, Black and Hispanic patients were less likely to have telehealth visits, had no significant change in frequency of in-person visits, and were more likely to develop COVID-19 (Table). [Formula presented] Conclusions: Significant disruptions to routine cancer care were observed during the pandemic period relative to the prior 3 months. Racial and ethnic barriers to the adoption of telehealth, and related socioeconomic factors, place these vulnerable populations simultaneously at disproportionate risk for decreased cancer-related visits and COVID infection, thereby exacerbating existing racial and ethnic health disparities. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: D. Doroshow: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen;Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim;Honoraria (self), Advisory/Consultancy: Athenaeum Partners;Honoraria (self), Advisory/Consultancy: Boston Healthcare Associates. A.L. Schmidt: Travel/Accommodation/Expenses: Pfizer;Travel/Accommodation/Expenses: Astellas. Z. Bakouny: Non-remunerated activity/ies: Bristol Myers Squibb;Research grant/Funding (self): Genentech/ImCore. M.M. Awad: Advisory/Consultancy, Research grant/Funding (self): Bristol Myers Squibb;Advisory/Consultancy, Research grant/Funding (self): Lilly;Advisory/Consultancy, Research grant/Funding (self): AstraZeneca;Advisory/Consultancy, Research grant/Funding (self): Genentech;Advisory/Consultancy: Merck;Advisory/Consultancy: Achilles;Advisory/Consultancy: AbbVie. R. Haddad: Advisory/Consultancy, Research grant/Funding (self): Bristol Myers Squibb;Advisory/Consultancy, Research grant/Funding (self): Merck;Advisory/Consultancy, Research grant/Funding (self): Pfizer;Advisory/Consultancy, Research grant/Funding (self): Genentech;Advisory/Consultancy, Research grant/Funding (self): AstraZeneca;Advisory/Consultancy, Research grant/Funding (self): GlaxoSmithKline. M.D. Galsky: Shareholder/Stockholder/Stock options: Rappta Therapeutics;Honoraria (self): BioMotiv;Honoraria (self): Janssen;Honoraria (self): Dendreon;Honoraria (self): Merck;Honoraria (self): GlaxoSmithKline;Honoraria (self): Lilly;Honoraria (self): Astellas Pharma;Honoraria (self): Genentech;Honoraria (self): Bristol-Myers Squibb;Honoraria (self): Novartis;Honoraria (self): Pfizer;Honoraria (self): EMD Serono;Honoraria (self): AstraZeneca;Honoraria (self): Seattle Genetics;Honoraria (self): Incyte;Honoraria (self): Alleron Therapeutics;Honoraria (self): Dracen;Honoraria (self): Inovio Pharmaceuticals;Honoraria (self): NuMab;Honoraria (self): Dragonfly Therapeutics;Honoraria (institution): Janssen Oncology;Honoraria (institution): Dendreon;Honoraria (institution): Novartis;Honoraria (institu ion): Bristol-Myers Squibb;Honoraria (institution): Merck;Honoraria (institution): AstraZeneca;Honoraria (institution): Genentech/Roche. T.K. Choueiri: Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): AstraZeneca;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Alexion;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Bayer;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): BristolMyersSquibb;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Cerulean;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Eisai;Honoraria (self), Research grant/Funding (self): Foundation Medicine;Honoraria (self), Research grant/Funding (self): Exelixis;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Ipsen;Research grant/Funding (self): 16 Tracon;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Genentech;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Roche;Honoraria (self), Research grant/Funding (self): Roche Products Limited;Honoraria (self), Research grant/Funding (self): Hoffman-LaRoche;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): GlaxoSmithKline;Advisory/Consultancy, Research grant/Funding (self): Lilly;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Merck;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Novartis;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Peloton;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Pfizer;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Prometheus labs;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Corvus;Research grant/Funding (self): Calithera;Research grant/Funding (self): Analysis Group;Honoraria (self), Research grant/Funding (self): Sanofi/Aventis;Research grant/Funding (self): Takeda;Honoraria (self), Advisory/Consultancy: EMD Serono;Honoraria (self), Advisory/Consultancy: UpToDate;Honoraria (self): NCCN;Honoraria (self), Advisory/Consultancy, Dr. Choueiri reports research support from AstraZeneca, Alexion, Bayer, Bristol Myers Squibb/ER Squibb and sons LLC, Cerulean, Eisai, Foundation Medicine Inc., Exelixis, Ipsen, 16 Tracon, Genentech, Roche, Roche Products Limited, F. Hoffmann-La Roche, GlaxoSmithKline, Lilly, Merck, Novartis, Peloton, Pfizer, Prometheus Labs, Corvus, Calithera, Analysis Group, Sanofi/Aventis, Takeda;Honoraria: AstraZeneca, Alexion, Sanofi/Aventis, Bayer, Bristol Myers-Squibb/ER Squibb and sons LLC, Cerulean, Eisai, Foundation Medicine Inc., Exelixis, Genentech, Roche, Roche Products Limited, F. Hoffmann-La Roche, GlaxoSmithKline, Merck, Novartis, Peloton, Pfizer, EMD Serono, Prometheus Labs, Corvus, Ipsen, Up-to-Date, NCCN, Analysis Group, NCCN, Michael J. Hennessy (MJH) Associates, Inc (Healthcare Communications Company with several brands such as OnClive, PeerView and PER), Research to Practice, L-path, Kidney Cancer Journal, Clinical Care Options, Platform Q, Navinata Healthcare, Harborside Press, American Society of Me: Analysis Group. All other authors have declared no conflicts of interest.