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Background. Coronavirus Disease 2019 (COVID-19) is associated with an increased incidence of pulmonary embolism (PE). Both conditions increase hospital complications and mortality, especially when exhibited concurrently. Unfortunately, both conditions may present similarly, and physicians often have a difficult time finding clinical indicators to suggest pursuing further evaluation of a PE during a COVID-19 infection. Methods. Using a multi-center facility database, we conducted a retrospective analysis of 3,675 COVID-19 patients at Methodist Health System from March 2020 to December 2020. COVID-19 infection was determined via molecular PCR testing and PE was determined by computed tomography (CT) scan with angiography. Patient demographics and laboratory values were determined by a manual review of patient charts. Chi-Square test was used to analyze observed variables. Odds ratios were calculated for variables with a statistically significant difference (p < 0.05). Results. Of the 3,675 patients diagnosed with COVID-19, 150 (4.1%) were diagnosed with PE. Elevated D-dimer level had a statistically significant association with increased rate of PE (OR 0.1988, 95% CI 0.0727 - 0.5438, p < 0.001). Factors such as elevated C-reactive protein (p = 0.61), IL-6 (p = 0.26), smoking history (p = 0.70), age over 65 (p=0.54), BMI over 25 (p = 0.42), and history of chronic kidney disease (p = 0.16) did not show a significant association with PE incidence. Of note, patients with PE during admission were seen to have an increased incidence of intubation (OR 0.40, 95% CI 0.2660 - 0.6029, p < 0.001). Conclusion. Our study suggests that COVID-19 patients with elevated D-dimer have higher odds of having a PE. This study also suggests that COVID-19 patients that develop a PE during hospitalization are more likely to require intubation.
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Background: Recent data has shown that sodium-glucose cotransporter-2 (SGLT- 2) inhibitors decrease cardiac related mortality in patients with and without diabetes. In this study we aim to explore the relationship between outcomes in patients hospitalized with coronavirus disease 19 (COVID-19) and whether they did or did not take SGLT-2 inhibitors. Method(s): Using an observational database, we analyzed 3293 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System from March to December 2020. We compared incidence of in-hospital death or hospice referral rates, major acute cardiovascular event (MACE), and acute respiratory failure requiring mechanical ventilation between patients who did or did not take SGLT-2 inhibitors on first encounter. In this study, MACE was identified as congestive heart failure (CHF) exacerbation, pericarditis, pericardial effusion, myocardial infarction (MI), stroke, pulmonary embolism (PE), deep venous thrombosis (DVT), or shock. We used Chisquare and odds ratio tests to analyze observed variables. Result(s): Of the 3293 COVID-19 patients, 149 (4.5%) took SGLT-2 inhibitors prior to admission while 3144 (95.5%) did not. A statistically significant difference was observed when comparing mortality as an outcome between patients who took SGLT-2 prior to admission and those who did not (OR 0.54, 95% CI 0.29-0.98, p = 0.04). Interestingly, an opposite trend was seen in these two groups when comparing whether they had an incidence of MACE during hospitalization (OR 2.36, 95% 1.69 - 3.29, p < 0.01). In specific, patients who took SGLT-2 prior to admission had higher incidences of MI (OR 2.02, 95% CI 1.43 - 2.85, p < 0.01) and stroke (OR 1.28, 95% CI 2.87 - 7.82, p < 0.01). Finally, we noted that there was no statistically significant difference in incidence of acute respiratory failure leading to intubation (p = 0.35), or mortality of intubated patients (p=0.18) when comparing these two groups. Conclusion(s): SGLT-2 inhibitors use was associated with a decreased incidence of in-hospital mortality of patients admitted with COVID-19 infection even in a patient population that had a significantly higher number of MACE during hospitalization. We also show that SGLT-2 inhibitors had no association with change in incidence of acute respiratory failure requiring intubation in this patient population.
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Background: Chronic kidney disease (CKD) and End-stage renal disease patients are at increased risk of severe disease and worse outcomes in coronavirus disease 2019 (COVID-19). In this study, we compared outcomes, including rates of hospital mortality, major adverse cardiovascular events (MACE) and respiratory failure requiring mechanical ventilation in unvaccinated COVID-19 patients with established CKD/ESRD to COVID-19 patients with baseline normal kidney function. Method(s): Using an observational database, we analyzed 3183 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System (Dallas, TX) from March 2020 to December 2020. The primary endpoint was all-cause in-hospital mortality. Severe disease was identified as any patient with a major adverse cardiovascular event (MACE) or respiratory failure requiring mechanical ventilation. A MACE was defined as congestive heart failure (CHF) exacerbation, myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, or shock. Chi-square (X2), Fischer's exact test, and odds ratio tests were used to analyze observed variables. Result(s): Of the 3183 COVID-19 patients, 476 (15%) had pre-existing kidney disease (either CKD or ESRD), 170 (5.4%) were dialysis-dependent and 279 (8.79%) were CKD KDIGO stages 1-5. Compared to the non-CKD group, the CKD/ESRD group had an increased risk of all-cause in-hospital mortality (OR = 1.41, 95% CI = 1.04-1.83, p < 0.04). CKD/ESRD patients also had increased risk of MACE (OR = 1.24, 95% CI = 1.03-1.48, p < 0.02), specifically, higher risk of CHF exacerbation (OR = 3.28, 95% CI = 2.16-4.97, p < 0.001) and shock (OR = 1.36, 95% CI 1.01-1.84, p < 0.04). The risk of respiratory failure requiring mechanical ventilation was comparable between the CKD/ESRD and non-CKD cohorts (OR = 1.06, 95% CI 0.78-1.44, p = 0.70). Conclusion(s): The COVID-19 pandemic had worldwide devastating outcomes for vulnerable groups such as CKD patients. In our study, we demonstrated that CKD and ESRD is associated with a higher incidence of mortality and MACE in COVID-19. By understanding the clinical course of these patients, clinicians may better anticipate and attempt to improve outcomes during inpatient visits.
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Background: Abnormal potassium (K) levels are strongly associated with higher mortality rates among all hospitalized patients. In this study we aim to identify a correlation between abnormal K levels and mortality in coronavirus disease (COVID-19) patients may likely optimize inpatient management. Method(s): Using an observational database, we analyzed 3310 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System from March 2020 to December 2020. We compared in-hospital death or hospice referral rates between patients with normal K levels (K= 3.5 to 5.0meQ/L), hypokalemia (K < 3.5meQ/L), or hyperkalemia (K > 5.0meQ/L) on first encounter. Chi-square (X2) and odds ratio tests were used to analyze observed variables. Result(s): Of the 3310 COVID-19 patients, 463 (14.0%) died in the hospital or were discharged to hospice and 2747 (86.0%) were discharged home or to a post-acute care facility. In this study cohort, 285 (8.6%) patients had hyperkalemia, 453 (13.7%) had hypokalemia, and 2572 (77.7%) had normal K levels. Patients with abnormal K levels on initial encounter had a higher mortality rate than those who had normal K levels (OR 1.32, 95% CI 1.05 - 1.64, p = 0.02). However, upon closer examination we found that hyperkalemia had a strong association with increased mortality in COVID-19 patients compared to normal K levels (OR 2.00, 95% CI 1.49 - 2.69, p < 0.001);however, hypokalemia did not (p = 0.66). Conclusion(s): Hyperkalemia on presentation is associated with a significantly increased risk of in-hospital death or hospice discharge among hospitalized COVID-19 patients.
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SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Multiple mechanisms may cause acute kidney injury (AKI) after mechanical ventilation. Cross-talk between the lung and kidney precipitates other complications such as fluid overload, electrolyte derangements and pro-inflammatory cytokine production. In this study, we compared hospital mortality rates in unvaccinated COVID-19 patients with respiratory failure (requiring mechanical ventilation) who developed oliguric AKI. METHODS: Using an observational database, we analyzed 3183 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System (Dallas, TX) from March 2020 to December 2020. The primary endpoint was all-cause in-hospital mortality in patients with respiratory failure requiring mechanical ventilation who developed AKI (as defined by the kidney disease improving global outcomes (KDIGO) guidelines). We also counted the rate of kidney replacement therapy and degree of kidney recovery among the survivors who developed AKI. Chi-square (X2), Fischer’s exact test, and odds ratio tests were used to analyze observed variables. RESULTS: Of the 3183 COVID-19 patients, 351 (11%) developed respiratory failure requiring invasive mechanical ventilation. Of those, 313 (89%) had previously normal kidney function (no documented CKD). Of the 313 intubated patients, 186 (59.4%) developed AKI and 127 (40.5%) patients did not. Thirty-five (18.9%) of the patients who developed AKI survived hospital admission, while 54 (42.5%) patients without AKI survived (OR = 3.306, 95% CI = 1.98-5.51, P<0.001). Ischemic acute tubular necrosis from septic shock was the most common cause of AKI. Hyperkalemia and metabolic acidosis were the most common indication for kidney replacement therapy, and continuous kidney replacement therapy was the most common modality used. The mean age for the AKI vs no AKI groups were 63.5 (SD 14.5) vs 62 (SD 14.49) years old. Mean BMI was comparable between both groups 32 (SD 9.7) vs 32 (SD 9.64), while the BUN level 26 (SD 26.75) vs 19 (SD 9.9) mg/dl and Cr 1.15 (SD 1.59) vs 0.08 (SD 0.27) mg/dl were higher in the AKI group. In the AKI group, kidney replacement therapy was prescribed in 73(39.2%) patients, of which only 33 (17.7%) recovered meaningful kidney function. CONCLUSIONS: As the world emerged from the COVID-19 pandemic, there are innumerable lessons still to be learned. In our study, we demonstrated that AKI in COVID-19 patients with respiratory failure is associated with a higher incidence of mortality compared to patients without AKI. CLINICAL IMPLICATIONS: The risk of new SARS-CoV-2 variants and the possibility of future pandemics makes the recognition of high-risk medical complications of COVID-19 crucial to improve outcomes in acutely ill patients. A true multi-disciplinary team and an incredible amount of resources is required to identify and treat such patients. This study reminds us that kidney replacement therapy is only a means of supportive treatment rather than a cure to COVID-19-related kidney pathology. DISCLOSURES: No relevant relationships by Victor Canela No relevant relationships by Manavjot Sidhu No relevant relationships by Lucas Wang