Aki in Hospitalized Covid-19 Patients- an Epidemiology Study in a Tertiary Center

Introduction: Coronavirus disease 2019 (COVID-19) related acute kidney injury (AKI) is a recognized complication of the disease and may result in high morbidity and mortality rate. The reported incidence and outcome vary worldwide. This study aimed to assess the AKI rate in hospitalized COVID-19 patients and identify risk predictors/prognosticator associated with the complication. Method(s): This is a retrospective study of hospitalized COVID-19 patients at the University Malaya Medical Center admitted from January 2021 until June 2021. Data on patients who were>= 18 years old and hospitalized for >= 48 hours for confirmed COVID-19 infection were captured. Clinical parameters and demographic of patients were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines. Result(s): A total of 1529 patients were found to have fulfilled the criteria for the study with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n=85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n=323). The proportion of different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. A total of 15 hospitalized patients (0.98%) needed dialysis. 190 patients (58.8%) of AKI group had complete recovery of renal function. Demographic factors that were associated with an increased risk of developing AKI included: age (p< 0.001), diabetes (p<0.001), hypertension (p<0.001), CKD (p<0.001) and vaccination status (p=0.002). Analysis of biochemical parameters in AKI cohort revealed statistically significant lower lymphocytes & platelet counts, higher ferritin levels, and poorer renal function (creatinine based)) compared with the non-AKI cohort. Outcome analysis in our cohort revealed that AKI was associated with prolonged hospitalization (p<0.001) and higher mortality rates with P< 0.001). [Formula presented] Conclusion(s): AKI is a common complication among hospitalized COVID-19 patients. The increased risk was associated with underlying comorbidities and had an adverse outcome on patient morbidity and mortality. No conflict of interestCopyright © 2023

Comparison of the causes of death in patients with delta variant versus omicron variant infections

Background. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) variant strain B.1.1.529 (omicron) has been less virulent than SARS-CoV-2 B.1.617.2 variant (delta), but there are limited data on the comparison of the cause of death between delta variant and omicron variant infections. We thus compared the causes of death in COVID-19 patients with the delta variant and omicron variant. Methods. We retrospectively reviewed the medical records of adult patients with COVID-19 who were admitted at Asan Medical Center, Seoul, South Korea, between July 2021 and March 2022. We divided into delta-variant dominant period (from July 2021 to December 2021) and omicron-dominant period (from February 2022 to March 2022) with the exclusion of January 2022 because this period was overlapping of delta and omicron variant. The causes of death were classified into COVID-19-associated pneumonia, other causes, and indeterminate cause. Results. A total of 654 patients with COVID-19 were admitted and 42 (6.4%) died during the omicron dominant period (between February and March 2022), while a total of 366 patients with COVID-19 were hospitalized and 42 (11.5%) died during the delta dominant period (between July and December 2021). The primary cause of death was COVID-19-associated pneumonia in 64% (27/42) during the omicron era whereas that was COVID-19-associated pneumonia in 88% (37/42) during the delta era (p value=0.01) (Table 1). Conclusion. We found that about two thirds of patients with omicron variant infection died due to COVID-19, while the majority of patients with delta variant infection died due to COVID-19.

Virtual Consultations-Should We Be Using Them?: A Two-Cycle Clinical Audit

Objective: In response to the coronavirus disease 2019 pandemic, the use of virtual appointments increased substantially. An audit was designed to evaluate the efficacy of virtual appointments at Alder Hey Children's Hospital. Patients and clinicians satisfaction of virtual appointments were also recorded. Materials and Methods: Patients having virtual appointments were identified, and data were recorded, including demographics and outcome of the appointment. A pilot study was conducted to identify any necessary modifications to the data collection process. Data were collected over two cycles, and the results were analyzed. Results: The first cycle was performed retrospectively and there were 158 patients identified who had a virtual appointment. An outcome could be drawn from the virtual appointment in over 70% of cases. Recommendations following the first cycle were implemented. A second cycle was then completed prospectively. A total of 145 patients were identified. An outcome could be drawn in 51% of cases. Patient and clinician feedback on virtual appointments was generally positive. Conclusion: This study demonstrated that a successful outcome could be drawn in the majority of virtual appointments, and clinicians and patients had positive experiences regarding virtual clinics. This highlights the usefulness of this service, which is particularly relevant due to the increased reliance on virtual clinics during the pandemic. © 2022. The Author(s).

POS-289 PARAFFIN WASHOUT IMMUNOFLUORESCENCE TECHNIQUE IMPROVE SAFETY AND ADEQUACY OF NATIVE KIDNEY BIOPSY AND TRANSPLANT KIDNEY BIOPSY IN A TERTIARY TEACHING HOSPITAL

Introduction: Kidney biopsy (KB) tissues are usually dissected 0.5-1.0 cm for fresh sample immunofluorescence study (FSIF). Paraffin washed-out immunofluorescence (PWIF) technique doesn’t require segmentation of the kidney biopsy sample that may jeopardise the sample adequacy for histopathological examination (HPE). Hypothetically, it reduces biopsy passes and complications. We examine the safety and adequacy of native kidney biopsy (NKB) and transplant kidney biopsy (TKB) using the FSIF technique and PWIF technique in HPE preparation for immunofluorescent study. Methods: We retrospectively collected clinical history, blood results, and renal biopsy reports for all the patients who had undergone KB using electronic medical records at University Malaya Medical Centre, Kuala Lumpur, Malaysia from 1/1/2015 to 31/4/2021. We performed 1520 KBs (795 NKBs & 725 TKBs) and 1336 KBs with complete data analysed (670 NKBs & 666 TKBs). Sixty-one of the 670 (9.1%) NKBs and 48 of the 666 (7.2%) TKBs employed the PWIF method from 13/10/2020 to 31/4/2021 (6 months) because of the COVID-19 pandemic. We collected 62 NKBs and 65 TKBs from 13/10/2018 to 31/4/2019 (6 months) as the control group which used the FSIF method. The control is chosen as such to correlate with the same months of another year. Results: There were no statistically significant differences in the baseline characteristics between the two groups of each cohort respectively except for the ethnicity distribution in the TKB cohort (p=0.037) and INR in NKB and TKB cohorts (p=0.000 & p=0.002 respectively). PWIF group in NKB and TKB recorded lesser pass (p=0.000 for both), longer HPE core (p=0.001 & p=0.024 respectively), better HPE adequacy (p=0.006 & p=0.012 respectively). There were no statistical differences in the diagnostic yield, immediate pain, gross haematuria, haematoma, and admissions or prolong hospitalisation due to biopsy complications in both groups for NKB and TKB cohorts (Table 1 & 2). [Formula presented] Conclusions: Paraffin washed-out immunofluorescence technique increased the native and transplant kidney biopsy adequacy with a lesser pass and better biopsy sample adequacy for histopathological examination but no difference in the incidence of complications. However, a greater number of cases are required to assess the statistically significant difference in the incidence of complications. No conflict of interest

Analysis on Applicability of Air Purifiers in Schools to Prevent the Spread of Airborne Infection of SARS-CoV-2

The social and economic losses caused by viruses such as SARS-CoV, MERS-CoV, and SARS-CoV-2 has been serious. In this study, the size of airborne droplet nuclei particles and the number of virions generated by speaking or coughing were analyzed. Particle collection efficiencies of E11 and H13 grade air filters used in commercial air purifiers were evaluated for different particle sizes and the possibility of removing the airborne droplet nuclei particles by air purifiers was studied. In addition, the reduction of SARS-CoV-2 virion concentration and dose by using air purifiers was theoretically investigated for elementary school classrooms. When an infected student continuously emits virions with a rate of 6.0x10(5) virions/h in a 165 m(3)-sized classroom, the virion concentration and dose was estimated to be reduced by more than 60% by using an air purifier of clean air delivery rate (CADR) 780 m(3)/hr and by more than 70% by using two air purifiers (that is, CADR 1560 m(3)/h) compared to when not in use of the air purifier. However, to prevent the spread of infection by the air stream generated by the air purifier, it is necessary to operate an instruction for using the air purifier such as facing the air outlet toward the ceiling and installing at least 50 cm away from occupants.