ABSTRACT
SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The SARS-CoV-2 coronavirus (COVID-19) infection can be associated with coagulopathy and a high incidence of thromboembolic events. Our study investigated the impact of full dose anticoagulation versus standard prophylaxis anticoagulation in hospitalized, predominantly Black patients with COVID-19 infection METHODS: This is a retrospective observational study based on chart review of patients admitted to the University Hospital of Brooklyn in New York City from March 23rd, 2020 through April 23rd, 2020. Inclusion criteria included age ≥ 18 years, confirmed COVID-19 infection, and available baseline D-dimer level. Patients were studied under two groups: full dose anticoagulant (AC) versus prophylactic dose (non-AC). The variables collected included demographics, comorbidities, laboratory results, type of anticoagulation, major bleeds, and Sepsis-Induced Coagulopathy (SIC) score. Follow-up clinic and telehealth visit notes were utilized to establish survival at 28 days RESULTS: A total of 138 hospitalized patients met the inclusion criteria. 119 (86.2%) were Black, 77 (56%) were males, 60 (44%) were females, and the average age of all was 66.6 years. 120 (85.5%) received full dose AC. Median hospital course for all patients was 12 days [IQR 7.00 to 24.25]. Kaplan Meier median survival was 25 days for AC group [95% CI 21.9-28.1] and 9 days [95% CI 6.4–11.6] for non-AC. Unadjusted proportional hazard ratio (HR) showed that full dose AC resulted in decreased mortality with a HR of 0.387 [95% CI 0.204 - 0.734;p=0.004], with multivariate proportional hazard adjusted for D-dimer, SIC score and CRP level of 0.159 [HR=0.159, 95% CI 0.070 - 0.361;p<0.001]. Patients who received full dose AC had higher D-dimer, CRP and SIC scores at baseline. Survival based on agent used showed no difference between direct oral anticoagulants (DOAC) and low molecular weight heparin (LMWH). Kaplan Meier median survival for DOAC was 20 days (95% CI 11.1-28.9) versus LMWH median survival of 25 days (95% CI 17.7-32.3). AC was stopped in a total of 11 patients (9 for major bleeds, 2 for down trending hemoglobin);with a Pearson’s chi-square=4.716 (p=0.09) which is statistically insignificant. CONCLUSIONS: In hospitalized patients with SARS-CoV-2 infection, administration of full dose anticoagulation showed a 28-day survival benefit in a predominantly Black population, especially those with a higher D-dimer, CRP, and SIC score at baseline. Further investigation with a randomized control trial of full dose anticoagulation in COVID -19 infection is warranted CLINICAL IMPLICATIONS: Empiric full dose anticoagulation has a role to play in the clinical management of high-risk hospitalized patients with COVID -19 infection while awaiting definitive therapies. DISCLOSURES: No relevant relationships by rishard abdul, source=Web Response No relevant relationships by Alla akivis, source=Web Response No relevant relationships by Yonatan Akivis, source=Web Response No relevant relationships by Aaliya Burza, source=Web Response No relevant relationships by Michael Farina, source=Web Response No relevant relationships by Bana Hadid, source=Web Response No relevant relationships by Ishmam Ibtida, source=Web Response No relevant relationships by Sridesh Nath, source=Web Response No relevant relationships by Yara Perez, source=Web Response No relevant relationships by Duarxy Sainvilien, source=Web Response No relevant relationships by Ghassan Samaha, source=Web Response No relevant relationships by Baho Sidiqi, source=Web Response No relevant relationships by Maya Srinivasan, source=Web Response No relevant relationships by Samrat Worah, source=Web Response No relevant relationships by Unaiza Zaman, source=Web Response
ABSTRACT
BACKGROUND: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested against the use of corticosteroids unless in clinical trials until the recent publication of the RECOVERY trial. Here, we analyzed the treatment effect of methylprednisolone on patients with AKI and ARDS during the initial 2 months of COVID-19 and detail the learning effect within our institution. METHODS: Between March 1 and April 30, 2020, 75 AA patients met our inclusion criteria for ARDS and AKI, of which 37 had received corticosteroids. Twenty-eight-day mortality, improvement in PaO2/FiO2 ratio, and renal function were analyzed. The impact of methylprednisolone treatment was assessed with multivariable methods. RESULTS: Survival in the methylprednisolone group reached 51% at 21 days compared to 29% in the non-corticosteroid group (P < .001). Methylprednisolone improved the likelihood of renal function improvement. PaO2/FiO2 ratio in the methylprednisolone group improved by 73% compared to 45% in the non-corticosteroid group (P = .01). Age, gender, BMI, preexisting conditions, and other treatment factors did not show any impact on renal or PaO2/FiO2 ratio improvement. The use of anticoagulants, the month of treatment, and AKI during hospitalization also influenced outcomes. CONCLUSION: In AA COVID-19 positive patients with ARDS and AKI, IV methylprednisolone lowered the incidence of mortality and improved the likelihood of renal and lung function recovery. Further investigation with a randomized control trial of corticosteroids is warranted.