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SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The SARS-CoV2 virus is known to cause atypical pneumonia, but in this uncertain time with a lack of sensitive testing, laboratory values such as inflammatory markers, procalcitonin, and brain natriuretic peptide (BNP) may suggest a diagnosis of COVID-19 pneumonia, bacterial pneumonia, or CHF exacerbation. Commonly, the patients with respiratory symptoms, bilateral infiltrates on imaging and a negative COVID-19 nasopharyngeal swab test have been continued to be isolated with suspicion of having COVID-19 pneumonia. There is still a lack of significant research, that evaluates the benefits of biomarkers towards getting a definite diagnosis. We conducted a prospective study to analyse the difference in clinical markers in COVID positive patients compared to COVID-19 negative patients with respiratory symptoms and bilateral infiltrates on imaging, to get a better understanding of characteristics that may help differentiate COVID-19 pneumonia from bacterial pneumonia or CHF on admission. METHODS: We conducted a prospective observational single health center study. Inclusion criteria were patients who were admitted to our hospital with confirmed COVID-19 testing by nasopharyngeal swab (Confirmed group) or COVID-19 negative patients with respiratory symptoms and bilateral infiltrates on imaging (High Suspicion group). Lab markers measured on these patients were ferritin, procalcitonin, BNP, and CRP. RESULTS: Out of 100 patients analyzed to have suspected pneumonia, 26 were in the Confirmed group, 74 were in the High suspicion group. 0% COVID positive patients had a history of CHF, whereas 20.2% of those High suspicion group had a h/o CHF. The Confirmed group had a Procalcitonin >0.2 in 42.8%, BNP ≥800 in 23%, Ferritin ≥800 in 45.5%, and CRP >4 in 69.5%. The High suspicion group had Procalcitonin >0.2 in 28.4% and BNP ≥800 in 40.5%. CONCLUSIONS: Many studies discussed a biomarker-based test to distinguish between bacterial and viral etiologies of pneumonia with sufficient accuracy and specificity for clinical. Based on our data there appears to be an importance of initial lab testing and thorough clinical examination to narrow down differentials between CHF, COVID pneumonia, and bacterial pneumonia. Procalcitonin, for example, was more elevated in the COVID group. We found that many patients in the High Suspicion group were empirically treated as COVID patients and isolated as such. Through more studies, developing a biomarker scoring system may help diagnose COVID pneumonia. CLINICAL IMPLICATIONS: Currently, there are no biomarker-based algorithms for establishing the etiology of pneumonia. Further studies are required to explore a combination of biomarkers and symptoms for use as a definitive diagnostic tool for COVID patients. DISCLOSURES: No relevant relationships by Laith Al-janabi, source=Web Response No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by Manishkumar Patel, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response No relevant relationships by Ahmed Zaki, source=Web Response
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SESSION TITLE: Disaster Medicine Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In December 2019, a viral pneumonia associated with a new coronavirus SARS COV-2 emerged in Wuhan, China and quickly spread throughout the world causing high mortality rates. As of May 30th,2020, coronavirus disease 2019 (COVID-19) has been confirmed in 56,884 people in Michigan, with case fatality rate of 10%. Since very little is known regarding patients with COVID-19 disease, we aim to describe the clinical characteristics and outcomes of patients hospitalized in a Michigan community hospital. METHODS: A single centre, retrospective chart review of 163 hospitalized patients with confirmed cases of COVID-19 at a community hospital from March 15 to April 10, 2020. Cases were confirmed by real-time polymerase chain reaction testing of nasopharyngeal samples. Epidemiological, demographic, laboratory and overall outcomes were obtained from electronic medical record. Data collected was then analysed using SPSS software. RESULTS: A total of 163 patients were reviewed and included in the study. Median age of patient with confirmed SARS-COV2 infection was 70 years (mean 68, range, 30-101), of which 52.8% were female, 60.7% white and 33.7% African American. The most common comorbidities were hypertension (112, 68.7%), obesity (79, 48.6%), and hyperlipidemia (54, 33.1%). Patients presented with shortness of breath (109, 66.9%), cough (107, 65.6%) and fever (99, 60.7%). Gastrointestinal symptoms were found in 81 (49.6%) of patients with the most common symptom being diarrhea in 44 (27%) patients. There were 66 (40.5%) patients with fever >100.4F on admission. Multilobe infiltrates were found in chest x-ray of 115 (70.6%) patients. Within one-month, overall mortality was noted to be 29.5%. Mean length of stay of non-intensive care unit (ICU) patients was 6.46 days (range 1-19) when compared 15.5 days (range 3-46) for ICU patients. During hospitalization, 55 patients (33.7%) (median age 68 years, 54.5% female, 60.1% white) were treated in the ICU of which 43(78.2%) required mechanical ventilation and 28 (50.9%) died. For patients requiring mechanical ventilation, 27 (62.8%) died and 16 (37.2%) were discharged alive. CONCLUSIONS: This study provides insight into presenting characteristics, demographics and overall outcome of patients hospitalized with COVID-19 in a Michigan community hospital. CLINICAL IMPLICATIONS: In medical emergencies like the COVID pandemic, it is important to analyze patient demographics in order to help identify the population most at risk. Knowledge of the most vulnerable population not only allows us to come up with strategies to help control the spread of disease but also helps us risk stratify the patients for better resource allocation. It is crucial to learn from an outbreak like this so we can be better prepared for the future. DISCLOSURES: No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by vesna tegeltija, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response
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SESSION TITLE: Lessons from the ICU: What have We Learned about the Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Throughout the years, several scoring systems have been established to measure disease severity in efforts to predict patient mortality and help guide management. In patients with sepsis, organ failure has been proven to worsen outcome, therefore utility of scores such as Sequential Organ Failure Assessment (SOFA) has helped determine the severity of disease and predict mortality. Patients infected with SARS COV-2 were observed to have varying disease progression with multiorgan involvement. Through this study, we intend to investigate the use of the SOFA score in predicting mortality in critically ill patients who tested positive for SARS COV-2. The aim of this study is to determine if the SOFA score is a strong predictor of mortality in critical care patients admitted with SARS-COV2 infection. METHODS: A single centered, retrospective chart review of 54 patients admitted to the intensive care unit (ICU) for COVID-19 infection from March 15th to April 10th 2020 was conducted. A comprehensive review of laboratory values on the day of ICU admission was done to calculate SOFA score. Total length of stay and overall patient outcome was also recorded. The collected data was statistically analyzed using the statistical software Statistical Package for the Social Sciences (SPSS). RESULTS: The results reveal that the average SOFA score of patients who tested positive for SARS COV2 was 6.31 ± 2.73. The average score of patients who survived was 4.73 ± 1.88 and the average SOFA score of the patients who died during the hospital stay was 7.78 ± 2.58. Overall, the mortality rate of patients admitted to the ICU was 51.85%, 46% of them were male and 54% female. The average length of hospital stay was calculated to be 14.5 days for those who died and 16.4 for those who survived. Logistic regression analysis was done (OR=0.56, 95% CI 0.41-0.77, p < 0.05) which was indicative of an increase in mortality by 0.56 times with every 1 point increase in SOFA score. CONCLUSIONS: COVID-19 is a new disease process and has led to many questions regarding appropriate management and treatment plans which remain unanswered. This study focused on determining whether the SOFA score is a valuable tool in predicting mortality of critically ill patients who tested positive for SARS COV2. We found that there was an increase in mortality by 0.56 times for every 1 point increase in SOFA score. High variance in clinical presentation and rapid progression of the disease made risk stratification of these patients challenging. Labs as well as clinical presentation changed significantly within the span of a day, therefore daily assessment using the SOFA score would be a better indicator of disease progression. Limitations of this study include small sample size and the novelty of the disease and its clinical progression. CLINICAL IMPLICATIONS: SOFA score on admission was not a good predictor of mortality in patients with COVID-19. DISCLOSURES: No relevant relationships by Laith Al-janabi, source=Web Response No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by DANYAL TAHERI ABKOUH, source=Web Response No relevant relationships by vesna tegeltija, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response
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SESSION TITLE: Respiratory Infections: What have We Learned About COVID-19 and New Trial Data for Management of Aspergilloma SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: An influx of SARS-COV2 infection has led to several unanswered questions, one such question raised was how to risk stratify these patients in order to better direct further management. The MuLBSTA score recently developed by Guo L. et al. in Shanghai, China is designed to predict 90-day mortality in patients with viral pneumonia. Since very little is known regarding patients with SARS COV-2 infection and COVID-19 disease, we aim to explore the applicability of MuLBSTA score in predicting disease severity and risk of mortality in these patients. METHODS: A single centre, retrospective chart review of one-hundred and sixty-three hospitalized patients with COVID-19 pneumonia at a community hospital in Michigan from March 15 to April 10, 2020. Several clinical characteristics were reviewed, six risk factors were incorporated into the MulBSTA score which included: multilobe infiltrate, absolute lymphocyte count ≤0.8 x 109/L, bacterial coinfection, smoking history, history of hypertension and age ≥ 60 years. The calculated score was then compared to the primary outcome of mortality and secondary outcomes which included length of stay and ventilator support. Data collected was then analysed using SPSS, validity of the data was analyzed using regression analysis and receiver operating characteristic curve. RESULTS: A total of 163 patients were manually reviewed, of which there was an overall mortality rate of 29.4%, an ICU mortality rate of 50.9% and ventilator associated mortality of 62.8%. The MuLBSTA score was applied to each patient manually at time of hospitalization. There was a mean MuLBSTA score of 8.67 (4.066) for patients who survived and a mean MuLBSTA score of 13.6 (1.87) for patients who died. There was a significant positive correlation of the MuLBSTA score with mortality (OR = 1.37, 95% CI 1.23-1.53, p =.0001). The area under the receiver operating characteristic (ROC) curve of MuLBSTA for predicting in-hospital mortality at time of admission was 0.813(SE 0.037). A positive correlation was also found with ventilator support (OR= 1.30, 95% CI 1.17-1.44, p=.0001) and length of stay (r (161) =.35, p=.0001). CONCLUSIONS: Analysis of data indicated that in patients with COVID-19 pneumonia, the MuLBSTA score successfully stratified hospitalized patients based on severity and accurately predicted overall outcome. CLINICAL IMPLICATIONS: This score correlated significantly with mortality, ventilator support and length of stay, which may be used to provide guidance to screen patients and make further clinical decisions. Further studies are required to validate this study in larger patient cohorts. DISCLOSURES: No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by vesna tegeltija, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response
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SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The COVID-19 pandemic has left the medical community floundering for answers as patients present with a variety of symptoms, at different stages of the infection. As the outbreak spread, the public was made aware of the range of symptoms associated with SARS-COV-2. Respiratory symptoms of dry cough and shortness of breath, Gastrointestinal symptoms such as nausea, vomiting, and even more vague signs such as Anosmia have been observed. Our case further highlights the devastating outcomes and the multi systemic involvement, the difficulty of false-negative testing on these patients, the associated hyper-coagulability causing multi-organ dysfunction. CASE PRESENTATION: Healthy 32-year-old gentleman presented with nausea, non-bloody emesis, epigastric pain, and poor oral intake of 6 days duration. Patient also reported shortness of breath and cough productive of yellow sputum for the past 2 day. He denied any sick contacts and initial real-time PCR COVID testing in ED was negative. On admission, patient was comfortable on room air, with tachycardia. lab findings significant for elevated lactate, Procalcitonin, and LFTs. CT abdomen w/o contrast revealed bilateral pleural effusions and ground glass opacities. Upon transfer to medical floors, rapid response was called for hypotension. Initially, patient was alert, oriented, and in no acute distress. Shortly thereafter, he began to gasp for air and complain of chest pain. pulse-oximetry decreased to 75% and patient became unresponsive, without a pulse. Cardiopulmonary resuscitation was initiated promptly per ACLS protocol. reversible causes including tension pneumothorax, cardiac tamponade, and electrolyte/metabolic disturbances were ruled out. The course of illness and clinical features were highly suggestive of acute massive pulmonary embolism, and intravenous TPA was administered. Thrombectomy was considered, however it was determined that it would not change the outcome. After 64 minutes of resuscitation and 21 doses of epinephrine, the efforts came to a halt and patient was pronounced dead. A repeat swab for COVID-19 was taken and later reported as positive. DISCUSSION: This puzzling case displays a rapid deterioration of a COVID-19 related complication. The infection creates a diagnostic dilemma due to the myriad of associated symptoms and multi-system involvement as well as the False-negative testing which may alter the course of management and admission criteria. Hypercoagulability triad is seen with lack of mobility, systemic inflammatory response, and endothelial invasion by SARS-CoV-2 causing endothelial damage. This phenomena may be the underlying cause of the systemic involvement. CONCLUSIONS: Although COVID-19 infection is widely viewed as a respiratory infection, it's crucial to recognize the multi-systemic involvement and array of symptoms. Reliable testing may possibly alter medical management, improve outcome, and reduce exposure. Reference #1: Magro C. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Translational research : the journal of laboratory and clinical medicine. 04/2020. Doi 10.1016/j.trsl.2020.04.007. Reference #2: Panigada M. Hypercoagulability of COVID-19 patients in intensive care unit. A report of thromboelastography findings and other parameters of hemostasis. Journal of thrombosis and haemostasis. 04/2020. doi: 10.1111/jth.14850. DISCLOSURES: No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by DANYAL TAHERI ABKOUH, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response
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SESSION TITLE: Lessons from the ICU: What have We Learned about the Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: SARS-CoV2 is known for causing atypical pneumonia with rapidly progressive respiratory failure requiring intubation. Usage of steroids have been shown to be of benefit in similar disease processes caused by other coronaviruses specifically SARS/MERS. Currently in the literature there is lack of consensus regarding steroids use in severely ill patients with COVID-19 pneumonia. We conducted a retrospective analysis to evaluate the efficacy of systemic corticosteroids and outcomes in COVID-19 patients with severe respiratory symptoms requiring ICU admission in a community hospital in Michigan. METHODS: This retrospective cohort study was conducted with 181 patients of COVID-19 with severe respiratory symptoms requiring ICU admission in a community hospital in Michigan March 18 to April 15, 2020. Patients were then divided into 2 groups, with or without steroid treatment. Treatment group received oral prednisone, doses range from 10 to 60mg twice daily for an average of 5 days, most of which received a loading dose of intravenous methylprednisolone. The primary outcome for the study was mortality rate, secondary outcome was extubation rate. RESULTS: 177 patients met inclusion criteria and among those, 93 patients received systemic steroids. Of the total 93 patients in the treatment group, 42 patients were admitted to ICU, 38 of which were intubated. Of the total 84 patients in the control group, 14 patients were admitted to ICU and 10 were intubated. The mortality rate was 53% in the treatment group compared to 57% in the control group (p>0.05);the extubation rate was 71% in the treatment group compared to 50% in the control group (p>0.05). Our results showed a clinically important difference between the two groups. CONCLUSIONS: Existing evidence from literature is inconclusive regarding use of steroids in COVID-19. Currently, Surviving Sepsis Campaign recommends using low-dose corticosteroid in intubated COVID-19 patients with ARDS, IDSA guidelines recommend use of steroid only in the setting of clinical trials, and National institutes of Health states that there is insufficient evidence for or against use of steroid in COVID-19 patients. Multiple retrospective cohort studies have shown variability in the benefit of steroid use in patients infected with SARS/MERS, which may not be applicable to COVID-19 patients. Our study indicates that in severely ill patients with COVID-19, systemic steroids with short-term application was associated with lower ICU mortality rates and higher extubation rates. CLINICAL IMPLICATIONS: Though our results did not achieve statistical significance, it was observed that there was an improved mortality rate and increased extubation rate in those who received corticosteroid. We suggest further studies, in form of a multi-center randomized control trial to assess additional benefits of systemic steroids in COVID-19 treatment. DISCLOSURES: No relevant relationships by Radha Kishan Adusumilli, source=Web Response No relevant relationships by Laith Al-janabi, source=Web Response No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Gloria Hong, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by Manishkumar Patel, source=Web Response No relevant relationships by Bernadette Schmidt, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response