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SESSION TITLE: Late Breaking Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. METHODS: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariate, multivariate, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate, and sPESI. Both lactate and sPESI were included as continuous variables. Our covariates included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. RESULTS: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariate analysis, both sPESI (p=3.4*10
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Background: The determinants of the susceptibility to SARS-CoV-2 infection and severe Coronavirus Disease 19 (COVID-19) manifestations are yet not fully understood. Amino-bisphosphonates (N-BPs) have anti-infammatory properties and have been shown to reduce the incidence of lower respiratory infections, cardiovascular events and cancer. Objectives: We conducted a population-based retrospective observational case control study with the primary objective of determining if oral N-BPs treatment can play a role in thesusceptibility to the development of severe COVID-19. Methods: Administrative ICD-9-CM and AT C data, representative of Italian population (9% sample of the overallpopulation), were analyzed. Oral N-BPs (mainly alendronate and risedronate) were included in the analysis. Patients treated with bisphosphonates (cases) were randomly matched (1:1 ratio) for age, sex and for other clinically relevant variables (presence of treatments other than bisphosphonates and hospitalizations) with all the health-assisted population without this treatment (controls). Results: Incidence of Covid-19 hospitalization was 12.32 [95%CI 9.61-15.04] and 11.55 [95%CI 8.91-14.20], of ICU utilization due to COVID-19 was 1.25 [95%CI 0.38-2.11] and 1.42 [95%CI 0.49-2.36] and of all-cause death was4.06 [95%CI 2.50-5.61] and 3.96 [95%CI 2.41-5.51] for oral N-BPs users and non-users, respectively (Figure 1A). Figure 1B Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated subjects with anti-osteoporotic drugs and without corticos-teroids. C. Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated without previous vertebral or hip fragility fractures. D. Incidence of COVID-19related events in bisphosphonates treated and untreated patients without previous vertebral or hip fracture without corticosteroid prescriptions. Conclusion: In conclusion, we found that the incidence of COVID-19 hospi-talization, intensive care unit (ICU) utilization and COVID-19 potentially related mortality were similar in N-BPs treated and non-treated subjects. Similar results were found in N-BPs versus other anti-osteoporotic drugs. We provided real-life data on the safety of oral N-BPs in terms of severe COVID-19 risk on a population-based cohort. Our results strongly support national and international guidelines that advocate against the discontinuation of oral bisphosphonates only for the fear of COVID-19.
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Background and aims: We aim at describing the impact of the first, second and third waves of the COVID-19 pandemic on stroke services in Tuscany. We measured the global impact of the COVID-19 pandemic on the volumes of both intracranial hemmorhage (ICH) and acute ischemic stroke (AIS) hospitalizations, as well as of reperfusion treatments throughout the pandemic years 2020-21 (January1, 2020 -June 30, 2021) compared with the year 2019 control period. Methods: Retrospective, observational, multicenter study, across 3 huband- spoke stroke systems, and 22 stroke hospitals. The diagnoses were identified by their ICD-9 CM codes and/or classifications in stroke databases at participating centers. Results: In comparison with the same periods of 2019, the hospitalization volumes for ICHs and for AIS declined by 26% and 30.1% respectively during the fist pandemic wave, by 11% and 24.6% during the second wave, and by 2.5% and 4% during the third wave. Reperfusion treatments decreased by 15% during the first wave, and by 11.4% and 0.3% during the second and third waves respectively. Treated patients' functional outcome at 90days did not vary throughout the pandemic waves. Casefatality at 30days increased from 10.3% to 10.8% for AIS, and from 26.5% to 27.6% for ICH before and after the COVID-19 outbreak. Conclusions: The COVID-19 pandemic waves were associated with a decreasing decline in the volume of stroke hospitalizations, nevertheless fewer and probably the most severe patients were able to reach the hospital within the therapeutic windows. We observed different pattern of variations across the three hub-and-spoke systems.
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Introduction: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. Methods: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariant, multivariant, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate elevation, and sPESI. Our covariants included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. Results: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariant analysis, both sPESI (p=3.4∗10∧-6, AUC = 0.74) and lactate (p=1.1∗10∧-7, AUC = 0.71) correlate with mortality. When included in the same multivariant model, both lactate (p=1.3∗10∧-5) and sPESI (p=3.2∗10∧-4) retained their statistical significance with mortality. Conclusion: As in previous studies, our analysis confirms these results (lactate p=1.1∗10∧-7;AUC = 0.71, sPESI p=3.4∗10∧-6, AUC = 0.74). However, we also demonstrate that both lactate and sPESI retain statistical significance when both are included in the same multivariant model (p-value for lactate = 1.3∗10∧-5, p-value for sPESI = 3.2∗10∧-4). Thus, both lactate and sPESI each demonstrate independent statistical significance, contributing to prediction of mortality. This finding makes a compelling case for inclusion of lactate in risk stratification models used by Pulmonary Embolism Response Teams (PERT) across institutions for triaging the management of acute pulmonary embolism in the hospital.
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OBJECTIVE: This study evaluated the association of the short-term exposure to environmental factors (relative humidity, temperature, NO2, SO2, O3, PM10, and CO) with hospital admissions due to acute viral lower respiratory infections (ALRI) in children under two years before the COVID-19 era. METHODS: We performed a bidirectional case-crossover study in 30,445 children with ALRI under two years of age in the Spanish Minimum Basic Data Set (MBDS) from 2013 to 2015. Environmental data were obtained from Spain's State Meteorological Agency (AEMET). The association was assessed by conditional logistic regression. RESULTS: Lower temperature one week before the day of the event (hospital admission) (q-value = 0.012) and higher relative humidity one week (q-value = 0.003) and two weeks (q-value<0.001) before the day of the event were related to a higher odds of hospital admissions. Higher NO2 levels two weeks before the event were associated with hospital admissions (q-value<0.001). Moreover, higher concentrations on the day of the event for SO2 (compared to lag time of 1-week (q-value = 0.026) and 2-weeks (q-value<0.001)), O3 (compared to lag time of 3-days (q-value<0.001), 1-week (q-value<0.001), and 2-weeks (q-value<0.001)), and PM10 (compared to lag time of 2-weeks (q-value<0.001)) were related to an increased odds of hospital admissions for viral ALRI. CONCLUSION: Short-term exposure to environmental factors (climatic conditions and ambient air contaminants) was linked to a higher likelihood of hospital admissions due to ALRI. Our findings emphasize the importance of monitoring environmental factors to assess the odds of ALRI hospital admissions and plan public health resources.