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1.
Pharmacopsychiatry ; 55(3):172, 2022.
Article in English | EMBASE | ID: covidwho-1967689

ABSTRACT

Introduction Safety studies have shown that COVID-19 vaccinations can provoke inflammatory processes in patients. The subsequent release of cytokines is accompanied by an increased inflammatory marker, C-reactive protein (CRP) [1]. For some antipsychotic drugs, inflammatory processes have been associated with increased drug levels, even above therapeutically approved ranges [2] [3]. It is not clear, whether this holds also true for COVID-19 vaccinations. Methods We present a case series comprising of 10 inpatients at the CIMH treated with an antipsychotic drug. Patients received a first, second or third dose of the COVID-vaccination Comirnaty in the morning. Blood samples were taken directly before the injection and were followed on day 1 and 4 while constant dosing. Blood testing included drug levels, safety laboratory, and CRP. Results CRP levels were elevated in nine patients;four of those also presented an increase in antipsychotic drug levels within a few days after COVID-19 vaccination. Blood level changes were i)+0%,+24%,+125%,+116% in quetiapine-, ii)+0%,+0%,+100% in olanzapine-, iii)+0,+42% in clozapine-treated patients, and iv)+205% in one risperidone-treated patient. As a result, three patients had drug levels above the therapeutically recommended range. Conclusion We present a series of patients with increased antipsychotic drug levels after COVID-19 vaccinations mediated via inflammatory processes. The intensity of inflammatory reactions strongly varies across patients. Hence, COVID-19 vaccinations may constitute an unpredictable risk factor for increased drug levels. Therapeutic drug monitoring can help to prevent safety risks in those patients with supra-therapeutic drug levels.

2.
Laryngo- Rhino- Otologie ; 101:S296, 2022.
Article in English | EMBASE | ID: covidwho-1967676

ABSTRACT

Introduction Sudden sensorineural hearing loss (SSNHL) is defined as a hearing loss occurred within 3 days with decreasing of hearing level at least 30 dB in as a minimum three frequencies. The exact etiology and pathology of SSNHL is still unknown and the causes can be identified in only 10 to 15 percent of diagnosed cases. Methods Goal: To study the correlation of SSNHL and Covid-19 infections. We selected 10 patients who came to our clinic with SSNHL and who recently recovered from Covid-19 infection. They were admitted to clinic on 20-25th days of their COVID-19 infection, all selected patients were received remdesivir, intravenous steroids and plasma exchange to treat their COVID-19 infection and clinically improved. During 1-3 weeks of the treatment their noticed left-sided tinnitus and SSNHL. They all had no previous ear pathology. Results On ear examination external auditory canal canals and tympanic membranes are normal, were found negative Rinne's test on left side and Weber's test lateralising to the opposite side, tympanogram type A, no acoustic reflexes on left ear. When performed laboratory tests after 2 months of post-onset of SSNHL in all patients were found a positive COVID-19 IgG antibodies which showing initial time of SSNHL incidence. Such as, was not found any other risk factors for evolving SSNHL except Covid-19, so we came to conclusion, that the patient's SSNHL is complication of COVID-19 infection and probably this infection can cause unilateral intralabyrinthine or intracochlear hemorrhage, damages the inner ear's delicate hair cells and/or the blood supply.

3.
Journal of Hepatology ; 77:S14, 2022.
Article in English | EMBASE | ID: covidwho-1967492

ABSTRACT

Background and aims: Approval of a drug therapy for NASH requires a very good safety/tolerability profile and acceptable therapeutic index. MAESTRO-NAFLD-1 (NCT04197479) is a randomized doubleblind (DB) Phase 3 clinical trial of placebo (PBO) versus resmetirom (RES), a once-a-day oral selective thyroid hormone receptor β agonist, in >1100 patients with NAFLD with safety as the primary end point. Method: Enrollment was Dec 2019 to Oct 2020 at 79 US sites. Requirements included 3 metabolic risk factors, fibroscan (FS) ≥5.5 kPa/CAP≥280 dBm, MRI-PDFF≥8%. Randomization was 1:1:1:1 to 3 DB arms, PBO, 80 or 100 mg RES (n = 972) or an 100 mg open label (OL) arm (n = 171). The primary objective was to evaluate the safety and tolerability of 80 or 100 mg RES versus PBO measured by the incidence of adverse events (AEs). Results: At baseline the DB safety population (n = 969) was age 55.9 (11.8);female, 54.4%, white 88.6%;hispanic 34.7%;BMI 35.3 (6.0) type 2 diabetes 49%, hypertension 76.1%, dyslipidemia 87.9%;FS 7.4 (4.7) kPa. Discontinuations (22.5%) did not differ by treatment, most patient decision (pandemic related). DB compliancewas impacted by COVID drug kit delays. AE withdrawals were 80 mg, 2.4%;100 mg, 2.8%;PBO, 1.3%. The primary objective was met. TEAEs were 80 mg, 88.4%;100 mg, 86.1%;PBO, 81.8%. TEAEs ≥grade 3 severity were 80 mg, 7.6%;100 mg, 9.0%;PBO, 9.1%. AEs in excess of PBOwere grade 1–2 AEs of diarrhea (80 mg, 23.5%;100 mg, 31.2%;PBO, 13.8%) and nausea (80 mg, 11.9%;100 mg, 18.2%;PBO, 7.9%), in the first few weeks. ALT increases ≥3XULN were 80 mg, 0.61%;100 mg, 0.31%;PBO,1.6%. Therewere no changes in bodyweight or HR. BP decreased by 2–3 mmHg in the RES arms. Key 2o end points were met (Table). Comparative mean reduction in FS VCTE was not significant;a responder analysis of FS and MRE showed significant reductions with RES treatment. Conclusion: RES achieved the primary safety end point in this 52- week Phase 3 NAFLD clinical trial that identified patients by metabolic risk and non-invasive imaging. Key 2o end points were met including LDL-C, ApoB, triglycerides, MRI-PDFF, FS (CAP).(Table Presented) 1MRE combined RES groups.

4.
Radiotherapy and Oncology ; 170:S1024-S1025, 2022.
Article in English | EMBASE | ID: covidwho-1967471

ABSTRACT

Purpose or Objective external beam whole breast irradiation (WBI) for low-risk early-stage breast cancer patients after breast conserving surgery. We present the experience at our center treating patients with PBI using an IORT technic with Xoft® Axxent® Electronic Brachytherapy (eBx®) System®. Materials and Methods Between April 2019 and August 2021, 44 patients diagnosed with low-risk early-stage breast cancer who met international criteria for PBI, received IORT in a single fraction of 20 Gy to the tumor bed after lumpectomy. Toxicities and follow up were prospectively registered. Results 3 of the 44 initial patients were discarded for IORT due to non-compliance with the minimum safety distance (<1 cm) between the applicator and the skin. Of the remaining patients, 32/41 patients (78%) received a PBI, while 9/41 (22%) required adjuvant WBI due to adverse prognostic factors identified on the definitive biopsy. The most frequent risk factor was close resection margins (<2mm), present in 8/9 patients (88,8%). Two patients additionally presented sentinel node involvement and in 1 case no axillary sample was obtained. The most used IORT applicator was the 3-4 cm balloon, with most likely filling volumes between 30cc and 40 cc. For all treatments, the mean filling volume of the applicator was 45 cc and there were no complications during the irradiation procedure. Surgical bed seroma was the most common acute effect, observed in 29/41 patients (70,7%), although only 8/29 (27,5%) required drainage. We observed wound dehiscence in 7/41 cases (17%), inflammatory complications requiring antibiotics in 9/41 cases (19,5%), and 4/41 cases of hematoma (9,7%). Regarding late toxicity, at the time of the analysis it was only assessable for 37 patients. We observed low rates of local grade I fibrosis (21,6%) and only 1 case of tumor bed G2 fibrosis. Hyperpigmentation G1 was observed in 8,1% of patients and 10,8% presented occasional mild local discomfort. With median follow-up of 17.14 months (range 4-29 months), no relapses were observed, but 1 patient died from covid-19 pneumonia. Conclusion Intra operative PBI with Xoft® Axxent® Electronic Brachytherapy (eBx®) System® is a feasible approach to treat low-risk early-stage breast cancer patients. Our preliminary results show that it presents advantages over conventional WBI allowing for less toxic and shortened treatment courses while maintaining good local tumor control.

5.
Gastroenterology ; 162(7):S-1280, 2022.
Article in English | EMBASE | ID: covidwho-1967447

ABSTRACT

Introduction: Solid organ transplant recipients have 2-5 times increased mortality after coronavirus disease 2019 (COVID-19) infection as compared to general population. These patients also have lower protection after vaccination against COVID-19. Therefore, the risk of breakthrough infection and hospitalization are also significantly higher in this patient population. Studies on efficacy of COVID-19 vaccination in post liver transplant (LT) patients are limited. We aimed to investigate the rate of mortality, hospitalization, and breakthrough infection and assess possible risk factors in COVID-19 infection mortality post LT. Methods: A retrospective chart review study. All post liver transplant patients at Carolinas Medical Center (CMC) who were tested positive for respiratory syndrome coronavirus 2 (SARS-CoV- 2) PCR test from Dec. 2020 (when first COVID-19 vaccine was approved in the US for emergency use authorization) until Nov. 2021 were included in this study. Breakthrough infection was defined as COVID-19 infection ≥14 days after full vaccination. Data was analyzed using Prism (GraphPad Software, San Diego, CA) and reported as mean ± SEM. T- test and chi square tests were applied for analyzing the data. Results: Thirty-six patients were identified and 66.1±9.6 months post liver transplantation (LT). Mean age was 61.2±1.6 years-old, male (72.2%) and Caucasian (91.6%). Ten patients (27.7%) expired. Chronic kidney disease (CKD) was present in 70.0% of expired patients as compared to 53.3% of recovered (p=0.0003). Type 2 diabetes (T2DM) was present in 70.0% vs. 25.0% of expired and recovered patients, respectively (p<0.0001). Hypertension (HTN) was present in 90.0% vs. 55.0% of expired and recovered patients, respectively (p<0.0001). No statistically significant difference was observed in weight of expired vs. recovered patients (50% vs. 65% obesity;p=0.4). Only 9 patients were vaccinated. Breakthrough infection rate was 25% and 2/9 (22.2%) died vs. 29.6% of non-vaccinated patients (p=0.4). COVID-19 infection occurred 4.9±0.86 months after vaccination. Hospitalization (44.4% vs. 55.5%) and ICU admission (22.2% vs. 37.0%) was not statistically different among vaccinated and non-vaccinated patients. Conclusion: T2DM and CKD were significantly higher among COVID-19 infected patients who expired, which are similar risk factors in patients who have not had a liver transplant. However, obesity was not significantly correlated with mortality as it was shown before in non-immunocompromised population. Although COVID-19 vaccine is effective in post LT patients, larger studies are warranted to evaluate its efficacy in this population. Our study also highlights that the efficacy of current COVID-19 vaccines decreases in 4-6 months after full vaccination, which warrants evaluating the efficacy of booster dose(s) in post LT patients

6.
Gastroenterology ; 162(7):S-1279-S-1280, 2022.
Article in English | EMBASE | ID: covidwho-1967445

ABSTRACT

Background and Aims: While the relationship between elevated liver enzymes and COVID- 19 related adverse events is well-established, a liver-dependent prognostic model that predicts the risk of death is helpful to accurately stratify admitted patients. In this study, we use a bootstrapping-enhanced method of regression modeling to predict COVID-19 related deaths in admitted patients. Method: This was a single-center, retrospective study. Univariate and multivariate Cox regression analyses were performed using 30-day mortality as the primary endpoint to establish associated hepatic risk factors. Regression-based prediction models were constructed using a series of modeling iterations with an escalating number of categorical terms. Model performance was evaluated using receiver operating characteristic (ROC) curves. Model accuracy was internally validated using bootstrapping-enhanced iterations. Results: 858 patients admitted to hospital with COVID-19 were included. 78 were deceased by 30 days (9.09%). Cox regression (greater than 20 variables) showed the following core variables to be significant: INR (aHR 1.26 95%CI 1.06-1.49), AST (aHR 1.00 95%CI 1.00- 1.00), age (aHR 1.05 95%CI 1.02-1.08), WBC (aHR 1.07 95%CI 1.03-1.11), lung cancer (aHR 3.38 95%CI 1.15-9.90), COPD (aHR 2.26 95%CI 1.21-4.22). Using these core variables and additional categorical terms, the following model iterations were constructed with their respective AUC;model 1 (core only): 0.82 95%CI 0.776-0.82, model 2 (core + demographics): 0.828 95%CI 0.785-0.828, model 3 (prior terms + additional biomarkers): 0.842 95%CI 0.799-0.842, model 4 (prior terms + comorbidities): 0.851 95%CI 0.809-0.851, model 5 (prior terms + life-sustaining therapies): 0.933 95%CI 0.91-0.933, model 6 (prior terms + COVID-19 medications): 0.934 95%CI 0.91-0.934. Model 1 demonstrated the following parameters at 0.91 TPR: 0.54 specificity, 0.17 PPV, 0.98 NPV. Bootstrapped iterations showed the following AUC for the respective models: model 1: 0.82 95%CI 0.765-0.882, model 2 0.828 95%CI 0.764-0.885, model 3 0.842 95%CI 0.779-0.883, model 4: 0.851 95%CI 0.808-0.914, model 5: 0.933 95%CI 0.901-0.957, model 6: 0.934 95%CI 0.901- 0.961. Conclusion: Model 1 displays high prediction performance (AUC >0.8) in both regression-based and bootstrapping-enhanced modeling iterations. Therefore, this model can be adopted for clinical use as a calculator to evaluate the risk of 30-day mortality in patients admitted with COVID-19. (Table Presented)

7.
Gastroenterology ; 162(7):S-1249, 2022.
Article in English | EMBASE | ID: covidwho-1967435

ABSTRACT

Background: The presence of comorbidities has been associated with worse outcomes in patients with SARS-CoV2 virus infection. It has been reported that patients with cirrhosis and COVID-19 showed higher mortality rates than patients without cirrhosis. This study aims to analyze the case fatality rate (CFR) in patients with cirrhosis and COVID-19, as well as the implications that this infection has on the incidence of acute decompensations. Methods: A multicenter prospective cohort study was conducted in 13 COVID-19 centers in Mexico. Patients with cirrhosis and COVID-19 were compared with randomly selected age- and sex-matched controls with COVID-19 without cirrhosis. The characteristics and development of decompensation in patients with cirrhosis were analyzed. Results: A total of 96 patients with cirrhosis and COVID-19 and 193 controls with COVID-19 were studied. Age (56.80 vs. 56.45 years, respectively;P=0.80) and male sex proportion (65.6% vs. 65.6%, respectively;P=0.98) was comparable between the two groups. Patients with cirrhosis and COVID-19 had a higher CFR than patients without cirrhosis (29.2% versus 19.2%, respectively, P=0.05) (Figure 1). There were no differences in the use of invasive mechanical ventilation, vasopressors, or the hospitalization length. The most common decompensations were worsening ascites (43%), encephalopathy (42%), and variceal bleeding (13%). Acute kidney injury occurred in 60% of patients with cirrhosis and 30% fulfill criteria of hepatorenal syndrome. Conclusion: Cirrhosis may impose a significant death risk factor in moderateto- severe COVID-19. Moreover, COVID-19 might be an important trigger of acute decompensation of cirrhosis, which could influence short-term CFR. (Figure Presented)

8.
Gastroenterology ; 162(7):S-1081, 2022.
Article in English | EMBASE | ID: covidwho-1967405

ABSTRACT

Background: The spread of COVID-19 has had a major impact on the health of people worldwide. The clinical background and clinical course of Japanese inflammatory bowel disease (IBD) patients with COVID-19 remains unclear. Patients with IBD are often on immunosuppressive therapy, and there has been concern about the severity of COVID-19. We conducted the multicenter registry study of Japanese patients with inflammatory bowel disease with COVID-19. Methods: This study is an observational cohort of Japanese IBD patients diagnosed with COVID-19, and was registered in the UMIN Clinical Trials Registry (ID UMIN000040656). Data on age, gender, IBD (classification, treatment, and activity), COVID-19 symptoms and severity, and treatment of COVID-19 were analyzed. Results: From 72 facilities in Japan, one hundred eighty-seven patients were registered from June 2020 to October 2021 (Table1). The estimated incidence ratio of COVID19 in Japanese IBD patients was 0.61%. The median age (±SD) was 42.0±15.6, 4.8% of patients were obese with BMI >30, 7.0% were current smokers, and 31.0% had some complications. Of the patients enrolled, 104 had ulcerative colitis, 74 had Crohn's disease, 3 had IBD-Unclassified, and 6 had intestinal Behcet's disease. The majority of IBD patients with COVID-19 (73%) were in clinical remission. COVID-19 cases were most common in the 20-50 age group, but the COVID-19 severity rate according to WHO classification tended to be higher in the elderly than in middle-aged persons (Figure1). In Japan, the second SARS-CoV-2 vaccination rate jumped from 0% to 90% in just four months from May to September 2021 because the elderly received vaccination preferentially. Therefore, during the fifth wave of the epidemic (July-September 2021), infections among elderly IBD patients were particularly low compared with the younger. According to WHO classification regarding COVID-19 severity, 172 patients (92%) had non-severe, 12 (6%) were severe including serious conditions. Most IBD patients (UC and CD) with COVID-19 had no change in disease activity. A logistic regression analysis stepwise method revealed that older age, higher BMI, and steroid use were risk factors for COVID-19 severity. Six of eight patients who had COVID-19 after vaccination were receiving anti-TNF-alpha antibodies. Conclusion: The estimated incidence ratio of COVID19 in Japanese IBD patients was 0.61%. Age, BMI, and steroid use were associated with COVID-19 severity in Japanese IBD patients. (Table Presented) Table1. Case profile of the registered patients (Figure Presented) Figure1. The Age distribution of patients with COVID-19 and the COVID-19 severity rate

9.
Gastroenterology ; 162(7):S-667-S-668, 2022.
Article in English | EMBASE | ID: covidwho-1967357

ABSTRACT

Background: The COVID-19 pandemic has allowed for the rapid expansion of telemedicine to continue to provide patients access to medical care while minimizing in-person contact. Studies have suggested that telemedicine may worsen healthcare disparities in certain segments of the population, driven in part by lack of access to appropriate technology or poor technological literacy. The aim of this study was to determine the impact of telemedicine on clinic no-show rates in the ambulatory gastroenterology setting. Methods: Single-center retrospective study of no-show visits for ambulatory in person (IP) and Telemedicine clinic appointments comparing the 15 months pre-pandemic to the first 15 months of the pandemic using an administrative database. The pre-pandemic cohort (PPC) was from January 1, 2019 to March 15, 2020 and the pandemic cohort (PC) was from March 16, 2020 to June 1, 2021. Race/ethnicity and preferred language were self-reported by patients during registration. Insurance types were categorized into private or public insurance. Statistical analysis was performed using descriptive statistics and univariate analysis. Results: There were 1841 no-show visits during the study period, 963 (52.3%) of which were PPC and 888 (48.2%) PC. In the PPC, 62.5% of these no-show visits were IP, whereas 86.8% were VV during the pandemic. The overall no-show rate decreased during the pandemic from 9.8% to 6.9% (p <0.0001). The no-show rate decreased in the PPC amongst Black (11.9 vs 8.6;p = 0.002) and Non-Hispanic White (53.8 vs 48.3, p=0.018) patients, but increased in Asian patients (8.2% vs 11.9%, p=0.007). There was a decrease in the proportion of no-show new patient appointments during the pandemic (28.2 vs 18.4, p <0.0001) along with telephone visits (22.5 vs 10.5, p<0.0001). Age >60 (OR 0.8, 95% CI 0.69-0.91, p=0.002), Hispanic ethnicity (OR 0.55, CI 0.46-0.66, p<0.00001), non-English speaking (OR 0.62, CI 0.47-0.83, p= 0.001), and follow-up appointments (OR 0.34, CI 0.28-0.4, p<0.00001) were associated with lower odds of showing up for an appointment during the pandemic period. Conclusion: When utilizing telemedicine as the primary modality for ambulatory clinic visits, there was an overall decrease in the proportion of no-show appointments during the pandemic. No show rates were improved for Black and non-Hispanic white patients but worsened for Asian patients. Elderly, Hispanic ethnicity and non-English speaking patients were also at higher risk of no-show visits during the pandemic. Future studies should aim to identify the risk factors within these populations that can be modified to improve access to healthcare. (Table Presented)

10.
Gastroenterology ; 162(7):S-600-S-601, 2022.
Article in English | EMBASE | ID: covidwho-1967348

ABSTRACT

Background This study aimed to compare the risk of COVID-19 in patients with IBD versus the general population, and to evaluate predictors of infection acquisition, progression to severe forms, and risk of developing persistent COVID-19. We also assess the differences between cases across the different COVID-19 pandemic waves in our target population. Methods This single-center prospective, cohort study included consecutive IBD patients diagnosed of COVID-19 either by a positive polymerase chain reaction test and/or antigen test in nasopharyngeal swabs, or by anti-SARS-CoV-2 antibodies, and that they had a followup of at least 4 months. Using logistic regression, we evaluated cases versus IBD controls included in the IBD Unit database for predictors of COVID-19 acquisition. COVID-19 cases were distributed according to pandemic waves. Cox regression analysis was used for predictors of severe and persistent COVID-19. Results By May 31, 2021, 160 out of 1911 IBD patients (8.3%) were diagnosed with COVID-19. IBD patients had a similar adjusted incidence of COVID-19 (OR 0.94;95% CI 0.86-1.02;P=0.42), and a similar associated mortality ratio (OR 0.83;95% CI 0.6-1.06;P=0.48), compared to the general population. In multivariable analysis, treatment with biologics was associated with a higher risk (OR 2.22, 95% CI 1.54-3.2, P<0.001), and treatment with salicylates with a lower risk (OR 0.71, 95% CI 0.50-0.99, P=0.048) of contracting COVID-19. Sixty-two COVID-19 cases were diagnosed during the first wave of pandemic (until the end of June 2020), and 54 and 44 cases during the second and third waves (until the end of December 2020 and May 2021, respectively). (Figure 1) In multivariate analysis, first wave cases were associated with a higher risk of progression to severe forms of infection (OR 4.76, 95% CI 1.83-12.37, P= 0.001), and development of persistent COVID-19 (OR 2.4, 95% CI 1.16-4.95, P=0.018). Twenty-nine patients (18.1%) required hospitalization and were classified as severe COVID- 19, which was associated in multivariable analysis with age>48 (HR 3.68, P=0.007), cases diagnosed in the first wave (HR 6.04, P<0.001), and comorbidities (evaluated with Duke Severity of Illness Checklist [DUSOI], P<0.001). (Table 1) During a median follow-up of 8.4 months, 68 patients (42.5%) were diagnosed with persistent COVID-19. Multivariable analysis identified UC (OR 2.00, 95% CI 0.99-4.03, P=0.053), comorbidities (P=0.090), and being diagnosed during the first wave (OR 2.48, 95% CI 1.23-5.00, P=0.011) as risk factors for persistent COVID-19. Conclusion IBD patients have a similar risk of COVID- 19 and associated mortality as the general population. Cases diagnosed during the first wave of the pandemic had severe and persistent forms of COVID-19 more frequently. Age and comorbidity were the main risk factors for severe forms of the disease. (Figure Presented) (Table Presented)

11.
Gastroenterology ; 162(7):S-600, 2022.
Article in English | EMBASE | ID: covidwho-1967347

ABSTRACT

Introduction Despite the global impact of the COVID-19 pandemic, vaccine hesitancy remains common in the general public. Adults who were on immunosuppressive medications were among the earlier groups recommended by the Centers for Disease Control and Prevention to receive the COVID-19 vaccine. It is unclear whether similar vaccine hesitancy is seen in patients with inflammatory bowel disease (IBD), especially those who are on immunosuppressive medications. We sought to examine rate of vaccine hesitancy in patients with IBD as well as associated demographic and socioeconomic risk factors. Methods We performed a retrospective chart review in November 2021 of 1383 patients with IBD seen at University of Maryland Medical Center, a tertiary referral medical center, between November 2020 and October 2021. Data obtained from patients' charts included demographics;disease characteristics including disease phenotype, number of years since diagnosis, number of IBD-related surgeries;and IBD therapy including biologics, thiopurines or methotrexate, corticosteroids, and mesalamine. Information on COVID vaccination and routinely recommended vaccines were also collected which included annual influenza vaccine, Prevnar/ Pneumovax, and Shingrix. Those with no recorded COVID-19 vaccine were contacted by nurses for updated vaccine status. Results 72% (990/1383) of patients in this cohort were on a biologic, 17% (232/1383) were on corticosteroids, and 16% (224/1383) were on thiopurine or methotrexate, indicating a cohort of patients with moderate to severe disease phenotype. Fifty-seven percent (792/1383) of patients received either the Pfizer, Moderna, or Johnson & Johnson vaccine. In a multivariate regression analysis, COVID vaccination was found to be positively associated with a number of factors including older age (p-value= 4.92e-4), female sex (p=1.61e-3), Asian and Caucasian races (p=9.13e-3, 6.47e-06), number of years since diagnosis (p=2.73e-2), number of clinic visits in the past 12 months (p= 2.66e-10), and biologic use (p=4.41e-4). This remained the case while controlling for IBD disease type;marital status;insurance (Commercial vs Medicaid vs Medicare);and tobacco, alcohol, and substance use history. Patients who received other routinely recommended vaccines (influenza, Prevnar/Pneumovax, Shingrix) were not more likely to receive COVID- 19 vaccine. Discussion Although majority of patients in this cohort were on an immunosuppressive medication, COVID-19 vaccination rate is only recorded to be at 57%. Number of clinic visits, presumably more education and conversation with healthcare providers, had a positive impact on COVID-19 vaccination. In this cohort, younger adults, males, and African Americans were less likely to receive COVID-19 vaccine. Healthcare providers need to recognize these potential risk factors for COVID-19 vaccine hesitancy.

12.
Gastroenterology ; 162(7):S-599, 2022.
Article in English | EMBASE | ID: covidwho-1967345

ABSTRACT

Background Coronavirus disease 2019 (COVID-19) can increase the risk of thrombosis, cardiovascular events, and kidney injury, but risks among patients with inflammatory bowel disease (IBD) remain unknown. We aimed to characterize risk for these complications among patients with IBD who developed COVID-19. Methods We analyzed complications of COVID-19 in patients reported to the Surveillance Epidemiology of Coronavirus Under Research Exclusion in Inflammatory Bowel Disease (SECURE-IBD) database prior to November 15, 2021. Our primary outcome was a composite of thrombotic complications (peripheral venous thrombosis, pulmonary embolism, thrombotic stroke, and peripheral arterial thrombosis), cardiovascular complications (new arrhythmia, heart failure, myocarditis/pericarditis, and vasculitis), and renal complications (acute kidney injury). Covariates included cardiovascular disease (including stroke), cardiovascular risk factors (diabetes mellitus, hypertension, or smoking), pulmonary disease (asthma, chronic obstructive pulmonary disease, or other chronic lung disease), thrombotic risk conditions (cancer), chronic kidney disease, chronic liver disease, “other” comorbidities, and COVID-19 vaccination with at least one dose. Multivariable analyses assessed the independent effect of variables significant in univariate analyses. Results Among 4,923 patients reported to SECURE-IBD, 79 (1.6%) had thrombotic, cardiovascular, and/or renal complications. There were 45 (0.9%) reports of acute kidney injury, 24 (0.5%) of arrythmias, 8 (0.2%) of peripheral venous thrombosis, 5 (0.1%) each of heart failure, myocarditis/pericarditis, and pulmonary embolism, and 1 (0.02%) each of vasculitis, peripheral atrial thrombosis, and thrombotic stroke. In univariate analyses, complications were more common in patients who were older (p < 0.01), black (p < 0.01), and on corticosteroids (p < 0.01) (Table 1). Patients with severe IBD were more likely to have complications than patients in remission (p < 0.01), as were those with more comorbidities (p < 0.01). Cardiovascular disease, cardiovascular risk factors, pulmonary disease, and chronic renal disease were associated with increased risk (p < 0.01 each). There was no association with vaccination status (p = 1). In multivariate analyses, age (aOR 1.04 [1.03, 1.06]), black race (aOR 4.02 [1.53, 10.55]), severe IBD (aOR 3.21 [1.31, 7.86]), corticosteroid use (aOR 3.63 [1.85, 7.12]), and one (aOR 2.33 [1.10, 4.91]), two (aOR 4.24 [1.42, 12.65]), and three or more (aOR 13.36 [3.48, 51.32]) comorbidities were significant predictors of complications (Table 2). Discussion Thrombotic, cardiovascular, and renal complications from COVID-19 were uncommon among patients with IBD. Patients with older age, black race, corticosteroid use, severe IBD, and greater number of comorbidities may require closer monitoring if they develop COVID-19. (Table Presented)

13.
Gastroenterology ; 162(7):S-595, 2022.
Article in English | EMBASE | ID: covidwho-1967338

ABSTRACT

Backgrounds Inflammatory bowel disease (IBD) is associated with a 2-to 3-fold increased risk of venous thromboembolism (VTE) and the risk is even higher in hospitalized IBD patients. Elevated risk of VTE has also been noted in patients with Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2). In this study, we aimed to assess the risk of VTE among hospitalized IBD patients who had exposure to SARS-CoV-2 compared to those with no exposure. Methods All hospitalized patients with IBD including Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) across Banner Health in Arizona with and without COVID-19 between March 2020 to October 2021 were included in the study. Baseline clinical demographics, comorbidities, risk factors associated with VTE, and rate of VTE were compared between groups using Wilcoxon-rank sum test, chi-square and Fisher's Exact tests as appropriate. The impact of COVID-19 on VTE was quantified using regression analysis. Of note, UC and IBD-U patients were grouped together for analyses. Results The study cohort of 8,977 (4643 CD, 3960 UC, 374 IBD-U) IBD patients had a median age of 55 (interquartile range [IQR], 37-69) years. 7% (n= 631) of hospitalized IBD patients contracted COVID-19 and it was more frequent in Hispanics (17.6% vs 9.4%, p<0.001). Baseline characteristics were similar among IBD patients with and without COVID-19 except steroid use (24% vs 15%, p<0.001), obesity (19% vs 12%, p<0.001), chronic kidney disease (16% vs 10%, p<0.001), and heart failure (13 % vs 6%, p<0.001) which were more frequent in patients with COVID-19 (Table). VTE rate was higher among IBD patients with COVID-19 compared to those without [8.1% (n= 51) vs. 4.4% (n=367), P< 0.001]. This association was still significant after multivariate adjustment for age, sex, race, IBD type, tobacco use, obesity, and other comorbidities (OR 1.43. 95% CI 1.04-2.0, P =0.03). UC compared to CD, was associated with greater VTE risk (OR 1.38. 95% CI 1.10-1.7, P =0.002). Similar association was also noted with tobacco use, obesity, malignancy, chronic kidney disease, and heart failure. Despite higher rate of COVID-19 in Hispanics, there was no increased risk of VTE (OR 0.95, 95% CI 0.7-1.4, P =0.768) in this group (Figure). Conclusions COVID-19 is an independent risk factor for VTE in hospitalized patients with IBD. Our findings suggest not only the need for early detection of VTE but also aggressive pharmacological prophylaxis against VTE in this population. Further studies are needed to evaluate the benefit of post-discharge thromboprophylaxis in this cohort. (Table Presented) (Figure Presented)

14.
Gastroenterology ; 162(7):S-564-S-565, 2022.
Article in English | EMBASE | ID: covidwho-1967331

ABSTRACT

Introduction: SARS-CoV-2, the causative organism for COVID-19, uses ACE2 to enter human cells. Pancreatic ductal, acinar and islet cells also express ACE-2;therefore, involvement of the pancreas is plausible. Elevated lipase and cases of acute pancreatitis related to COVID-19 have been reported in previous studies. Patients with chronic pancreatitis (CP) have a low-grade inflammatory state and pancreatic parenchymal fibrosis, which may predispose them to pancreatic injury and worse COVID-19 outcomes. However, large studies reporting the incidence and outcomes of COVID-19 in patients with chronic pancreatitis are lacking. Methods: A retrospective cohort study was performed using TriNetX (a multiinstitutional research network). Prevalence and Incidence Rate Ratio (IRR) (cases/ personday) of COVID-19 were charted for patients with CP between January 2020 and July 2021. Patients diagnosed with COVID-19 during this period were stratified into two groups based on the presence of CP (CP cohort and non-CP cohort). Outcomes of COVID-19 in the CP cohort were compared to the non-CP cohort after 1:1 propensity score matching (PSM) for age, gender, race, diabetes, ischemic heart disease, hypertension, lung disease, cirrhosis, smoking, and alcohol abuse. Results: A total of 4420 patients with CP diagnosed with COVID-19 were identified and compared to 1,169,773 patients without CP. A large proportion of patients with CP were diagnosed with COVID-19 and the IRR peaked between December 2020-January 2021 and then declined subsequently (Figure 1). Patients in the CP cohort were older and had a higher prevalence of multiple comorbidities (Table 1). In crude, unmatched analysis, COVID-19 patients with CP had higher mortality (4.96% vs 2.16%;RR: 2.29, 95% CI:2.02-2.61), need for hospitalization (RR: 3.64, 95% CI:3.47-3.83), critical care need (RR: 3.16, 95% CI:2.86-3.50), and acute kidney injury (AKI) (RR: 3.96, 95% CI:3.71-4.24) compared to patients without CP (Table 1). No residual imbalance was noted (SMD <0.1 for all covariates) after PSM. After PSM, no difference in mortality or rate of mechanical ventilation was noted, however, patients with CP had a significantly higher risk of hospitalizations (RR: 1.51, 95% CI:1.39-1.64) and AKI (RR: 1.28, 95% CI:1.16-1.42) (Table 1). No difference in mortality, hospitalization, and critical care was noted for patients with alcohol-induced CP vs other etiologies. Conclusion: Patients with CP have high mortality and risk of poor outcomes after COVID-19 due to the presence of a significant burden of comorbidities and risk factors for severe COVID-19. In addition, CP is independently associated with higher healthcare utilization and complications such as AKI in patients with COVID-19. (Figure Presented) Figure 1: Prevalence and Incidence rate (cases/person-day) of COVID-19 in patients with chronic pancreatitis (Table Presented) Table 1. Characteristics and outcomes of patients with COVID-19 in matched and unmatched Chronic Pancreatitis (CP) and non-CP cohorts

15.
Gastroenterology ; 162(7):S-488-S-489, 2022.
Article in English | EMBASE | ID: covidwho-1967322

ABSTRACT

Background: Gastrointestinal (GI) bleeding is one of the impactful complications in patients hospitalized from Covid-19 infection. The previous study showed the risk factors of overall (upper and lower) GI bleeding in patients with Covid-19 infection but no study focused on patients with upper GI bleeding (UGIB). This study aimed to identify the risk factors and outcomes of patients who were hospitalized from Covid-19 infection and developed UGIB. Methods: This is a retrospective in university-hospital which enrolled patients who were admitted due to Covid-19 infection and developed UGIB between April and October 2021. The primary outcome was the associated factors of high risk UGIB defined by having hematemesis or fresh blood from NG tube or hematochezia plus hemodynamic instability. The secondary outcomes were etiologies of high risk UGIB and mortality in those patients. Results: Of 7,214 patients hospitalized though the period, 49 patients (0.7%) had evidence of UGIB. The majority were male (63.3%) with mean ages of 70+12 years. Twenty-seven from 49 patients (55.1%) had mechanical ventilator, 40 patients (81.6%) received systemic corticosteroids, and 13 patients (26.5%) received anticoagulants for venous thromboembolic prophylaxis. Seven from 49 patients (14%) had high risk UGIB;5 hematemesis (71.4%), 1 fresh blood from NG tube (14.3%), and 1 hematochezia (14.3%). There was no significant difference in term of number of patient taking antiplatelets, anticoagulants, or steroids and severity of COVID-19 infection (e.g. Mechanical ventilator needed) between two groups. The emergency endoscopy was performed in 6/7 (85.7%) patients and showed 5 peptic ulcer with non-bleeding visible vessel and 1 gastric lymphoma with blood oozing (Table 1). All 6 patients underwent endoscopic hemostasis including adrenaline injection, bipolar coaptation, clipping, Hemospray®, and over-the-scope clip. There was a robust result when conducting uni- (p=0.005) and multi-variate analysis (OR 6.38;95%CI 1.04-38.92;p= 0.045) that an absence of proton-pump inhibitor (PPI) use was the significant risk factor of high risk UGIB in targeted patients (Table 2). The overall mortality rate in patients with UGIB was 20/49 (40.8%) and 1 from 20 patients (5.0%) expired from UGIB due to moribund condition and unsuitable for endoscopy. None of patients with high risk UGIB and underwent therapeutic endoscopy expired during admission. Conclusion: Our study demonstrated that the absence of PPI use was a sole significant risk factor for high risk UGIB which required therapeutic endoscopy in patients with COVID-19 infection. We suggest that PPI prophylaxis should be prescribed in those patients once they need hospitalization regardless of the severity of COVID-19 infection and anticoagulant usage to minimize the severity of UGIB.(Table Presented)

16.
Gastroenterology ; 162(7):S-441-S-442, 2022.
Article in English | EMBASE | ID: covidwho-1967305

ABSTRACT

Introduction: The start of the COVID-19 pandemic in March 2020 led to an increased rate of telehealth visits. Older adults, however, may be more vulnerable to missing appointments given cognitive, physical, and technological gaps. We looked to determine the completion rate of telehealth appointments for older adults with inflammatory bowel disease (IBD), as well as predictors of incomplete appointments. Methods: We conducted a retrospective analysis of all patients with IBD who had at least one telehealth visit at the NYU IBD Center between 3/1/2020-8/31/2021. Only the status of the first telehealth appointment was considered, with an incomplete visit defined as left before being seen, a cancellation or noshow. Medical records were parsed for relevant co-variables, and logistic regression was used to estimate the adjusted association between demographic factors and telehealth appointment completion rates. Results: From 3/1/2020 to 8/31/2021 there were 2,508 patients with inflammatory bowel disease (IBD) who had at least one telehealth appointment, with 1088 (43%) having Crohn's disease (CD), 1037 (41%) having ulcerative colitis (UC), and 383 (15%) with indeterminate colitis (Table 1). Of the 2,508 initial telehealth visits, 519 (21%) were not completed, including 435 (20%) among patients under the age of 60-years as compared to 84 (23%) among patients over the age of 60-years. On multivariable analysis, patients with CD had higher odds of an incomplete appointment as compared to patients with UC (adjOR 1.37, 95%CI 1.10-1.69). Additionally, females had significantly higher odds of an incomplete appointment vs. males (adjOR 1.26, 95%CI 1.04-1.54), and patients who had a non-1st degree relative listed as an emergency contact also had significantly higher odds of an incomplete appointment vs. those with a spouse listed (adjOR 1.69, 95%CI 1.16-2.44;Table 2). Age over 60-years, partnership status, and comorbidities were not associated with appointment completion rates. Among the 361 patients over the age of 60-years who had a telehealth appointment, sex, emergency contact information, IBD subtype, and partnership status were not found to be associated with odds of completing a telehealth appointment. Conclusions: In our study, older patients with IBD were not at higher risk for missed telehealth appointments as compared to younger patients. On multivariable analysis, patients with CD as compared to patients with UC, females as compared to males, and patients who had a non-1st degree relative listed as an emergency contact as compared to those who had a spouse listed were more likely to miss telehealth appointments. Future studies should explore the role of these factors, including the role of social support, in order to design interventions aimed at limiting missed telehealth appointments. (Table Presented) (Table Presented)

17.
Gastroenterology ; 162(7):S-291-S-292, 2022.
Article in English | EMBASE | ID: covidwho-1967287

ABSTRACT

Background: Post-COVID-19 conditions are defined as new, recurring, or ongoing health issues which present weeks after SARS-CoV-2 infection. The gastrointestinal (GI) involvement of COVID-19 suggests that a group of patients with lingering GI symptoms may develop Post-COVID-19 DGBI including irritable bowel syndrome (IBS) (Schmulson M et al. Am J Gastroenterol. 2021;116:4-7). In this study, we aimed to determine the epidemiological features of Post-COVID-19 DGBI. Methods: Subjects with confirmed COVID-19 at least 6 months before the study who had sustained GI symptoms were invited to complete an internet-based survey on Qualtrics, between March and August 2021. The survey included demographics, acute symptoms, comorbidities, as well as Rome IV questionnaire, Generalized Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire (PHQ)-9 for depression. Data was analyzed using ANOVA and multivariate analysis. Findings were reported as percentage or [p-value;(95% odds ratio CI)]. Results: Overall, 164 subjects (70% female, 14% male, and others unknown) with a positive COVID-19 test completed the survey. Among them, 4% were >65 years old and 24% reported hospitalization. Body mass index ³30 was present in 38%, diabetes in 6.7%, and vitamin D deficiency in 11% of the participants. In total, 108 (66%) subjects fulfilled Rome IV criteria for at least one DGBI. Of 108 with DGBI, only 27 (25%) had DGBI before COVID-19;DGBI developed in 81 subjects after COVID-19. The most common Post-COVID-19 DGBI were functional dyspepsia observed in 38 (postprandial distress syndrome n=31, epigastric pain syndrome n=22) followed by IBS in 26 subjects (IBS with Diarrhea n=7, IBS with Constipation n=4, Mixed-IBS n=14, Unsubtyped IBS n=1) (Table-1). The risk factors of severe COVID-19 including age >65, diabetes, and obesity were not associated with developing Post-COVID- 19 DGBI. Seventy (86%) of subjects with Post-COVID-19 DGBI had at least one GI symptom (abdominal pain, nausea/vomiting, and/or diarrhea) in the acute phase of COVID-19. Nausea/ vomiting during the acute illness increased [p-value of 0.02 with 95% OR CI (0.7-10.4)], and BMI less than 25 also increased the odds [p-value of 0.03 (95% OR CI: 0.26-8.4)] for Post-COVID-19 IBS. Anxiety was present in 48% and depression in 65% of subjects with Post-COVID-19 DGBI. Conclusions: Post-COVID-19 DGBI are new entities associated with a high rate of anxiety and depression. Although the majority of those with Post-COVID-19 DGBI reported having GI symptoms in the acute illness, some appeared in subjects without acute GI symptoms. (Table Presented)

18.
Gastroenterology ; 162(7):S-290, 2022.
Article in English | EMBASE | ID: covidwho-1967283

ABSTRACT

Background/Aim The prevalence of marijuana use has increased in the United States as many states have legalized its use. Cannabinoid hyperemesis syndrome (CHS) is an adverse effect that 17-30% of chronic users of marijuana will experience. The impact of the COVID- 19 pandemic on healthcare disruptions has been well established. The effect of the pandemic on vice-associated conditions has been described with increases in alcohol and substance related hospitalizations and mortality. Few studies have evaluated the effect of the COVID- 19 pandemic on CHS with regards to prevalence, admissions, readmissions, and healthcare burden. We sought to identify the impact of the COVID-19 pandemic on CHS using admissions and readmissions as metrics to evaluate healthcare burden. Methods Using Slicer-Dicer, an electronic medical record based self-service query tool, all cases of CHS requiring hospital admissions and those resulting in readmissions were recorded at the university's 3 hospital centers and stratified by gender, age, and location. Data was separated into pre-COVID (August 5, 2018 to April 5, 2020) and post-COVID (April 6, 2020 to October 5, 2021). Additionally, all positive cases of tetrahydrocannabinol (THC) tested were recorded and stratified by postal code. The primary outcome was identification of CHS cases requiring admission from the emergency department pre-COVID and post-COVID. The secondary outcome was identifying any differences in admission and readmission rates pre- COVID and post-COVID. Results A significant increase in total THC positive cases (p = <0.001) was seen with 2485 pre-COVID and 2936 post-COVID cases. 68 patients were diagnosed with CHS pre-COVID and 75 post-COVID. Cases requiring admission were 27.9% pre-COVID CHS and 30.7% post-COVID with a significant increase in admissions from one campus from 0% to 30.4% (p = 0.025). Pre-COVID CHS cases requiring readmission after an index admission was 31.6% and post-COVID was 26.1%. No significance was seen when stratifying the cohorts by gender and age. Discussion Our study shows a significant increase in CHS diagnoses and admissions with an associated significant increase in THC-positivity when comparing the pre-COVID and post-COVID cohorts. This is consistent with prior studies describing an increase in alcohol and substance use during the pandemic. Data from the Centers for Disease Control and Prevention also reveal a 30% increase in substance related deaths in 2020 when compared to 2019. Some suggest that factors related to the pandemic including social isolation stress, substance use in isolation, and decreased access to substance use treatment or programs are contributors. This study highlights the importance to identify this association to better understand and respond to pandemic-associated risk factors for substance use disorders to help alleviate its effect on healthcare burden.

19.
Gastroenterology ; 162(7):S-285-S-286, 2022.
Article in English | EMBASE | ID: covidwho-1967274

ABSTRACT

Background: COVID-19 has been shown to have profound effects on multiple organ systems including the gastrointestinal (GI) tract. Due to the novelty of the virus, it is unknown whether the presence of COVID-19 infection affects the recovery from acute GI bleeds or increases the risk of complications including rebleeding. We aimed to describe the epidemiology of GI bleeding in patients with COVID-19 and to determine if active infection affects GI bleeding outcomes. Methods: We utilized the TriNetX research network, a globally federated health research network (with waiver from Western IRB) which accumulates deidentified data from electronic health records of 41 participating health care organizations located within the United States. We identified initial GI bleeding events in 3 groups: subjects with active COVID-19, recovered COVID-19, and no COVID-19. Primary outcome included rate of recurrent bleed within 30, 60, and 90 days of initial bleed. Secondary outcomes included mortality, ICU requirement, need for endoscopic therapy, and blood transfusion requirement within 30, 60, and 90 days of initial bleed. We also performed a multivariate logistic regression to examine predictors for primary and secondary outcomes. Results: We identified 119,549 patients (Recovered COVID-19 = 715, Active COVID-19 = 1853, No COVID-19 = 116,981), with a mean age of 57.7 years, and 50.04% of patients being female. Active COVID-19 patients were significantly older, predominately male, and predominately African American. Compared to patients without COVID or COVID recovered, patients with active COVID-19 had statistically significant higher rates of recurrent GI bleeding, overall mortality, blood transfusion requirements, and ICU stay within 30, 60, and 90 days of initial bleed (Table 1). Multivariate analyses revealed several risk factors that predicted higher rates of rebleeding, mortality, endoscopic therapy requirement, and ICU stay within 30 days of initial bleed (Table 2). Location of GI bleed (upper versus lower) did not significantly predict higher rebleeding or mortality rates. Conclusion: Based on our results, we determined that patients with active COVID-19 infection who have an initial GI bleed, either upper or lower bleed, are at increased risk for rebleeding and have higher overall mortality, transfusion requirements, and ICU needs compared to patients without infection or who have recovered. Although other factors including comorbidities and medications need to be accounted for, patients with COVID-19 should be monitored closely after an initial GI bleed given high likelihood of poor outcome. (Table Presented) Table 1. Univariate analysis of the outcomes of recurrent bleeding, mortality, blood transfusion requirement, and ICU requirement, within 30, 60 and 90 days of initial bleed event. (Table Presented) Table 2. Multivariate logistic regression analyses of predictors of outcomes of 30-day recurrent bleeding, mortality, endoscopic therapy requirement, and ICU requirement *OR= odds ratio, CI= confidence interval

20.
Gastroenterology ; 162(7):S-276-S-277, 2022.
Article in English | EMBASE | ID: covidwho-1967261

ABSTRACT

Introduction: The global pandemic caused by SARS-CoV-2 (COVID-19) has caused respiratory failure and prolonged intubation in millions of patients. As rates of new hospitalizations in America for COVID-19 decline, clinicians must now address maintenance management of a prolonged illness. Gastrostomy tubes provide a method for enteral feeding over a prolonged period of critical illness and recovery. Understanding outcomes in COVID-19 infected patients after gastrostomy tube placement and rates of long-term enteral feeding requirements is necessary in order to ensure proper allocation of a limited resource and guide patient decision making, and has not been previously studied. We sought to identify clinical factors associated with in-hospital mortality after gastrostomy tube placement and describe rates of long-term gastrostomy tube requirements. Methods: All adult patients undergoing gastrostomy tube placement admitted with COVID-19 between 1/1/2020-5/1/ 2021 at two of Northwell Health tertiary referral centers in New York were identified. We analyzed medical history, hospital course, procedural details, respiratory status at time of gastrostomy, long-term gastrostomy needs as well as risk factors for mortality. Results: A total of 155 patients underwent gastrostomy tube placement during the study period. The mean age was 64 years old, 61% were male, and mean duration of time from intubation to gastrostomy tube placement was 35 days. 73% of patients were ventilator dependent at time of gastrostomy tube placement. (Table 1) Overall, 27% (n=42) of patients expired during index admission after gastrostomy tube placement. In-hospital mortality was associated with ventilator dependence at time of gastrostomy placement (OR 4.8133, 95% CI, p=0.005). In-hospital mortality was not associated with age, elderly status, obesity, medications, or duration of intubation. (Table 2) Among the 113 patients discharged from index admission, post-discharge follow-up was available for 111 patients, with average follow-up time of 127 days. Among patients with follow-up, 61% (n=68) no longer required gastrostomy tube at follow-up visits. Discussion: Gastrostomy tube placement is often performed in patients with prolonged critical illness. With limited clinical clues to predict recovery from COVID- 19 induced respiratory failure, physicians should attempt to optimize respiratory status prior to gastrostomy tube placement, as ventilator dependence is associated with in-hospital mortality after gastrostomy placement. Families should be counseled that the majority of COVID-19 patients surviving the hospitalization will not require long-term gastrostomy tube feeding.(Table Presented)(Table Presented)

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