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1.
Biomedica ; 42(Sp. 2): 59-72, 2022 10 31.
Article in English, Spanish | MEDLINE | ID: covidwho-2100348

ABSTRACT

Introducción. Desde el primer reporte en la provincia de Wuhan (China) en el año 2019, el SARS-CoV-2 se ha diseminado por todo el mundo, provocando un enorme impacto en la salud pública. Para su diagnóstico, la Organización Mundial de la Salud ha incentivado el desarrollo de pruebas rápidas, de simple ejecución, sensibles y específicas, que complementan la RT-qPCR como prueba de referencia. La prueba RT-LAMP ha mostrado ser una excelente alternativa para la detección del SARS-CoV-2 en diferentes biofluidos. OBJETIVO: Validar la técnica RT-LAMP colorimétrica en muestras de hisopado nasofaríngeo previamente confirmadas por RT-qPCR, usando el protocolo Charité, Berlín, Alemania. Materiales y métodos. Un total de 153 muestras de hisopado nasofaríngeo de individuos con sospecha de COVID-19 se sometieron a RT-qPCR y RT-LAMP, usando un estuche comercial colorimétrico (NEB, Germany). La RT-LAMP se practicó con las muestras de ARN extraídas del hisopado nasofaríngeo y con muestras crudas sin previa extracción de ARN. El resultado fue evaluado por un simple cambio de color en la reacción. RESULTADOS: La sensibilidad y especificidad de la técnica RT-LAMP para detectar el gen N del SARS-CoV-2 mediante un set de cebadores previamente reportados (set de Broughton), arrojó valores de 0,97 (0,85-1,00) y 0,81 (0,65-0,92), respectivamente, con un intervalo de confianza del 95%. Otro set de cebadores dirigidos contra otra región del mismo gen (set de Lalli) arrojó valores de sensibilidad y especificidad de 0,96 (0,78-1,00) y 0,77 (0,55-0,92), respectivamente. Sin previa extracción de ARN, se encontró que la sensibilidad fue del 0,95 (0,74-1,00) y la especificidad del 0,88 (0,64-0,99). CONCLUSIONES: Estos resultados evidencian que la técnica RT-LAMP podría considerarse una prueba diagnóstica rápida, de fácil ejecución, libre de equipos sofisticados, sensible y específica, para el diagnóstico del SARS-CoV-2 en muestras de hisopados nasofaríngeos.


Introducción. Desde el primer reporte en la provincia de Wuhan (China) en el año 2019, el SARS-CoV-2 se ha diseminado por todo el mundo, provocando un enorme impacto en la salud pública. Para su diagnóstico, la Organización Mundial de la Salud ha incentivado el desarrollo de pruebas rápidas, de simple ejecución, sensibles y específicas, que complementan la RT-qPCR como prueba de referencia. La prueba RT-LAMP ha mostrado ser una excelente alternativa para la detección del SARS-CoV-2 en diferentes biofluidos. Objetivo. Validar la técnica RT-LAMP colorimétrica en muestras de hisopado nasofaríngeo previamente confirmadas por RT-qPCR, usando el protocolo Charité, Berlín, Alemania. Materiales y métodos. Un total de 153 muestras de hisopado nasofaríngeo de individuos con sospecha de COVID-19 se sometieron a RT-qPCR y RT-LAMP, usando un estuche comercial colorimétrico (NEB, Germany). La RT-LAMP se practicó con las muestras de ARN extraídas del hisopado nasofaríngeo y con muestras crudas sin previa extracción de ARN. El resultado fue evaluado por un simple cambio de color en la reacción. Resultados. La sensibilidad y especificidad de la técnica RT-LAMP para detectar el gen N del SARS-CoV-2 mediante un set de cebadores previamente reportados (set de Broughton), arrojó valores de 0,97 (0,85-1,00) y 0,81 (0,65-0,92), respectivamente, con un intervalo de confianza del 95%. Otro set de cebadores dirigidos contra otra región del mismo gen (set de Lalli) arrojó valores de sensibilidad y especificidad de 0,96 (0,78-1,00) y 0,77 (0,55-0,92), respectivamente. Sin previa extracción de ARN, se encontró que la sensibilidad fue del 0,95 (0,74-1,00) y la especificidad del 0,88 (0,64-0,99). Conclusiones. Estos resultados evidencian que la técnica RT-LAMP podría considerarse una prueba diagnóstica rápida, de fácil ejecución, libre de equipos sofisticados, sensible y específica, para el diagnóstico del SARS-CoV-2 en muestras de hisopados nasofaríngeos.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , SARS-CoV-2/genetics , China , Retrospective Studies
2.
J Infect Public Health ; 15(12): 1403-1408, 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2095663

ABSTRACT

BACKGROUND: Saliva samples may be an easier, faster, safer, and cost-saving alternative to NPS samples, and can be self-collected by the patient. Whether SARS-CoV-2 RT-qPCR in saliva is more accurate than in nasopharyngeal swaps (NPS) is uncertain. We evaluated the accuracy of the RT-qPCR in both types of samples, assuming both approaches were imperfect. METHODS: We assessed the limit of detection (LoD) of RT-qPCR in each type of sample. We collected paired NPS and saliva samples and tested them using the Berlin Protocol to detect SARS-CoV-2 envelope protein (E). We used a Bayesian latent class analysis (BLCA) to estimate the sensitivity and specificity of each test, while accounting for their conditional dependence. RESULTS: The LoD were 10 copies/mL in saliva and 100 copies/mL in NPS. Paired samples of saliva and NPS were collected in 412 participants. Out of 68 infected cases, 14 were positive only in saliva. RT-qPCR sensitivity ranged from 82.7 % (95 % CrI: 54.8, 94.8) in NPS to 84.5 % (50.9, 96.5) in saliva. Corresponding specificities were 99.1 % (95 % CrI: 95.3, 99.8) and 98.4 %(95 % CrI: 92.8, 99.7). CONCLUSIONS: SARS-CoV-2 RT-qPCR test in saliva specimens has a similar or better accuracy than RT-qPCR test in NPS. Saliva specimens may be ideal for surveillance in general population, particularly in children, and in healthcare or other personnel in need of serial testing.

3.
Embase; 26.
Preprint in English | EMBASE | ID: ppcovidwho-346543

ABSTRACT

While significant attention has been paid to the immunologic determinants of disease states associated with COVID-191,2, their contributions to post-acute sequelae of COVID-19 (PASC) remain less clear3-5. Due to the wide array of PASC presentations6, it is critical to understand if specific features of the disease are associated with discrete immune processes, and whether those processes may be therapeutically targeted. To this end, we performed wide immunologic and serological characterization of patients in the early recovery phase of COVID-19 across a breadth of symptomatic presentations. Using high-parameter proteomics screening and applied machine learning (ML), we identify clear signatures of immunologic activity between PASC patients and uncomplicated recovery, dominated by inflammatory cytokine signaling, neutrophil activity, and markers of cell death. Consistent with disease complexity, heterogeneity in plasma profiling reveals distinct PASC subsets with striking divergence in these ongoing inflammatory processes, here termed plasma quiescent (plaq) and inflammatory (infl) PASC. In addition to elevated inflammatory blood proteomics, inflPASC patients display positive clinical tests of acute inflammation including C-reactive protein and fibrinogen, increased B cell activity with extrafollicular involvement coupled with elevated targeting of viral nucleocapsid protein and clinical autoreactivity. Further, the unique plasma signatures of PASC patients allowed for the creation of refined models with high sensitivity and specificity for the positive identification of inflPASC with a streamlined assessment of 12 blood markers. Additionally, refined ML modeling highlights the unexpected significance of several markers of potential diagnostic or therapeutic use for PASC in general, including the peptide hormone, epiregulin. In all, this work identifies clear biological signatures of PASC with potential diagnostic and therapeutic potential and establishes clear disease subtypes that are both easily identifiable and highly relevant to ongoing efforts in both therapeutic targeting and epidemiological investigation of this highly complex disease. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.

4.
New Armenian Medical Journal ; 16(2):25-32, 2022.
Article in English | EMBASE | ID: covidwho-2067787

ABSTRACT

Objectives: to assess the effect-related inflammatory and coagulation biomarkers in pregnancy and their connection with the coronavirus disease of 2019 (COVID-19). Method(s): A prospective case-control study was carried out among normal third-trimester pregnant women admitted to the labor room of Dr. Soetomo General Academic Hospital between January until June 2021. Two classified groups of patients were established in accordance with the result of the RT-PCR test. Demographic, clinical and laboratory results data of the two groups were collected and compared. Result(s): Platelet-to-lymphocyte ratio (PLR) was shown to be the only significant biomarkers found in the expectant with COVID-19, which was 35.8% higher compared to the ones free of COVID-19 [212.25 (157.57-269.37) vs 156.29 (128.55-195.3), p=0.048]. Logistic regression analysis of PLR between groups showed that the level of PLR was an independent factor in pregnant women with COVID-19 (OR 4.483, 95%CI 1.262-15.926). The ROC analysis showed that the PLR cut-off among the expectant was 171.335, with both sensitivity and specificity were 66.7% (p=0.021). The result shows no significant differences in leukocyte count, absolute neutrophils - lymphocyte count and percentage, neutrophil-to-lymphocyte ratio (NLR) and D-Dimer level between pregnant women infected with COVID-19 and free of the virus (p>0.05). Conclusion(s): Intriguingly, physiological adaptation during the course of the third trimester of pregnancy found no difference in most inflammation and coagulation markers, both in the condition of infected COVID-19 or not. The evidence from this single-centre study supports the viewpoint that elevated PLR was associated with independent biomarkers and thereby might be helpful to detect expectant with COVID-19. Copyright © 2022, Yerevan State Medical University. All rights reserved.

5.
Minerva Dental and Oral Science ; 71(4):206-211, 2022.
Article in English | EMBASE | ID: covidwho-2067530

ABSTRACT

BACKGROUND: Aquick diagnosis is crucial in effectively limiting the spread of SARS-CoV-2. The study aims to assess the prevalence of positive rapid tests in private dental practices. METHOD(S): This is an observational study. 532 COVID-19 rapid nasopharyngeal antigen tests were carried out in the Veneto region of Italy. Patients of 4 dental practices in different cities (Caorle, Montebelluna, Treviso and Vicenza) were screened with a rapid test (Rapid Test COVID-19 Ag immunochromatographic assay, Techno Genetics) throughout November and December 2020. All the positive results from rapid tests were further investigated with a molecular test (PCR). All the patients tested showed no symptoms associated with SARS-CoV-2 infection and had already undergone triage and temperature measurement. In total 532 tests were taken: 202 in Caorle (Venice), 130 in Montebelluna (Treviso), 100 in Treviso, and 100 in Vicenza. Statistical analysis was carried with the computing environment Rversion 3.2.1 (R Foundation for Statistical Computing, Vienna, Austria). In particular, R was used for estimating the P value of the x2 test. The test was considered significant if the P value was lower or equal to 0.05. RESULT(S): The prevalence of the rapid tests that resulted positive was 7.14% (38 out of 532 in total, 22 out of 202 in Caorle, 6 out of 130 in Montebelluna, 4 out of 100 in Treviso and 6 out of 100 in Vicenza). Among these patients, 36 tested positive also with a molecular test (94.74%), in particular, 21 in Caorle, 5 in Montebelluna, 4 in Treviso, and 6 in Vicenza. CONCLUSION(S): The prevalence of positive patients screened with a rapid test in private dental practices stands at 7.14% and it was confirmed in most of the patients with molecular tests. Therefore, in high-risk environments like dental practices, it is imperative to follow all the precautionary measures, and having every patient tested with a rapid test could be taken into consideration to limit the spread of COVID-19 infection. Copyright © 2022 Journal of Korean Ophthalmological Society. All rights reserved.

6.
NeuroQuantology ; 20(11):4252-4263, 2022.
Article in English | EMBASE | ID: covidwho-2067343

ABSTRACT

There is a huge the spread of Covid-19 pandemic (Corona) in large areas of the country, including modern and rural areas, and due to the scarcity of medical tools and supplies, especially in rural areas. Therefore, artificial intelligence researchers are using technologies to help detect disease early by using chest X-rays to classify whether or not the disease is present. Note that doctors have agreed in more than one scientific article that the initial examination to detect this disease is carried out through chest x-rays, the devices of which are available in most places.Because the Internet is available in most rural areas and in order to reduce the spread of this pandemic, in this paper we built a project by deep transfer learning using an application in Keras called "InceptionV3" on cloud, this model trained and tested 10 thousand images of people with the disease and others where the data distribution was equal to avoid From imbalanced data, and this model will be used across the cloud by web framework so that we can get proactive decisions and avoid spread. This model has been applied in the Department of Respiratory Medicine at Dr. ShankarraoChavan Government Hospital, Nanded, under the supervision of a medical staff headed by Dr. V. R. Kapse, associate professor and head of the department of pulmonary, we have obtained results after training and evaluating the model are training accuracy 97.6%, testing accuracy 97.5%, precision 97.8%, sensitivity 100% and specificity 99.9%. Copyright © 2022, Anka Publishers. All rights reserved.

7.
NeuroQuantology ; 20(11):684-699, 2022.
Article in English | EMBASE | ID: covidwho-2067331

ABSTRACT

Lung cancer (LC) is one of the most common malignant tumors, with rapid growth and early spread. LC is one of the most common malignant tumors. Lung cancer is a deadly disease, and early detection is essential. To achieve more precise diagnoses, cancer segmentation aids clinicians in determining the extent and location of cancer. But manually segmenting lung tumors from large medical images is a time-consuming and difficult task. A convolutional neural network (CNN)-based encoding network with position awareness is proposed in this study for automatically segmenting LC from computed tomography images. It is our model's design philosophy to change the usual link net architecture so that we can properly identify cancer. Our innovation resides in the manner we connect each encoder with decoder, in contrast to previous neural network topologies used for segmenting. During the encoder's many downsampling processes, spatial information is lost. By employing simply the encoder's down sampled output, it is impossible to retrieve this lost information Through the use of untrainable indices, the encoder and decoder are connected together. The output of an encoder may also be sent straight into a decoder, which can then execute segmentation on it.To conduct this study, a spatial attention-based encoder and a decoder that bypasses each encoder's input to the output of its related decoder were employed. Decoding and upsampling procedures will benefit from the spatial information that is recovered in this manner. With each layer of encoded information, the decoding process may require less parameter space, making it more efficient. Lung Image Database Consortium image collecting dataset obtained 98.5 percent accuracy in verifying the suggested system's performance. According to the study mentioned, a subjective comparison between the suggested approach and certain current methodologies is also carried out. Experiments have shown that the suggested method outperformed current technologies, allowing radiologist to more precisely locate a lung tumour while using it.

8.
Haseki Tip Bulteni ; 60(4):345-350, 2022.
Article in English | EMBASE | ID: covidwho-2066933

ABSTRACT

Aim: Coronavirus disease-2019 (COVID-19) is more severe in hemodialysis patients than in the average population and causes much higher mortality. This study investigated the effect of inflammation parameters obtained from complete blood count on the prognosis of COVID-19 in hemodialysis patients with COVID-19. Method(s): Hemodialysis patients admitted to our hospital between 11.03.2020 and 01.12.2020 with the diagnosis of COVID-19 were included in this study. The relationship between the oxygen requirement, intensive care requirements, and mortality development of the patients and the parameters obtained from the complete blood count, C-reactive protein (CRP), secondary infection, and demographic characteristics of the patients were investigated. Result(s): A total of 94 hemodialysis patients were included in the study. There was a correlation between secondary infections and the need for oxygen and intensive care (p=0.001 and p<0.001, respectively). CRP levels were associated with mortality, need for intensive care and oxygen demand (p=0.031, p=0.019 and p=0.014, respectively). Systemic inflammation index, derived neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were associated with oxygen demand (p=0.002, p=0.009 and p=0.044, respectively). The systemic inflammation index, platelet-lymphocyte ratio, and derived neutrophil-lymphocyte ratio exhibited the highest specificity (19.4% vs 26.9% vs 16.4%) and sensitivity (96.7% vs 92.6% vs 96.7%) and the largest areas under the curve of 0.672 vs 0.652 vs 0.666, respectively. Conclusion(s): Systemic inflammation index, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio obtained from complete blood count parameters in hemodialysis patients are functional parameters that can be used to predict the course of COVID-19. Copyright © 2022 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.

9.
Archives of Disease in Childhood ; 107(Supplement 2):A369-A370, 2022.
Article in English | EMBASE | ID: covidwho-2064047

ABSTRACT

Aims Raised Intracranial Pressure (ICP) is frequently encountered condition amongst children due to neurological and non-neurological etiologies. It contributes towards 20% of the admissions in our PICU at tertiary care institute of North India. Timely diagnosis of raised intracranial pressure is critical for appropriate management. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is non-invasive point of care tool to recognize raised intracranial pressure however there are very limited studies in pediatric population on this. Aim of this study was to measure the ONSD of children admitted in pediatric intensive care unit (PICU) to identify the difference in ONSD among the pediatric patients with normal and raised ICP and to achieve the cut-off value for diagnosing raised ICP. Methods A Hospital based observational comparative study conducted at PICU of a tertiary care institute of national importance in North India. ONSD measurement of all the patients aged 2-14 years admitted in pediatrics department for >48 hours was done in two phases due to COVID-19 related restrictions in routine admissions for some months. First phase was from 1st January 2020 to 31st March 2021 and second phase started from 15th January 2022. Complete enumeration technique was used for the study. Children receiving treatment for raised ICP based on clinical features (Muir's criteria) and neuroimaging were included in raised ICP group and they were compared with the patients without any signs of raised ICP. Optic nerve sheath diameter was measured in both the groups on Day 1 (i.e. within 24 hours of admission) and Day 2 of admission. Third and last ONSD measurement was done on any day between day 4 and day 7 of admission. On each day, 3 readings were taken from each eye and average of 3 readings was used for final statistical analysis for that particular day. Treating team was unaware of the USG findings throughout the stay of the patient in the department. Results Total 101 patients recruited, among them 16 patients had raised ICP and 85 patients had normal ICP. The mean optic nerve sheath diameter on day 1 was found to be higher in the patients with raised ICP (Mean ONSD = 4.955 +/- 0.80) as compared to those with normal ICP (Mean ONSD = 4.05 +/- 0.43). Their mean difference was 0.90 mm (95% CI 0.07-1.48 p value <0.01). Mean ONSD on day 2 also was higher in raised ICP patients (Mean ONSD = 4.82 +/- 0.73) in comparison to normal ICP patients (Mean ONSD = 4.06 +/- 0.47) which was statistically significant (p value = 0.001). The cut-off ONSD value for detecting the raised ICP was estimated to be 4.35 mm on ROC curve with area under the curve 0.862 (95% CI, 0.721-0.943), sensitivity of 75% and specificity of 76.5%. Conclusion Raised ICP is one of the important neurological entities in children contributing towards significant morbidity. Measurement of ONSD by trans-orbital ultrasound was able to detect raised ICP with excellent discriminatory performance.

10.
American Journal of Transplantation ; 22(Supplement 3):647, 2022.
Article in English | EMBASE | ID: covidwho-2063508

ABSTRACT

Purpose: Advanced age is associated with impaired humoral immune response to SARS-CoV-2 mRNA vaccines in kidney transplant recipients (KTR), however mechanisms are poorly understood. Frailty syndrome assessment in geriatric KTR may reveal the most vulnerable population. Method(s): This is the subcohort analysis of prospective study (NCT04832841) dealing with seroconversion after SARS-CoV-2 mRNA vaccination. In 101 KTR aged 70+ who were SARS-CoV-2 naive, the Fried frailty components were evaluated. Antibodies against S1 and S2 subunit of SARS-CoV-2 were evaluated >14 days after second dose of mRNA vaccines using immunochemiluminescent assay (cut off 9.5 AU/ml, sensitivity of 91.2% and specificity of 90.2%). The clinical variables affecting the humoral response were analyzed by multivariable binary regression model based on results of univariable analysis. Result(s): The seroconversion after SARS-CoV-2 vaccination was observed in 33 out of 101 (33%) KTR. In the univariable regression model, eGFR (OR=1.03, p=0.001), MMF-free immunosuppression (OR=4.32, p=0.002), physical inactivity (OR=0.36, p=0.039), grip strength (OR=1.05, p=0.045), male gender (OR=2.09, p=0.09), and Fried frailty score (OR=0.74, p=0.09) were associated with seroconversion. Multivariable binary logistic regression model adjusted for KTR age and gender retained as independent significant predictors for seroconversion the Fried frailty cumulative score (OR=0.6, p=0.048), eGFR (OR=1.05, p<0.001), MMF-free immunosuppression (OR=8.25, p=0.001) and longer follow-up from transplantation (OR=1.01, p=0.021). Conclusion(s): The frailty but not age itself is associated with impaired humoral response to SARS-CoV-2 mRNA vaccines in KTR. Intervention to reduce physical inactivity prior to vaccination may improve seroconversion rate in elderly KTR.

11.
American Journal of Transplantation ; 22(Supplement 3):993, 2022.
Article in English | EMBASE | ID: covidwho-2063460

ABSTRACT

Purpose: Limited data exists on CT chest abnormalities during acute Coronavirus disease 2019 (COVID-19) infection and associated post-illness loss of lung function among lung transplant (LT) patients. Method(s): The institutional database was interrogated for any LT patient diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021;n=54). 44 patients with acute COVID-19 were alive at 3-month follow up (COVID-survivors: 81.5%). Of the survivors, 34 had a CT chest during the first two weeks of acute illness. A validated CT score was used to quantify the parenchymal abnormalities due to COVID-19. Each lung was divided into 10 separate regions which were scored 0-2 based on the severity and extent of parenchymal opacification (maximum score per lung=20). To avoid confounding from underlying lung disease, only the allograph was assessed in single LT. The average score of both lungs was calculated in bilateral LT. The primary outcome measure was sustained decline of FEV1 or FVC >10% from pre-infection spirometry. Result(s): Abnormal CT score and lung opacities on CT chest were nearly ubiquitous during acute COVID-19 illness (>0;36/37, 97.3%, median score with IDR: 7.25, 4.625-10.125). The lower lobes (LL) were more affected by COVID-19 than the upper and middle lobes (UML) (median CT score in LL: 4, 2.75-6 vs 3.5, 1.25-5 in UML). A >10% decline in FEV1 or FVC was common after COVID-19 pneumonia (38.2%). The overall CT score correlated with amount of lung function loss (r=0.36, p=0.03) although the association was modest and limited to regions reflecting the UML. On ROC curve, CT score was modestly predictive of lung function decline (Fig 1). CT score from UML had the highest area under the curve (78.2%, 61.1-95.4%;p=0.006) with a score of 4.5 being the best cut-off (sensitivity 71%, specificity 85% for post-COVID lung function loss >10%). An UML CT score >4.5 was strongly associated with respiratory failure during acute illness (69% vs 24%;OR: 7.2, 1.5-33.8;p=0.01) and lung function decline >10% (77% vs 19%;OR: 14.2, 2.6-76.7;p=0.001). Conclusion(s): The CT score during acute COVID-19 infection provides prognostic information regarding loss of lung function among LT patients who survive COVID-19. Parenchymal abnormalities in the UML best predict subsequent lung function loss.

12.
American Journal of Transplantation ; 22(Supplement 3):764-765, 2022.
Article in English | EMBASE | ID: covidwho-2063421

ABSTRACT

Purpose: To investigate the mortality risk factors of COVID-19 infection among kidney transplant recipients (KTRs) in Thailand due to data scarcity in Asian populations. Method(s): We analyzed the data from the Thai Transplant Registry which collected data from all transplant centers from March 2020 to November 2021. The outcomes were the mortality rate over time, ICU admission rate and mortality risk factors including patients' demographic data, comorbidities, vaccination, immunosuppression, and laboratory tests. Result(s): Seventy-two KTRs were infected with COVID-19. The mortality rate was 16.7% (12/72) which was highest (6/12) in July 2021 when the B.1.617.2 variant became most dominant strain. All dead patients were deceased donor kidney transplant (DDKT, 100%). 33.3% (24/72) need to be admitted to the ICUs. The mean age of patients in non-survivor group was significantly higher than those in survivor group (53.4 +/- 10.3 vs 44.5 +/- 9.9 years, p=0.006). The underlying diseases including diabetes and hypertension did not increased mortality. However, hypertension significantly increased ICU admission risk (OR 6.8, 95%CI 1.8-30.6). The mean BMI among non-survivor group was similar to survivor group (25.0 +/- 3.9 vs 23.3 +/- 4.5 kg/m2, p=0.23). The transplantation vintage was not different among both groups (73.5 [12.5-180.5] in the non-survivor vs 52.0 [29.0-97.0] months in the survivors p=0.77). Baseline immunosuppressive regimens were not associated with mortality. The non-survivor group had significantly higher baseline serum creatinine (2.87 +/- 2.63 vs 1.68 +/- 0.82 mg/dL, p=0.006). The area under the ROC curve for mortality was 0.62 for neutrophil to lymphocyte ratio (NLR). The NLR of 3.3 showed highest sensitivity (71%) and specificity (53%) in predicting mortality. Higher IL-6 was associated with requiring ICU admission (23.2 [15.4-70.6] vs 10.4 [4.1-24.2], p=0.04). In non-survivor group, 9 (75%) KTRs were unvaccinated and 3 (25%) KTRs were incomplete vaccinated (1 dose of ChAdOx1 nCoV-19 vaccine in 2 KTRs, and 1 dose of CoronaVac vaccine in 1 KTRs). In non-survivor group, most common medical complications were bacterial pneumonia (58.3%) and lifethreatening bleeding (16.7%). Conclusion(s): In Thailand, the mortality rate of COVID-19 infected KTRs was comparable to worldwide reports which was 10-32%. Higher patients' age, DDKT as well as admission serum creatinine and IL-6 were associated with increasing disease severity. Both unvaccinated and not fully vaccinated KTRs were significantly at higher risk of death.

13.
American Journal of Transplantation ; 22(Supplement 3):426-427, 2022.
Article in English | EMBASE | ID: covidwho-2063400

ABSTRACT

Purpose: Due to heterogeneity observed in the kidney transplant population, it has been extremely challenging for traditional methods such as histopathology to predict graft outcomes. In this real-world evidence(RWE) study, we applied machine learning (ML) models to a multi-analyte urinary biomarker assay to predict whether a kidney allograft would experience a rejection episode. Method(s): A cohort of 550 (37.5% biopsy matched) urine samples from patients across 3 renal transplant centers were used to develop a predictive ML model (scaled 0-100) to prognosticate allograft failure. Samples were collected between 1-1539 days post-transplant from allograft recipients with ages ranging from 7-77 years. Of the 206 biopsy matched samples, acute kidney allograft rejection (AR) and no-rejection (NR) phenotypes were confirmed in 136 and 70 respectively. We also evaluated the developed ML model on two additional cohorts of 15 COVID+ transplant recipients and 30 non-transplant healthy population. The ML model incorporates clinico-demographics with 6 urinary biomarkers: Clusterin, total protein, CXCL10, Creatinine, cfDNA and methylated cfDNA. Monte Carlo confidence intervals for the model incorporated biomarker assay and sample variances. Result(s): The novel rejection score was able to discriminate AR from NR efficiently. Score below 32 classified stable allograft, score range of 32 - 55 identified progression of AR, and Score > 55 identified AR with high sensitivity: 92%, and specificity: 89%;AUC: 96% and accuracy: 91%(figure). The associated NPV and PPV of 87% and 93% respectively. In the COVID cohort with 86% clinician assessed rejection, the median score was 51(IQR:30-87). In the non-transplants the median score was 19(IQR:13-26). It was established that presence of COVID was not a confounder in the model. Conclusion(s): The accuracy of the novel rejection score emphasizes the promise of applying ML algorithms as an aid to decision-making in evaluating graft outcomes with high sensitivity and specificity. Moreover, this RWE retrospective analysis demonstrates the efficacy of the urine multi-analyte approach to accurately predict acute rejection in kidney transplant recipients. (Figure Presented).

14.
Hypertension. Conference: American Heart Association's Hypertension ; 79(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2064363

ABSTRACT

Background: Connected health technology can enable healthcare professionals to provide multiple solutions to meet the growing demand of care and control of COVID-19 infected patients, by optimizing economic resources and extending the scope of monitoring beyond the hospital. An innovative mobile device, the BioBeat Watch, developed in Israel, with an APP that can be downloaded directly to the Smart Phone, is characterized by sensors already validated according to the regulations of the Food and Drug Administration for vital signs, the ECG track and the European Society Hypertension for the detection of blood pressure. Purpose(s): Wearable medical devices and the BioBeat software platform are appropriate for use in different settings for the management of acute, chronic cardiovascular, respiratory and inflammatory pathology, a tool capable of early identification of the instrumental signs of deterioration even before the exclusively clinical recognition that becomes even more difficult if we consider the patients at home.The aim of this study is to test the sensitivity and specificity of the biobeat wearable system applied in patients with paucisymptomatic COVID-19 infection (group A) and in those with previous SARS-COV2 disease discharged from the hospital who still needed post-acute monitoring (group B) and compared with clinical control, managing to determine early the clinical signs of worsening. Method(s): The data recorded by individual patients are systolic and diastolic blood pressure, heart and respiratory rate, peripheral oxygen saturation and body temperature. The criteria of deterioration or worsening of the clinical condition are represented by the need to hospitalize the patient, alteration of one of the criteria grouped in the ABCDE. Result(s): We calculated the sensitivity of the methodology related to the alerts detected and the outcome of the patients. Sensitivity was 86.3% with a 95% CI of 0.71 to 1.03 and a specificity of 7.7%. Conclusion(s): Continuous monitoring with biobeat watch showed a high sensitivity in detecting early any alerts predictive of worsening of the disease.

15.
Cardiology in the Young ; 32(Supplement 2):S103, 2022.
Article in English | EMBASE | ID: covidwho-2062128

ABSTRACT

Background and Aim: Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a postim-munological reaction after SARS-CoV-2 infection. Various car-diac manifestations of PIMS-TS have been reported, namely pericardial effusion, ventricular arrhythmia, myocarditis, valvular regurgitation, and pericarditis. The aim of this study was to analyze clinical and laboratory features to distinguish any possible predic-tion for cardiac involvement in children with PIMS. Method(s): The PIMS patients under 18 years old treated in our center between July 2020 and December 2021 were included. Data of the patients were retrospectively obtained from their medical records. Result(s): A total of 46 patients with PIMS were examined during the study period. The mean age of study group was 9.4 +/- 4.6 years, 18/46 were female and 3 groups were formed according to their age ranges. Among them, seventeen patients (37%) had cardiac involvement with mean age was 8.7 years. Impaired cardiac func-tions were seen more in male patients (n: 10/17). Coronary artery dilatation seen in seven patients especially with mean age of 5.2 years (Age group 1,2,3;%36.4,%14.3,%0;p = 0.033;respectively) and especially related to high troponin T levels (p = 0.006). In our study group, cardiac involvement was shown more related to ProBNP and Troponin T (p = 0.008;p = 0.003). The cut-off val-ues of proBNP and troponin T for predicting in cardiac dysfunc-tion were 2759 pg/mL (95% confidence interval (CI), 0,83-1;sensitivity, 0.86;specificity, 0.93;AUC:0.92, p lt;0,001). Conclusion(s): Although there is a wide variability of symptoms, MIS-C is a rare, severe, less understood complication of COVID-19 that may cause multisystemic involvement in the patients. Clinicians should be aware of this condition in children with persistent fever and a family history of COVID-19. Cardiac involvement in chil-dren with PIMS may strongly be predicted by levels of Troponin T and ProBNP. Further more younger age and high Troponin T levels are the independent predictors for the coronary artery dila-tation among children with PIMS.

16.
Chest ; 162(4):A2671-A2672, 2022.
Article in English | EMBASE | ID: covidwho-2060981

ABSTRACT

SESSION TITLE: Late Breaking Investigations From Pulmonary and Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Although spirometry is the standard lung functional test, it requires the patient to perform a series of maneuvers correctly, which is difficult for elderly, children, and patients with severe lung impairments. Furthermore, spirometry lacks regional assessment for detecting and monitoring subtle changes in lung diseases, e.g., chronic obstructive pulmonary disease (COPD) and potentially COVID-19. We aim to establish a home-based imaging system, portable electrical impedance tomography (EIT), that can detect lung function deterioration and monitor its recovery through a close-to-effortless breathing paradigm. METHODS: We developed a palm-sized EIT system and a novel guided breathing paradigm that consists of a periodic inhalation and exhalation at 12 breaths per minute. We validated them on healthy subjects (n=23) performing different breathing efforts (deep vs shallow), then on patients with ILD (n=2), COPD (n=8), asthma (n=4) and bronchiectasis (n=4) against healthy (n=8) cross-sectionally, and last monitored a COVID-19 discharged subject with two age- and gender-matched healthy controls longitudinally. We further applied machine learning to distinguish between healthy and patients, and calculated its sensitivity and specificity. RESULTS: We detected higher amplitude during deep breathing compared to shallow (p < 0.001) in healthy subjects, with right lung having more activated voxels and higher total amplitude than the left lung (p < 0.001), likely due to the position of the heart. Cross-sectionally, we observed lower amplitude in patients compared to healthy (p < 0.01), while coefficient of variation (CV) of the amplitude in the lungs is higher in patients (p < 0.05). Note that CV is a parameter reflecting inhomogeneity which is indicative of lung function deterioration. Longitudinally, the COVID-19 discharged subject had higher CV in the left lung (p < 0.001) which decreased across time (p < 0.01), suggesting a functional deterioration at the beginning followed by a recovery. Regional analysis further pin-pointed the potential deterioration and recovery was in the anterior left lung. Separately, despite the small sample size, the sensitivity and specificity for detecting patients using a machine learning classifier were 76% and 62%, respectively, and will likely increase with a larger sample. CONCLUSIONS: Home-based portable EIT with close-to-effortless guided breathing paradigm can map global and regional lung function deterioration and recovery cross-sectionally and longitudinally. More importantly, it can potentially be deployed as a screening tool for various lung diseases through the application of machine learning. CLINICAL IMPLICATIONS: Portable EIT with guided breathing paradigm enables lung function diagnostic screening and treatment monitoring at home, advancing telemedicine and lowering hospital burden. DISCLOSURES: no disclosure on file for Peng Cao;Owner/Founder relationship with Gense Technologies Ltd Please note: Since 2017 Added 06/06/2022 by Russell Chan, value=Ownership interest No relevant relationships by Wang Chun Kwok No relevant relationships by Wei-Ning Lee No relevant relationships by Terence Tam Employee relationship with Gense Technologies Please note: Setpember 2021 - Now Added 06/07/2022 by Adrien Touboul, value=Salary contractor relationship with Gense Technologies Ltd Please note: since Apr 2021 Added 06/06/2022 by Eddie Wong, value=Consulting fee Employee relationship with Gense Technologies Please note: since 2020 Added 06/06/2022 by Fedi Zouari, value=Royalty

17.
Chest ; 162(4 Supplement):A2106-A2107, 2022.
Article in English | EMBASE | ID: covidwho-2060900

ABSTRACT

SESSION TITLE: Lung Nodule Biopsy: Yield and Accuracy SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Atypia is common on biopsy specimens of peripheral pulmonary lesions (PPLs) and may result from inflammation or inadequate sampling of a malignancy. The significance of atypical cells on PPLs biopsies has not been well described. In addition, recent studies of navigational bronchoscopy have variably considered atypia on biopsies as diagnostic. METHOD(S): We analyzed a prospective database of consecutive PPLs sampled via navigational bronchoscopy at our institution (IRB: 212187). Search terms "atypia" and "atypical" were applied to pathology reports generated by these procedures. Manual inspection ensured atypia was present in the PPL itself. Definitive PPL diagnosis was established during a two-year routine clinical follow-up. Bronchoscopy diagnostic yield was defined as histopathological findings which readily explained a nodule (malignancy, organizing pneumonia, frank purulence, granulomatous inflammation) and permitted management of the patient without an immediate additional diagnostic intervention. Atypia was considered nonspecific and, therefore, nondiagnostic. RESULT(S): From 11/2017 to 4/2019, 461 biopsied PPLs were identified. Eleven cases, none exhibited atypia, lacked complete two-year follow-up, and were excluded. Ultimately, 274 of 450 (61%) analyzed PPLs were malignant. Diagnostic biopsies were obtained in 331 (73.5%) cases. Atypical cells were present in 33 PPLs (7% of overall cohort, 28% of the 119 nondiagnostic cases). Two-thirds (22 of 33) were eventually determined to be malignant. Lung adenocarcinoma was the most common ultimate malignant diagnosis (10 cases). Most benign PPLs with atypia regressed on follow-up imaging without further pathological data (5 cases). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of atypia for an eventual diagnosis of malignancy among the 223 PPLs not diagnosed as malignant at index bronchoscopy were 46% (95% CI 31-61%), 94% (89-97%), 92% (85-96%), and 53% (46-60%), respectively, with positive likelihood ratio (+LR) of 7.3 (3.8-14). CONCLUSION(S): The presence of atypical cells was a common finding, found in 28% of PPLs without a specific diagnosis after bronchoscopy. Two-thirds of PPLs with atypia were ultimately malignant, with a high PPV (92%) for malignant diagnosis in this cohort with an overall prevalence of malignancy of 61%. CLINICAL IMPLICATIONS: Atypia not diagnostic of malignancy in bronchoscopic biopsy specimens is a nonspecific finding, which may be due to inadequate sampling of a malignant PPL or inflammation. However, the high PPV and +LR of atypia for ultimate malignant PPL diagnosis suggest that in populations with a similar prevalence of malignancy and/or in the clinical context of a high pre-test probability of malignancy, atypical findings might prompt repeat biopsy or definitive PPL management (resection or ablation). DISCLOSURES: No relevant relationships by Robert Lentz No relevant relationships by Kaele Leonard No relevant relationships by See-Wei Low PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Briana Swanner Copyright © 2022 American College of Chest Physicians

18.
Chest ; 162(4 Supplement):A2087-A2088, 2022.
Article in English | EMBASE | ID: covidwho-2060897

ABSTRACT

SESSION TITLE: Lung Nodule Biopsy: Yield and Accuracy SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: A variety of endpoints have been used to evaluate the diagnostic performance of navigational bronchoscopy for sampling peripheral pulmonary lesions (PPLs), including diagnostic yield (rate of biopsies with a specific diagnosis that facilitates clinical decisions) and diagnostic accuracy (yield plus a follow-up to assess for false negative/positive initial results). There is also significant variation in what non-malignant findings are considered diagnostic, especially regarding nonspecific inflammatory changes. We hypothesized a diagnostic yield definition excluding nonspecific findings as diagnostic would lead to few false negative PPL biopsies. METHOD(S): Our center maintains a prospective cohort of consecutive PPLs targeted via navigational bronchoscopy. Diagnostic yield was defined as specific findings readily explaining the presence of a PPL (malignancy, organizing pneumonia, granulomatous inflammation, frank purulence, other specific finding) permitting management without immediate additional diagnostic intervention. "Other specific finding" required pulmonologist and lung pathologist agreement. All other findings were considered non-diagnostic. RESULT(S): A total of 450 PPLs biopsied 2017-2019 with complete two-year follow-up were included in the analysis. Ultimately, 274 of 450 (60.9%) PPLs were determined to be malignant. Diagnostic biopsies were obtained in 331 cases (73.6%). There was a single false-positive among 228 malignant biopsies (0.4%, carcinoid tumor on cytopathology, alveolar adenoma on resection surgical pathology). Among 223 PPLs without malignant diagnosis at initial bronchoscopy, 48 were later determined to be malignant. Most (n=39) exhibited nonspecific abnormalities on initial pathology. Two of 104 specific benign biopsies were false negative (1.9%). Both demonstrated organizing pneumonia on initial pathology but re-biopsy months after index bronchoscopy revealed Hodgkin's lymphoma and metastatic renal cell carcinoma, respectively. The sensitivity, specificity, and positive predictive value of specific benign findings for an ultimately benign nodule were 58% (95% CI, 51-66%), 95% (86-99%), and 90% (70-97%). The sensitivity, specificity, and positive predictive value of nonspecific benign findings for an ultimately benign PPL diagnosis were 32% (95% CI, 25-39%), 19% (9-33%), and 20% (16-24%). CONCLUSION(S): A definition of diagnostic yield excluding nonspecific benign findings had low false positive/negative rates. If bronchoscopy is not diagnostic of malignancy, a specific benign finding was highly predictive of an ultimately benign PPL, while nonspecific findings poorly predicted benignity. CLINICAL IMPLICATIONS: This definition of diagnostic yield could be used as the primary outcome in future studies, permitting distribution of reliable diagnostic results without requiring years of follow-up. DISCLOSURES: No relevant relationships by Joyce Johnson No relevant relationships by Robert Lentz No relevant relationships by Kaele Leonard No relevant relationships by See-Wei Low PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Briana Swanner Copyright © 2022 American College of Chest Physicians

19.
Chest ; 162(4):A901, 2022.
Article in English | EMBASE | ID: covidwho-2060721

ABSTRACT

SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anchoring bias is a cognitive bias where one relies too heavily on initial information early on in the decision making process, affecting subsequent decisions due to future arguments being discussed in relation to the "anchor. Overemphasis on COVID-19 due to the pandemic has impacted the timely diagnosis and treatment of other diseases. CASE PRESENTATION: A 39-year-old man with a past medical history of COVID 19 in 12/2020 presents to the ED with increasing weakness, chest pain, recurrent fevers, diarrhea, and cough. CXR revealed bilateral infiltrates suggestive of pneumonia/pulmonary edema. Patient was empirically started on ceftriaxone. CT chest was suspicious of COVID-19;however repeat testing was negative. Diarrhea did not improve. Patient later admitted to recent travel to Jamaica. Ova and parasite, C-difficile, and stool culture were negative. On hospital day 8, the patient was intubated and placed on mechanical ventilation for worsening hypoxic respiratory failure Infectious disease was consulted for recurrent fevers of unknown origin and diarrhea with recent travel. Testing for typhoid fever, hantavirus, malaria, HIV, zika virus, chikungunya, dengue, and yellow fever were performed. Consent was obtained for HIV testing. HIV antibody tests were positive, CD4 count of 7, and viral load greater than 900k. Since a new diagnosis of AIDS with a CD4 count of 7 was obtained, the patient was subsequently tested for opportunistic infections such as TB. TB sputum PCR testing was positive but AFB smear was negative for TB. Antiretroviral and tuberculosis treatments were initiated. DISCUSSION: Anchoring bias can delay critical diagnoses and impede patient care if it is not recognized. According to Watson et. al, one way physicians circumvent the thought of pretest probability when ordering tests based on patient history and the subsequent list of differential diagnoses is anchoring bias. Bypassing the pretest probability also alters the sensitivity and specificity of testing because results that do not confirm or rule out a top differential diagnosis are thought to be inaccurate and are then repeated attributing the initial result to a bad specimen or an improper collection of the specimen. CONCLUSIONS: The case presented exemplifies clearly the concept of anchoring bias. Upon initial presentation, the patient had nonspecific symptoms such as weakness, chest pain, recurrent fevers, diarrhea, and cough, all of which can be symptoms of COVID 19 in the setting of a global pandemic. It is clear that the initial diagnosis based on these symptoms was COVID 19. When initial testing was negative, anchoring bias still played a role in the decision to test the patient once again, despite the first negative test. Repeat testing still did not support the diagnosis of COVID 19, which expanded the differential diagnosis and ultimately led to the correct diagnosis of AIDS with concomitant TB infection. Reference #1: Saposnik, et. Al. Cognitive Biases Associated with Medical Decisions: A Systematic Review. BMC Med Inform Decis Mak. 2016 Nov. 3. PMID: 27809908 Reference #2: Harada, et. al. COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era. Eur J Case Rep Intern Med. 2020 Oct 23. PMID: 33194872. Reference #3: Singh, et. al. The Global Burden of Diagnostic Errors in Primary Care. BMJ Qual Saf. 2016 Aug 16. PMID: 27530239. DISCLOSURES: No relevant relationships by Sagar Bhula

20.
Chest ; 162(4):A838-A839, 2022.
Article in English | EMBASE | ID: covidwho-2060702

ABSTRACT

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The Sepsis Prediction Model (SPM) is a proprietary decision support tool created by Epic Systems. The basis of the SPM is a Predicting Sepsis Score (PSS) calculated from demographic, comorbidity, vitals, labs, medication, and procedural data. We assessed the diagnostic accuracy and timeliness of the PSS for sepsis as defined by Centers for Disease Control (CDC) Adult Sepsis Event (ASE) criteria. The performance of the PSS was compared to, Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and SOFA scores. METHODS: Retrospective review of 62,460 adults admitted to 4 Wake Forest Baptist Health System hospitals from June 1, 2019 through December 31, 2020 with PSS scores calculated every 15 minutes. A sepsis event was defined as receipt of 4 or more days of antimicrobials, blood cultures collected within 48 hours of initial antimicrobial administration, and at least one organ dysfunction. This definition of sepsis was modified to also include Covid-19 infection with organ dysfunction. Time zero was defined as time of first contact for the healthcare encounter. 30-day readmissions, facility transfers, and deaths in the Emergency Department were excluded. RESULTS: The prevalence of sepsis in the sample was 4.5%. The optimal PSS threshold based on Youden’s J statistic was a score of 8 (sensitivity 0.72, specificity 0.74, Youden’s J 0.46). SIRS (sensitivity 0.90, specificity 0.42), qSOFA (sensitivity 0.64, specificity 0.69), and SOFA (sensitivity 0.89, specificity 0.43) had a Youden’s J statistic for sepsis of 0.32, 0.33, and 0.32, respectively. At a PSS score of ≥ 8, median time to score positivity among those who reached that score (28.4% of sample) was 217 minutes (IQR 74-1477 minutes). For SIRS, qSOFA and SOFA, median time to score positivity was 54 minutes (IQR 24-456), 360 minutes (IQR 53-1593) and 107 minutes (IQR 39-474), respectively. CONCLUSIONS: Discrimination of the PSS for detection of sepsis was highest at a threshold score of 8. Overall, the PSS discriminated better than SIRS, qSOFA and SOFA. Positive SIRS and SOFA scores occurred at an earlier time-point than PSS score. The time to positivity appears to limit the tool’s best expected performance to improve time to initial antimicrobial and compliance with the 3-hour sepsis bundle. CLINICAL IMPLICATIONS: Clinical application of the Epic SPM to improve adherence with sepsis treatment goals is constrained by time to positive screen as compared to other screening tools. DISCLOSURES: No relevant relationships by Alain Bertoni No relevant relationships by Kristin Lenoir No relevant relationships by Beverly Levine No relevant relationships by Morgana Mongraw-Chaffin No relevant relationships by Adam Schertz Stock Ownership Interest relationship with Johnson & Johnson Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership interest stock ownership relationship with Gilead Sciences Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership Stock ownership interest relationship with Bristol-Myers Squibb Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership interest Stock Ownership Interest relationship with Pfizer Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership interest Stock Ownership Interest relationship with Doximity Please note: 1 year Added 04/15/2022 by Karl Thomas, value=Ownership interest No relevant relationships by Brian Wells No relevant relationships by Jack White

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