Concomitant COVID-19 Infection Research Articles

Necrotizing fasciitis of the head and neck in era of COVID-19: a single-institution experience

ObjectivesNecrotizing fasciitis (NF) of the head and neck is a critical condition, known for its severe impact and high mortality rates, often linked with diabetes, odontogenic infections, and immunosuppression. Observations from the University of Ottawa's Department of Otolaryngology – Head and Neck Surgery indicate an increase in NF cases since the COVID-19 pandemic began, suggesting a possible association between COVID-19 and NF. This study aims to assess the incidence of NF since the pandemic's onset and explore its association with COVID-19. DesignConducted as a single-center retrospective review from January 1, 2015 to April 7, 2023, this study included patients aged over 18 years with histopathologic confirmation of NF, analyzing clinical risk factors, treatment, and outcomes. Patients were divided into pre- and post–COVID-19 groups for comparison. ResultsOf 16 patients, 68.7% were in the post–COVID-19 group, with a notable increase in 2022. The most common risk factors were diabetes mellitus (43.8%) and history of odontogenic infection or extraction (31.3%). Only one patient (6.3%) presented with concomitant COVID-19 infection and NF. All patients underwent treatment with serial surgical debridement and intravenous antibiotics with mortality rates rising to 12.5% after the pandemic. ConclusionsOur study demonstrates an increased incidence of NF cases in our institution after the COVID-19 pandemic.

Analyzing the Impact of Concomitant COVID-19 Infection on Outcomes in Trauma Patients.

The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to understand the impact of concomitant COVID-19 infection on outcomes in trauma patients. We conducted a retrospective cohort study of patients ≥18years old admitted to a level I trauma center from March 2020 to December 2022. Patients tested for COVID-19 infection using a rapid antigen/PCR test were included. We matched patients using 2:1 propensity accounting for age, gender, race, comorbidities, vaccination status, injury severity score (ISS), type and mechanism of injury, and GCS at arrival. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, 30-day readmission, and major complications. Of the 4448 patients included, 168 (3.8%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in age, sex, BMI, ISS, type of injury, and regional AIS. The proportion of White and non-Hispanic patients was higher in COV- patients. Following matching, 154 COV+ and 308 COV- patients were identified. COVID-19-positive patients had a higher rate of mortality (7.8% vs 2.6%; P = .010), major complications (15.6% vs 8.4%; P = .020), and thrombotic complications (3.9% vs .6%; P = .012). Patients also had a longer hospital LOS (median, 9 vs 5days; P < .001) and ICU LOS (median, 5 vs 3days; P = .025). Trauma patients with concomitant COVID-19 infection have higher mortality and morbidity in the matched population. Focused interventions aimed at recognizing this high-risk group and preventing COVID-19 infection within it should be undertaken.

The rapid progression of Creutzfeldt–Jakob disease with concomitant COVID-19 infection: a case report

The rapid progression of Creutzfeldt–Jakob disease with concomitant COVID-19 infection: a case report

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia.

COVID-19 infection confers an increased risk of coagulation dysfunction (1) predisposing to thromboembolism in many anatomical sites including the gastrointestinal tract (GIT) (2). This study investigates the clinical presentation and outcome in patients presenting with concurrent COVID-19 infection and gastrointestinal tract ischaemia. Furthermore, differentiation and comparisons are drawn between those with arterial and venous aetiology for mesenteric ischaemia. A systematic search was undertaken on EMBASE, PubMed, and MEDLINE. Two independent reviewers screened titles, abstracts, and full-text articles according to the inclusion criteria and extracted relevant data. Data analyses were conducted using Excel®. Forty-one studies were included in the data analyses, yielding 44 patients. Twenty-six patients had mesenteric arterial occlusion, sixteen patients had mesenteric venous occlusion, and two patients had both arterial and venous mesenteric occlusion. All patients had concurrent COVID-19 infection. The survival rate in patients with arterial aetiology was 38.5% in contrast to 68.8% in patients with venous aetiology. Twelve patients (29.3%) experienced respiratory symptoms in the community before the onset of gastrointestinal symptoms, and five (12.2%) developed gastrointestinal symptoms during their inpatient stay for COVID-19 pneumonitis. Acute mesenteric ischaemia presents a clinical challenge to diagnose due to its non-specific symptoms. Concurrent COVID-19 infection with its predominant respiratory symptoms adds a further challenge in recognising the non-specific symptoms of mesenteric ischaemia. Our study draws attention to the increased thromboembolic risk posed by COVID-19 infection and the need for a high index of suspicion to aid prompt diagnosis and management of acute mesenteric ischaemia, even in the post-pandemic era.

Abstract 12670: Trends in Patients With COVID-19 and Device Related Infections: A National Inpatient Sample Trend From 2020

Background: Cardiac implantable electronic devices (CIED) are essential for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. However, device-related infections (DRI) remain a significant complication of CIED and are associated with primary adverse outcomes. However, limited data exists on concomitant Covid-19 infection and its effects on outcomes of DRI. Methods: National Inpatient Sample 2020 was used to identify patients hospitalized for DRI based on ICD-10 codes. DRIs were further stratified into concomitant Covid-19 infected patients and non-Covid-19 infected groups. Logistic regression was used to compare in-hospital outcomes. Results: In 2020, there were 59,270 admissions for DRIs. 1,890 (3.2%) DRI cases were observed to have concomitant Covid-19 infection. Racial disparities observed included higher rates of DRI and concurrent Covid-19 infection in the African American (30.6% -vs- 20.2, p=0.002) and Hispanic (18.2% -vs- 9.4%, p=0.002) population. Lead extraction rates were lower in the Covid-19 infection with DRI group (5.33% -vs- 11.17%, p&lt;0.001). Cases with DRI and concurrent Covid-19 infection also had a significantly longer length of stay (LOS, 21.6 -vs- 11.5 days, p&lt;0.001), higher total hospital cost (305,644 -vs- 172,711, p&lt;0.001), and higher mortality (23.1% -vs- 6.6%, p&lt;0.001). This group was also observed to have increased needs for ICU level of care including higher proportion of ARDS, shock, mechanical ventilation and vasopressor use as listed in Table 1. Conclusion: DRIs with concurrent Covid-19 infection had higher all-cause mortality, complication rates, LOS and total hospital costs. Further research needs to be performed to delineate long-term outcomes in this patient population.

A Nationwide Analysis of the Outcomes Among Hospitalized Patients with Heparin Induced Thrombocytopenia and Concomitant COVID-19 Infection

Background Heparin induced thrombocytopenia (HIT) and COVID-19 infection are independently associated with thromboembolic complications. Our study aims to assess outcomes among hospitalised patients with concomitant HIT and COVID-19 infection, since data among this subgroup is lacking. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified patients who have heparin induced thrombocytopenia (HIT) and COVID-19 infection using appropriate ICD-10 CM codes. We stratified patients based on the presence or absence of COVID-19 infection. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &amp;lt;0.05 was considered statistically significant. The aim of this study was to investigate the impact of COVID-19 infection on in-hospital mortality, hospital LOS, total hospitalization charge and risk for arterial or venous thrombosis among hospitalized patients with HIT. Results We identified a total of 9896 hospitalized patients with heparin-induced thrombocytopenia (HIT), of which 7.68% (760/9896) had concomitant COVID-19 infection. The overall in-hospital mortality among those hospitalized patients with HIT was 17.14% (1695/9896). Among those with concomitant COVID-19 infection, the mortality rate was significantly higher at 50% (380/760, p=0.001). Further, compared to those without COVID-19 infection, those with concomitant COVID-19 infection had a significantly longer median LOS (21 days vs 11 days, p=0.001) and higher total hospitalization charge ($292,325 vs $143,972, p=0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, COVID-19 infection was found to be an independent predictor of increased in-hospital mortality (adjusted OR 5.13; 95% confidence interval [CI], 3.36-7.84; p=0.001), longer LOS (adjusted OR 6.21; 95% confidence interval [CI], 3.56-8.86; p=0.001) and higher total hospitalization charge (p=0.001). However, it was not significantly associated with increased risk for arterial (adjusted OR 0.72; 95% confidence interval [CI], 0.18-2.83; p=0.63) or venous (adjusted OR 0.91; 95% confidence interval [CI], 0.48-1.74; p=0.79) thrombosis. Conclusion Our analysis showed that among hospitalized patients with HIT, concomitant COVID-19 infection increased the risk for in-hospital mortality, longer LOS and higher total hospitalization charge, however, it did not significantly increase the risk for the development of arterial and venous thrombosis. Prospective studies with control of possible confounders are warranted in order to better describe these associations.

Impact of COVID 19 on Patients with Multiple Myeloma : A National Inpatient Sample Analysis

Introduction: Multiple myeloma (MM) is characterized by the proliferation of clonal immunoglobulins and suppression of normal immunoglobulins. These patients are susceptible to infections due to multiple factors such as hypogammaglobulinemia, impaired lymphocyte function, steroid-related immunosuppression, and neutropenia secondary to chemotherapy. There is limited data on the association of COVID-19 infection with in-hospital outcomes of MM. We hypothesize that COVID-19 infection is associated with adverse outcomes. Methodology: We queried the National Inpatient Sample (NIS) Database 2020 for adult (aged ≥ 18 years) hospitalizations with a primary diagnosis of MM. The cohort was subcategorized based on the presence of COVID-19 infection. The primary outcome studied was in-hospital mortality. Multiple secondary outcomes were analyzed including length of stay, cost of hospital stay, and individual organ system failures. Multivariable logistic regression was performed adjusting for patient and hospital level characteristics to evaluate outcomes. An alpha error of 0.05 was accepted for all analyses. Results: A total of 111,540 MM hospitalizations were included in the study, of which 2,195 (1.96%) had concomitant COVID-19 infection. The mean age was almost similar in both groups. Patients with MM and concurrent COVID-19 infection, had significantly higher in-hospital mortality [adjusted odds ratio (aOR) 6.54, 95% CI 5.25-8.20, p&amp;lt;0.001], length of stay [aOR 4.12 (2.92-5.32), p&amp;lt;0.001] and hospitalization cost [$54,940 ($34,688-$75,191), p&amp;lt;0.001]. They had higher rates of cardiac arrest (2.9% vs 1.1%, p&amp;lt;0.001), acute renal failure (48.8% vs 31.3%, p&amp;lt;0.001), acute liver failure (2.5 % vs 1.1%, p&amp;lt;0.001), acute respiratory failure (50.8% vs 17.3%, p&amp;lt;0.001). They also required higher levels of care in terms of hemodialysis (14.8% vs 8.8%, p&amp;lt;0.001), non-invasive ventilation (8.4% vs 3.3%, p&amp;lt;0.001), and invasive ventilation (1.6 % vs 0.3%, p&amp;lt;0.001). Discussion: Patients with MM who were admitted with COVID-19 had higher odds of in-hospital mortality, and developing (end-organ)complications such as cardiac arrest, respiratory failure, renal failure, and liver failure. They also had longer and costlier stays. The development of COVID-19 in patients with MM causes such poor outcomes likely due to shared endothelial dysfunction, thrombosis, and hyperinflammation. Prior studies have also shown impaired response to mRNA vaccination in this population. Thus, as COVID-19 restrictions are now at ease, increased vigilance is required in this vulnerable population. The limitations of our study are retrospective use of the administrative database with a potential of missing or inaccurate data, lack of information on specific treatments in MM patients limiting the ability to assess treatment-related outcomes, and unknown vaccination status.

S1182 Outcomes in Patients Hospitalized for an Inflammatory Bowel Disease Flare and Concomitant COVID-19 Infection

S1182 Outcomes in Patients Hospitalized for an Inflammatory Bowel Disease Flare and Concomitant COVID-19 Infection

Impact of COVID-19 Diagnosis on Mortality in Patients with Ischemic Stroke Admitted during the 2020 Pandemic in Italy.

The impact of the COVID-19 pandemic on the event rate of patients with ischemic stroke has been poorly investigated. We sought to evaluate the impact of the COVID-19 infection on mortality in patients with ischemic stroke admitted during the 2020 pandemic in Italy. We analyzed a nationwide, comprehensive, and universal administrative database of patients who were admitted for ischemic stroke during and after the national lockdown for the COVID-19 infection in 2020, and the equivalent periods over the previous 5 years in Italy. The 2020 observed hospitalization and mortality rates of stroke patients with and without COVID-19 infection were compared with the expected rates, in accordance with the trend of the previous 5 years. During the period of observation, 300,890 hospitalizations for ischemic stroke occurred in Italy. In 2020, 41,302 stroke patients (1102 with concomitant COVID-19 infection) were admitted at 771 centers. The rate of admissions for ischemic stroke during the 2020 pandemic was markedly reduced compared with previous years (percentage change vs. 2015: -23.5). Based on the 5 year trend, the 2020 expected 30 day and 1 year mortality rates were 9.8% and 23.9%, respectively, and the observed incidence of death rates were 12.2% and 26.7%, respectively (both p < 0.001). After multiple corrections, higher rates of mortality were observed among patients admitted for stroke with a concomitant COVID-19 diagnosis. During the COVID-19 pandemic in 2020 in Italy, the rate of hospitalizations for ischemic stroke was dramatically reduced, although both the 30 day and 1 year mortality rates increased compared with the previous 5 year trend.

New-onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination: a rare case report

BackgroundRare cases of COVID-19 infection- and vaccine-triggered autoimmune diseases have been separately reported in the literature. In this paper, we report the first and unique case of new onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination in a previously healthy 26-year-old Tunisian female.Case presentationA 26-years old female with a family history of a mother diagnosed with schizophrenia, and no personal medical or psychiatric history, was diagnosed with mild COVID-19 infection four days after receiving the second dose of Pfizer-BioNTech COVID-19 vaccine. One month after receiving the vaccine, she presented to the psychiatric emergency department with acute psychomotor agitation, incoherent speech and total insomnia evolving for five days. She was firstly diagnosed with a brief psychotic disorder according to the DSM-5, and was prescribed risperidone (2 mg/day). On the seventh day of admission, she reported the onset of severe asthenia with dysphagia. Physical examination found fever, tachycardia, and multiple mouth ulcers. Neurological evaluation revealed a dysarthria with left hemiparesis. On laboratory tests, she had severe acute kidney failure, proteinuria, high CRP values, and pancytopenia. Immune tests identified the presence of antinuclear antibodies. Brain magnetic resonance imaging (MRI) revealed hyperintense signals in the left fronto-parietal lobes and the cerebellum. The patient was diagnosed with systemic lupus erythematosus (SLE) and put on anti-SLE drugs and antipsychotics, with a favorable evolution.ConclusionsThe chronological relationship between COVID-19 infection, vaccination and the first lupus cerebritis manifestations is highly suggestive, albeit with no certainty, of the potential causal link. We suggest that precautionary measures should be taken to decrease the risk of SLE onset or exacerbation after COVID-19 vaccination, including a systematic COVID-19 testing before vaccination in individuals with specific predisposition.

The impact of COVID-19 on hospitalization outcomes of patients with acute myocardial infarction in the USA

Background/study objectiveThe effect of the COVID-19 pandemic affected health care delivery, as it led to variable outcomes in different disease states including cardiovascular diseases. In this study, we evaluated the impact of coexisting COVID-19 on Acute Myocardial Infarction (AMI). Design/settingWe analyzed discharge records of AMI patients from the National Inpatient Sample (NIS) in the year 2020. Main outcome measuresUsing propensity score matching, we assessed the impact of COVID-19 infection on the in-hospital outcomes of patients presenting with AMI. ResultsThere were 1154 patients with concomitant COVID-19 infection and AMI who were matched with 109,990 patients with AMI and without COVID-19. We found that patients with COVID-19 who had AMI were less likely to have dyslipidemia (64.6 % vs. 70.4 %, p < 0.001), peripheral vascular disease (2.4 % vs. 3.8 % p = 0.0017), smoking history (23.5 % vs. 28.2 % p < 0.0001) and hypertension (37.1 % vs. 40.1 % p = 0.004).COVID-19 was associated with higher hospital mortality rates (Adjusted odds ratio aOR: 2.72, CI: 2.23–3.30, p < 0.001), cardiac arrest (aOR: 1.65, 95 % CI: 1.26–2.15, p < 0.001), cardiogenic shock (aOR:1.36,95 % CI: 1.10–1.68, p = 0.004) and respiratory failure (aOR:1.81, 95 % CI: 1.55–2.11 p < 0.001) compared to AMI patients without COVID-19. There was also a significant association between coexisting COVID-19 and longer duration of hospital stay (Adjusted mean differences:1.40, 95 % CI: 1.31–1.59 p < 0.0001) in AMI patients. ConclusionCOVID-19 infection is associated with worse in-hospital mortality and cardiorespiratory complications in patients with AMI.

SARS-CoV-2 Infection, A Risk Factor for Pituitary Apoplexy? A Case Series and Literature Review.

Introduction: Pituitary apoplexy (PA) is a rare phenomenon, characterized by a hemorrhagic or ischemic event of the pituitary gland, most often in association with a pituitary lesion. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the strain of virus responsible for the internationally recognized global pandemic COVID-19. Multiple clinical manifestations associated with this virus have been described, ranging from asymptomatic, mild flu symptoms to acute respiratory distress syndrome, end-organ failure leading to death. Cases of patients with concomitant COVID-19 infections and PA are being further recognized in the literature, but the causal association between the 2 entities remains speculative. Objectives: The objectives of this case series are 3-fold: to describe additional cases of patients with concomitant COVID-19 infection and PA (1), to review the current evidence regarding this potential complication associated with a COVID-19 infection (2), and to discuss physiopathological hypotheses, treatments, and prognoses of this newly recognized association (3). Method: We conducted an electronic chart review of patients treated for PA with concomitant COVID-19 infection from March 2020 to December 2021. A literature review was performed using MEDLINE, Web of Science, and Embase databases to identify other cases of COVID-19-associated PA. Results: From March 2020 to December 2021, 3 patients presented to our center with PA following a symptomatic COVID-19 infection. Two of these patients developed PA symptoms days following the viral infection, whereas the third patient developed PA after a 2-month period. The 2 first patients were managed surgically because of persistent visual symptoms. Results from our literature review yielded 12 other cases of COVID-19-associated PAs. Conclusions: The association between COVID-19 infection and PA has been increasingly reported in the literature. With the addition of the 3 cases described in our article, a total of 15 cases have been published. Many contributing mechanisms may lead to PA following COVID-19 infection. Coagulopathy is probable major contributing cause responsible for hemorrhage or infarction of the pituitary gland. Our case series provides further arguments that PA may be a direct manifestation of a COVID-19 infection.

Acute kidney injury is a risk factor for in-hospital mortality in patients with acute cardiovascular pathology and concomitant COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Although respiratory failure and hypoxemia are the main manifestations of COVID-19, many patients also experience worsening kidney function. Hemodynamic disorders in patients with acute cardiovascular pathology can also worsen renal function. The aim of this study was to assess kidney function and its significance for the development of in-hospital complications in patients who were hospitalized with acute cardiovascular pathology and had a co-infection with COVID-19. 139 pts with acute cardiovascular pathology who were diagnosed with COVID-19 were examined. 69 (49.6%) pts had ACS (47 pts with AMI), 33 (23.7%) pts - hypertensive urgency, 24 (17.3%) pts - ADHF, 9 (6.5%) pts - tachysystolic paroxysm of atrial fibrillation, 2 (1.4%) pts - acute pulmonary embolism, and 2 (1.4%) pts - syncope. The average age was 67.9±12.7 y.o., 70 (50.4%) pts were male. Concomitant arterial hypertension was found in 87.1%, DM – 20.9%, CHF - 30.9%, COPD – 9.4% of pts, history of AMI – 20.1% and ischemic stroke – 9.4% of pts. The initial creatinine level was 110.7±66.1 μmol/l, eGFR CKD-EPI - 63.3±20.3 ml/min/1.73m2 (eGFR&amp;lt;60 ml/min/1 ,73m2 – 46.0% of patients). Patients with eGFR&amp;lt;60 ml/min/1.73m2 were older, more often female, often had a history of AF, had a lower level of hemoglobin and blood pressure at admission, a greater number of complications (need for NIV, inotropic therapy) and higher in-hospital mortality (25.0% vs. 5.3%, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (creatinine level increase ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR&amp;lt;60 ml/min/1.73m2, p&amp;lt;0.05). These patients did not significantly differ from patients without AKI in terms of basic clinical and anamnestic characteristics, but had a lower spO2 level at admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), VTE (14.3% vs. 0.9%, p=0.070), death from of all causes (47.6% vs. 7.0%, p=0.002) and more often required organ support therapy: non-invasive/invasive lung ventilation (52.4% vs. 11.3%, p&amp;lt;0.001), inotropic therapy (57, 1% versus 5.2%, p&amp;lt;0.001). The simplified criterion of AKI (increase of creatinine level ≥ 26.5 μmol/l in comparison with the value at admission at any time during the hospital period) also made it possible to distinguish the category of patients at high risk of hospital complications and death (37.9% vs. 8.2% , p=0.004). Acute kidney injury is a powerful risk factor for in-hospital complications and mortality in patients with acute cardiovascular pathology and concomitant COVID-19 infection.

PO-02-173 TRENDS IN COVID-19 AND ATRIAL FIBRILLATION: A NATIONAL INPATIENT SAMPLE TREND FROM 2020

Atrial fibrillation (AF) is the most common arrhythmia in the United States. Concomitant Covid-19 infection and the outcomes of AF are unknown. The study's goals were to analyze the outcomes of AF during the Covid-19 pandemic. We conducted a retrospective cohort study based on the 2020 National Inpatient Sample (NIS) of Adults (>18 years) hospitalized for AF as the primary admitting diagnosis based on the ICD-10 codes and stratified these groups into concomitant covid-19 infection vs. non-covid-19 infection. All-cause mortality was our primary outcome, while the rate of ICU admission, length of stay, hospital charges were our secondary outcomes. Temporal trends were assessed using logistic regression. In 2020, there were 1,994,985 admissions for atrial fibrillation, out of whom 104,495 (5.3%) had concomitant Covid-19. In the 104,495 AF admissions with covid-19, the mean age was 75y and 56.8% were males. Our results, image 1, showed AF with and without concomitant Covid-19 had similar rates of comorbid conditions including HTN, DM, OSA, CAD. HFrEF, and ESRD. AF patients with Covid-19 infection had a lower prevalence of smoking (31.83% vs. 39.4%, p<.001) and alcohol use (2% vs. 4.2%, p<.001). AF patients from both groups had similar rates of stroke (1.6% vs. 1.0%, p<.001). New AF patients with concomitant Covid-19 had worsening in-hospital outcomes such as shock (12.8% vs. 3.7%, p<.001), admission to the ICU (18.1% vs. 6.4%, p<0.001), higher all-cause mortality (21.8% vs. 3.9%, p<0.001), a longer length of stay (9.96 days vs 6.08 days, p<.001), and total hospital costs ($114,387 vs. $85,830, p<.0001). The incidence of AF catheter ablation on initial hospital admission for AF Covid-19 was lower compared to the AF non-covid-19 patients (.08% vs. 1.39%, p<.001). In 2020, Covid-19 infection was an independent predictor of higher all-cause mortality, length of stay, and costs in patients admitted for atrial fibrillation. In addition, these patients were less likely to get catheter ablation on hospital admission.

A-7 | Outcomes of Non–ST-Segment Elevation Myocardial Infarction Patients With Concomitant COVID-19 Infection in the United States

A-7 | Outcomes of Non–ST-Segment Elevation Myocardial Infarction Patients With Concomitant COVID-19 Infection in the United States

B-37 | Outcomes Among Patients Hospitalized for Transcatheter Aortic Valve Replacement (TAVR) With Concomitant COVID-19 Infection: A Nationwide Analysis

B-37 | Outcomes Among Patients Hospitalized for Transcatheter Aortic Valve Replacement (TAVR) With Concomitant COVID-19 Infection: A Nationwide Analysis

Abstract #1403761: The Impact of COVID-19 Infection on Diabetic Ketoacidosis Acidosis Hospitalization: A Nationwide Analysis

One of the potentially fatal consequences for diabetic patients is diabetic ketoacidosis acidosis (DKA), which is also linked to poor hospital outcomes. There is no much information in literature about COVID-19 and how it relates to other hospitalizations. The impact of COVID-19 on in-hospital mortality and other clinically relevant outcomes for DKA patients is being investigated for the first time in this study. Patients admitted with a primary diagnosis of DKA with or without a subsequent diagnosis of COVID-19 Infection were found in the National Inpatient Sample (NIS) Database 2020. Patients were divided into two groups: those who have COVID-19 and those who don't. Univariate and multivariate logistic regression models were utilized to account for frequent confounders and assess the risk of mortality and in-hospital outcomes between the two groups. The total of 110,130 DKA admissions were identified between Jan and Dec 2020. COVID-19 Infection was diagnosed in 2,504 patients (2.2%). The average age of the cohort sample was 35 years old, 51% were male, and 60% were white. The average length of stay (LOS) was 3 days, and the average total hospital charges were 33,132 US dollars. The total number of patients who died was 225 patients. When the two groups were compared, COVID-19 Infection was associated with an increased risk of in-hospital mortality among DKA patients (OR 5.3, 95% CI 1.7–15.9, p=0.003). COVID-19 patients had a higher risk of acute respiratory failure (OR 2.9, 95% CI 1.7–3.9, p< 0.001) and septic shock (OR 3.9, 95% CI 1.5–9.8, p=0.003). There was no significant difference between the COVID-19 and non-COVID-19 groups in the risk of acute coronary syndrome (OR 1.2, 95% CI 0.49–3, p=0.66), cardiac arrest (OR 2, 95% CI 0.5–7.9, p=0.31), hypokalemia (OR 1.14, 95% CI 0.92–1.4, p=0.214), deep vein thrombosis (OR 0.59, 95% CI 0.14–2.4, p=0.47), or pulmonary embolism (OR 3.6, 95% CI 0.84 – 15.4, p=0.083). COVID-19 patients had a longer mean LOS (4.2 vs 2.9 days, p< 0.001) and higher mean total hospital charges (41,216 vs 32,973 $, p=0.004). Patients admitted with DKA and concomitant COVID-19 infection found to have a higher risk of in-hospital mortality and worse hospital outcomes, particularly acute respiratory failure and septic shock. In comparison to non-COVID patients, COVID-19 patients have a longer mean LOS and a higher mean of total hospital charges.

Long-Term Safety, Tolerability, And Efficacy of Efgartigimod in Patients with Generalized Myasthenia Gravis: Concluding Analyses from the ADAPT+ Study (S5.006)

Long-Term Safety, Tolerability, And Efficacy of Efgartigimod in Patients with Generalized Myasthenia Gravis: Concluding Analyses from the ADAPT+ Study (S5.006)

Impact of the COVID-19 pandemic on the incidence and prognosis of acute myocardial infarction - a single-center restrospective analysis

Introduction: COVID-19 pandemic has led to a signifi cant change in the incidence and prognosis of acute myocardial infarction (AMI) by indirect and direct mechanisms. Aim: To assess the impact of the COVID-19 pandemic on the incidence and prognosis of AMI. Material and methods: We performed a retrospective analysis of consecutive patients with AMI (STEMI and NSTEMI) during two time periods &amp;ndash; the complete lockdown in Bulgaria and one of the waves of the pandemic. We compared patients&amp;rsquo; risk profi le, index event, investigations and treatment to a control group from the pre-pandemic period. Results: During the fi rst period we included 52 patients with AMI without COVID-19 and compared them to a control group of 66 patients. We found a decrease primarily in the number of patients with STEMI. The scores for assessing diseaseseverity (GRACE, APACHE II, SOFA) were higher in 2020 compared to the pre-pandemic period. More patients presented with acute congestive heart failure, mortality was similar. During the second period we included 83 patients, 21 of them with COVID-19 infection. System delay was increased in all patients. Disease severity scores and baseline troponin were higher especially in the COVID-19 group. In-hospital mortality was substantially higher in patients with COVID-19 compared to controls (23,8% versus 9%, &amp;#1088; = 0,0375), probably due to increased incidence of cardiogenic shock and need for mechanical ventilation. Conclusion: During the complete lockdown there was a reduction in the number of patients admitted with AMI, higher incidence of acute congestive heart failure and similar mortality. During one of the waves of the pandemic we found a signifi cant increase in system delay, not exceeding the recommended time frame of 120 minutes, and in disease severity in all patients. Concomitant COVID-19 infection was associated with higher in-hospital mortality due to increased incidence of cardiogenic shock and need for mechanical ventilation.

Abstract WP130: Intracerebral Hemorrhage Outcomes And Trends During The Covid-19 Pandemic. An Observational Study Of 61,417 Cases.

Background: Patients with ischemic stroke have worse outcome if there is concomitant coronavirus 2019 (COVID-19) infection. We hypothesize that patients with intracerebral hemorrhage (ICH) during the pandemic era had worse outcomes than ICH patients during the pre-pandemic period, and that concomitant COVID-19 in ICH patients is associated with worse outcome. Methods: We analyzed data from Get With The Guidelines® Stroke. We implemented a two-stage design: first, we compared outcomes for ICH patients pre-pandemic (admitted between March 2019 and February 2020) with outcomes for ICH patients admitted during the pandemic (from March 2020 to February 2021); second, we compared outcomes of ICH patients with and without COVID-19 infection admitted during the pandemic (from March 2020 to February 2021). We used multivariable logistic regression adjusted by age, sex, race/ethnicity, and clinical covariates for in-hospital mortality and poor functional outcome using the modified Rankin Scale (mRS) at discharge (mRS &gt;= 4) and a for length of stay (LOS). Results: The first stage included 62,743 pre-pandemic and 64,681 intra-pandemic ICH cases 64,681. ICH patients during the pandemic had worse outcomes, including higher modified rankin scale (mRS) (OR 1.10, CI 1.06-1.14) and higher mortality (OR 1.04, CI 1.01-1.07). The second stage included 60,091 COVID-19-negative and 1,326 COVID-19-positive ICH patients. Patients with concomitant COVID-19 infection had worse outcomes, including higher LOS (RR 1.32, CI 1.25-1.39), high mRS (OR 1.68, CI 1.40-2.01), and increased mortality (OR 1.50, CI 1.33-1.71). (Table). Conclusion: When comparing pre- and intra-pandemic cases of ICH, critically ill stroke patients admitted during the pandemic had worse outcomes. When comparing COVID-19 positive and negative ICH cases that happened during the pandemic, those with the infection had worse clinical outcomes. COVID-19 infection is an independent risk factor for poor outcomes in ICH.