Confirmed SARS-CoV2 Infection Research Articles

Exploring the lived experiences and perspectives of individuals with communication and swallowing difficulties associated with Long-COVID

BACKGROUND: Long-COVID occurs in individuals with a history of probable or confirmed SARS CoV-2 infection. Long-COVID can affect individuals who experience both mild and severe acute COVID-19 and can involve and affect multiple body systems. Research thus far acknowledges swallowing and communication difficulties as a characteristic of Long-COVID, however, this research lacks detail and does not address the psychosocial impact of these problems. OBJECTIVES: To establish an understanding of the presence, severity, and trajectory of swallowing and communication difficulties as a symptom of Long-COVID among adults. To investigate the psychosocial impact of these characteristics and explore supports and barriers to recovery. METHODS: The objectives were addressed by utilizing a qualitative research design. Semi-structured interviews were carried out with participants using online Zoom sessions. The interviews were recorded and transcribed and reflexive thematic analysis was used to analyse the data. RESULTS: Seven participants from Ireland, Scotland and Australia were interviewed. Four main themes were identified including dysphagia-related issues, communication-related issues, psychosocial impact of dysphagia and communication disorders, and accessing Long-COVID related healthcare for dysphagia and communication disorders. The presentation of swallowing and communication problems was diverse and had significant psychosocial and mental health consequences. Furthermore, access to healthcare services to effectively treat these issues was challenging. CONCLUSIONS: The lack of recognition of swallowing and communication as a symptom of Long-COVID and its adverse effects is a pertinent issue which warrants further research and updated guidelines for individuals living with Long-COVID and healthcare professionals alike.

Role of Tau protein in long COVID and potential therapeutic targets.

Long COVID is an emerging public health burden and has been defined as a syndrome with common symptoms of fatigue, shortness of breath, cognitive dysfunction, and others impacting day-to-day life, fluctuating or relapsing over, occurring for at least two months in patients with a history of probable or confirmed SARS CoV-2 infection; usually three months from the onset of illness and cannot be explained by an alternate diagnosis. The actual prevalence of long-term COVID-19 is unknown, but it is believed that more than 17 million patients in Europe may have suffered from it during pandemic. Currently, there is limited understanding of the pathophysiology of this syndrome, and multiple hypotheses have been proposed. Our literature review has shown studies reporting tau deposits in tissue samples of the brain from autopsies of COVID-19 patients compared to the control group, and the in-vitro human brain organoid model has shown aberrant phosphorylation of tau protein in response to SARS-CoV-2 infection. Tauopathies, a group of neurodegenerative disorders with the salient features of tau deposits, can manifest different symptoms based on the anatomical region of brain involvement and have been shown to affect the peripheral nervous system as well and explained even in rat model studies. Long COVID has more than 203 symptoms, with predominant symptoms of fatigue, dyspnea, and cognitive dysfunction, which tauopathy-induced CNS and peripheral nervous system dysfunction can explain. There have been no studies up till now to reveal the pathophysiology of long COVID. Based on our literature review, aberrant tau phosphorylation is a promising hypothesis that can be explored in future studies. Therapeutic approaches for tauopathies have multidimensional aspects, including targeting post-translational modifications, tau aggregation, and tau clearance through the autophagy process with the help of lysosomes, which can be potential targets for developing therapeutic interventions for the long COVID. In addition, future studies can attempt to find the tau proteins in CSF and use those as biomarkers for the long COVID.

Long postcovid injury on left ventricle function

Abstract Funding Acknowledgements Type of funding sources: None. Post COVID19 condition occurs in individuals with a history of probable or confirmed SARS Cov2 infection, usually 3 months from the onset of COVID19 with symptoms that last for up to at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction, but also arterial hypertension and generally have an impact on everyday function. Symptoms may be new onset following initial recovery from an acute COVID 19 episode or persist from the initial illness. Aim COVID 19 pneumonia initiates new onset arterial hypertension (AH) and aggravates the structural and functional myocardium remodeling in the long term after hospitalization. Methods The study population /initially questioned 1500 patients for symptoms after acute COVID 19 pneumonia / included 220 patients without history of any disease, mean age of 45±12 years, male 145 (43±10 years) female 75 ( 52± 14 years).We used Speckle tracking echocardiography to analyze the global longitudinal strain (GLS). GLS was extracted by 3, 4 and 2 chamber apical view images on 70 fr/s for left ventricle ( LV ) and right ventricle( RV ).CMR with LGE was performed at 3rd (3mFU) and 12th months (12mFU) also to confirm our resulst. AMBP analysis, MAP and HR were performed at baseline /30–40 days after acute infection/ 3rd and 12th months follow up. Results From initial population /1500 pts/ self-reported symptoms at 12mFU are 1265 ( 84.6 % ) and 235 (15.4 % ) are symptom free at 12mFU. AH presence at 3mFU in 143( 65% of patients )up to 161 patients (73% at 12mFU). Symptoms of heart failure with preserved EF were found at 3mFU in 91 pts (41%) and in 99 pts (45%) at 12mFU Despite normal EF, GLS / minus 18.5 %, p<0.01) and segmental LS in all apical and mid anteroseptal, inferoseptal and basal anteroseptal and inferoseptal levels ( minus 16% to minus 18%, p <0.01) and RV ( 22.3% to 24%) at 12mFU shown diminished and still preserved values, even in 3 level layers. Performed CMR confirmed injured segments. Conlusions New onset AH is one of major symptoms after COVID 19 and remains at 12mFU. Despite of satisfactory improvement of conventional parameters for LV and RV function, GLS indicate worsening of the LV systolic function. In pts with COVID-19 pneumonia echocardiography showed predominantly decrease of the load on the right heart at 3mFU. LV function showed slightly improvement at 12mFU.

Complications in hospitalized patients with SARS-CoV2 infection

OBJECTIVES: The present study aimed to assess the prevalence of complications during hospitalization in patients diagnosed with COVID-19, as well as the association with mortality and prognosis. METHODS: A retrospective cohort study involved 306 patients admitted to a COVID ward and ICU aged 18 years or older with confirmed SARS-CoV2 infection admitted to a Brazilian Tertiary Hospital. Demographic, clinical, biochemical, radiological and outcome data were collected from the patients' charts. RESULTS: According to the data analyzed during hospitalization, 230 (75.2%) patients developed complications, 281 (91.8%) patients had comorbidities and 169 (55.2%) patients died. There are no differences regarding the sex of the patients. The most prevalent complication was ventilator-associated pneumonia, present in 130 (42.5%) patients, followed by acute kidney injury or chronic kidney disease requiring hemodialysis, presented by 100 (32.7%) patients. The calculation of the relative risk of death according to the occurrence of complications showed p<0.0001 for acute renal failure, p<0.0001 for orotracheal intubation and p=0.0434 for acute myocardial infarction. CONCLUSION: The relative risk of death in COVID-19 is significant, showing an increase in relation to age, length of hospital stay and complications. Prevention, early diagnosis and appropriate treatment are essential to reduce the mortality rate in patients with SARS-CoV-2 infection.

S-42-5: NEW ONSET HYPERTENSION AND EARLY CHANGES IN LEFT VENTRICULAR FUNCTION IN POST COVID -19 CONDITION

Background: Post COVID19 condition occurs in individuals with a history of probable or confirmed SARS Cov2 infection, usually 3 months from the onset of COVID19 with symptoms that last for up to at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction, but also arterial hypertension (AH) and generally have an impact on everyday function. Aim: COVID 19 pneumonia initiates new onset AH and aggravates the structural and functional myocardium remodeling in the long term after hospitalization. Methods: The study population /initially questioned 1500 patients for symptoms after acute COVID 19 pneumonia / included 220 patients without history of any disease, mean age of 45 ± 12 years, male 145 (43 ± 10 years) female 75 (52 ± 14 years). The global longitudinal strain (GLS) was extracted for left ventricle (LV)and right ventricle(RV) and AMBP analysis, mean arterial pressure (MAP)and heart rate HR were performed at baseline /30–40 days after acute infection/ 3rd and 12th months follow up. CMR was performed at 3rd (3mFU) and 12th months (12mFU) also to confirm our resulst. Results: From initial population /1500 pts/ self-reported symptoms at 12mFU are 1265 (84.6 %) and 235 /15.4 %) are symptom free at 12mFU. At 3mFU HR and MAP increased significantly / from 75 ± 6 beats /min to 88 ± 12 beats/ min, 109 ± 15 mmHg to 118 ± 19mmHg. Sys BP increased slightly at 3mFU /128 ± 14, p = 0.6/ and continue at 12mFU / 129 ± 12, p = 0.7/. Diastolic BP increased significantly at 12mFU /86 ± 12.3 to 91 ± 10.0, p > 0.01/ and AH presence at 3mFU in 143 (65%)up to 161(73%) at 12mFU. Symptoms of heart failure with preserved EF were found at 3mFU in 91 pts (41%) and in 99 pts (45%) at 12mFU. Echocardiography showed predominantly decrease of the load on the right heart at 3mFU and 12mFU (RV FAC % p < 0.019, TAPSE p < 0.05, RVOT VTI p < 0.01). LV function showd increased EDD, ESD, EDV, ESV, and decreased EF and GLS at 3mFU and slightly improvement at 12mFU. Despite normal EF, GLS / 18.5 %,p < 0.01) and segmental LS in all apical and mid anteroseptal, inferoseptal and basal anteroseptal and inferoseptal levels (16% to 18%, p < 0.01) and RV (22.3% to 24%) at 12mFU shown diminished and still preserved values. Conclusion: New onset AH is one of major symptoms after COVID 19 and remains at 12mFU. Despite of satisfactory improvement of conventional parameters for LV and RV function, GLS indicate worsening of the LV systolic function.

1089. Evaluation of breakthrough infections in solid organ transplant recipients: the prospective CONTRAST cohort

Abstract Background Solid organ transplant (SOT) recipients are at higher risk than general population for complicated COVID-19 course. Moreover COVID-19 vaccination in this setting is associated with a suboptimal immune response. However, the impact of this finding on the risk of breakthrough infection (BI) in SOT recipients has to be yet determined. Methods Single-center prospective longitudinal cohort of adult SOT recipients who received three doses of mRNA COVID-19 vaccine between February and December 2021 and were followed up to March 30 2022. Patients were tested for antibody response at several timepoints (1 st dose, 2 nd dose, 3±1 month after 1 st dose, and 1 month after 3 rd dose). Main endpoints were: i) BI defined as laboratory confirmed SARS-CoV2 infection diagnosed ≥14 day after 2 nd dose; ii) positive antibody response (AbR) defined as anti-rapid binding domain titer ≥5 U/ml determined by Elecsys Anti-SARS-CoV-2 ECLIA assay (Roche Diagnostics, CH), the last available determination before BI was considered. Results Study cohort consists of 642 SOT (277 kidney, 191 liver, 144 heart, 37 lung) recipients: 63.9% males, median age 54 ± 14.5 years. Of them, 111 (17.8%) developed BI, BI rates were 19.9%, 18.1%, 15.2% and 10.8% among liver, heart, kidney and lung transplant recipients, respectively. Positive-AbR was observed in 60% of all patients, but rates varied from 8.7% to 91.3% among patients with BI and without BI, respectively. Predictors of BI infection at multivariable analysis were liver (vs. other grafts) transplant (OR 2.98, 95%CI 1.47-6.03), mycophenolate (1.63, 0.92-2.88) and steroids (1.8, 1.05- 3.33), while positive-AbR (0.61, 0.35-1.04) and age (0.97, 0.95-0.99) were protective. On the other hand, liver transplant (1.94, 1.02-3.69), time from transplant (1.09, 1.05-1.21), and Moderna vaccine (2.32, 1.46-3.70) were associated with positive-AbR, while age (0.97, 0.95-0.98), heart transplant (0.56, 0.33-0.96), mycophenolate (0.65, 0.39-1.06) and steroids (0.39, 0.23-0.65) with lower probability of positive-AbR. Conclusion Although associated with positive-AbR, liver transplant and younger age were also BI predictors, suggesting the importance of social factors and the controversial role of immune monitoring. Disclosures All Authors: No reported disclosures.

COVID-19 and protection of vaccination in patients with systemic sclerosis-associated interstitial lung disease.

Data on COVID-19 in patients with interstitial lung disease are scarce and whether SARS-CoV-2 may trigger interstitial lung disease progression remains unknown. We aimed to analyze outcomes of COVID-19 in patients with systemic sclerosis-associated interstitial lung disease, including possible thoracic radiographic progression. All 43 patients with systemic sclerosis-associated interstitial lung disease followed in our center (mean ± SD, 55.2 ± 11.6 years, 36 female) with confirmed SARS-CoV2 infection up to 1 September 2022 were analyzed. Individual interstitial lung disease extent on high resolution CT (HRCT) performed before (up to 3 months) and after COVID-19 (2-5 months) was compared. At SARS-CoV-2 infection, 9/43 patients were unvaccinated, whereas 5, 26, and 3 had received 2, 3, or 4 doses of an mRNA vaccine, respectively. Thirty-one patients were either on monotherapy with immunosuppressives (mycophenolate, n = 7; cyclophosphamide, n = 2; methotrexate, n = 10; tocilizumab, n = 7; rituximab, n = 1; etanercept, n = 1), or their combinations (n = 3). Eight patients (20%), of whom four unvaccinated, required hospitalization for pneumonia and three (7%) died of acute respiratory failure (n = 2, both unvaccinated) or cardiac arrest. Lack of vaccination was the only independent predictor for hospitalization (OR = 7.98, 95% CI: 1.25-51.09) and marginally for death (OR = 32.7, 95% CI: 0.97-1110.98), regardless of the presence of diffuse systemic sclerosis, interstitial lung disease extent greater than 20% or immunosuppressive treatment. In 22 patients with available HRCT pairs (vaccinated = 20), the interstitial lung disease extent before COVID-19 (20.4%± 17.8%) remained unchanged (22.4% ± 18.5%) in all but one patient. SARS-CoV-2 vaccination is of outmost importance for every systemic sclerosis patient with interstitial lung disease. COVID-19 does not seem to promote progression of systemic sclerosis-associated interstitial lung disease in vaccinated patients, but further studies are warranted.

Palliative care of COVID-19 patients with do-not-resuscitate status in underrepresented minorities.

The impact of the COVID-19 pandemic on palliative care intervention (PCIs) in patients with do-not-resuscitate (DNR) status remains uncertain. Case-control study of patients with DNR order with RT-PCR confirmed SARS-COV2 infection (cases), and those with DNR order but without SARS-COV2 infection (controls). The primary outcome measures included timing and delivery of PCIs, and secondary measures included pre-admission characteristics and in-hospital death. The ethnicity distribution was comparable between 69 cases and 138 controls, including Black/African Americans (61% vs. 44%), Latino/Hispanics (16% vs. 26%) and White (9% vs. 20%) (trend-p=.54). Cases were employed more (17% vs. 6%, adjusted-p=.012), less frail (fit 47% vs. 21%; mildly frail 22% vs. 36%; frail 31% vs. 43%, trend-p=.018) and had fewer comorbidities than controls. Cases had higher chances of intensive care unit admission (HR 1.76 [95% CI: 1.03-3.02]) and intubation (53% vs. 30%, p=.002), lower chances to be seen by palliative care team (HR .46 [.30-.70]) and a longer time to palliative care visit than controls (β per ln-day .67 [.00-1.34]). In the setting of no-visiting hospitals policy, we did not find significant increase in utilisation of video conferencing (22% vs. 13%) and religious services (12% vs. 12%) both in case and in controls. Do-not-resuscitate patients with COVID-19 had better general health and higher employment status than 'typical' DNR patients, but lower chances to be seen by the palliative care team. This study raises a question of the applicability of the current palliative care model in addressing the needs of DNR patients with COVID-19 during the pandemic.

Non-contrast cardiac magnetic resonance imaging after SARS-CoV2 infection or vaccination in asymptomatic adolescents: insights from the EnIGMA study

Abstract Background Myocarditis after SARS-CoV2 infection or vaccination is rare, but seems to be relatively more frequent in young population. Cardiac magnetic resonance (CMR) T2 weighted sequences have the potential to detect subclinical myocarditis. However, there is paucity of data on the potential myocardial involvement after SARS-CoV2 infection or vaccination in asymptomatic adolescents. Purpose To evaluate the presence of subclinical myocardial damage in adolescents who were infected with SARS-CoV2 or vaccinated against SARS-CoV2 using non-contrast CMR imaging. Methods Asymptomatic adolescents enrolled in the “Early ImaginG Markers of unhealthy lifestyles in Adolescents” (EnIGMA) project were scanned using a 3-Tesla CMR scanner between March 2021 and October 2021. CMR scans included CINE imaging and myocardial T2-mapping sequences. SARS-CoV2 IgG antibody testing was performed in capillary blood samples, and date of confirmed SARS-CoV2 infection and/or vaccination if any was collected. Participants were assigned to three different groups according to SARS-CoV2 status: Group 1 (non-infected and non-vaccinated), Group 2 (infected and non-vaccinated), and Group 3 (vaccinated, independently of past infection status). CMR images were analyzed by experienced observers blinded to adolescent's SARS-CoV2 status. ANOVA and multiple regression analysis, together with correlation coefficients, were used to study between-group differences and associations among variables of interest. Results A total of 115 adolescents with a mean age of 16.0 years (standard deviation (SD)=0.4), 54% girls, completed the CMR study and SARS-CoV2 data successfully, and were assigned to Group 1 (n=72), Group 2 (n=22), and Group 3 (n=21). Left and right ventricular ejection fraction (LVEF/RVEF) did not significantly differ among groups: mean LVEF was 62.8% (SD=4.1), 63.0% (SD=3.7) and 60.9% (SD=3.9) [p=0.12] and mean RVEF was 56.5% (SD=4.2), 56.5% (SD=5.5) and 54.5% (SD=5.1) [p=0.23] in Groups 1, 2 and 3, respectively. Similarly, there were no between-group significant differences in myocardial T2 relaxation values: mean T2 values were 44.1 ms (SD=2.2), 44.1 ms (SD=1.8) and 44.4 ms (SD=1.9) in Groups 1, 2, and 3, respectively (p=0.63) (Figure 1). No differences were found either after adjusting for age and gender. Median time (interquartile range) from date of infection or vaccination to CMR acquisition was 133 (121) days and 28 (38) days in Group 2 and Group 3, respectively. No correlation between time from infection/vaccination to CMR acquisition and T2 values was detected (Figure 2). Conclusions This observational study did not find evidence of subclinical myocardial involvement after SARS-CoV2 infection or vaccination in asymptomatic adolescents, as assessed with T2-mapping magnetic resonance imaging. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Instituto de Salud Carlos III (ISCIII)-Fondo de Investigaciόn Sanitaria.European Regional Development Fund/European Social Fund (“A way to make Europe”/“Investing in your future”.

SARS-CoV2 Infection During Pregnancy Causes Persistent Immune Abnormalities in Women Without Affecting the Newborns.

SARS-CoV2 infection in pregnancy and exposed newborns is poorly known. We performed a longitudinal analysis of immune system and determined soluble cytokine levels in pregnant women infected with SARS-CoV2 and in their newborns. Women with confirmed SARS-CoV2 infection and their exposed uninfected newborns were recruited from Hospital General Universitario Gregorio Marañón. Peripheral blood mononuclear cells (PBMCs), cord cells and plasma were collected at birth and 6 months later. Immunophenotyping of natural killer (NK), monocytes and CD4/CD8 T-cells were studied in cryopreserved PBMCs and cord cells by multiparametric flow cytometry. Up to 4 soluble pro/anti-inflammatory cytokines were assessed in plasma/cord plasma by ELISA assay. SARS-CoV2-infected mothers and their newborns were compared to matched healthy non-SARS-CoV2-infected mothers and their newborns. The TNFα and IL-10 levels of infected mothers were higher at baseline than those of healthy controls. Infected mothers showed increased NK cells activation and reduced expression of maturation markers that reverted after 6 months. They also had high levels of Central Memory and low Effector Memory CD4-T cell subsets. Additionally, the increased CD4- and CD8-T cell activation (CD154 and CD38) and exhaustion (TIM3/TIGIT) levels at baseline compared to controls remained elevated after 6 months. Regarding Treg cells, the levels were lower at infected mothers at baseline but reverted after 6 months. No newborn was infected at birth. The lower levels of monocytes, NK and CD4-T cells observed at SARS-CoV2-exposed newborns compared to unexposed controls significantly increased 6 months later. In conclusion, SARS-CoV2 infection during pregnancy shows differences in immunological components that could lead newborns to future clinical implications after birth. However, SARS-CoV2 exposed 6-months-old newborns showed no immune misbalance, whereas the infected mothers maintain increased activation and exhaustion levels in T-cells after 6 months.

PB2270: CLEARANCE OF PERSISTENT SARS-COV2 INFECTION WITH ANTIBODY CONTAINING PLASMA IN LEUKEMIA AND LYMPHOMA PATIENTS

Background: Patients with hematological malignancies or other reasons for inadequate immune response are at high risk for poor outcome of COVID-19 disease. In addition, a significant fraction of patients unable to mount an antibody response fail to clear SARS-Cov2 virus putting them at risk for clinical deterioration. Also, persistent COVID-19 infection impedes further treatment of the underlying disease. So far, no treatment has been established for persistent COVID-19 infection in immunocompromised patients. Aims: Here, we treated eight immunocompromised patients with active SARS-COV2 infection with plasma from convalescent or/and vaccinated donors in a case series of individual treatments. Methods: Patients were eligible for treatment if active SARS-Cov2 infection was confirmed at least 14 days after initial detection. In two out of eight patients sequencing results confirmed the omicron variant. Therapies before plasma treatment included antivirals and monoclonal antibodies. Underlying diseases were B-ALL (n=3; including one patient after allogeneic stem cell transplantation), multiple myeloma (n=2), lymphoma (n=2) and immunosuppression after kidney transplantation (n=1). Median age was 48 years (range 7 – 78). Antibody containing plasma was obtained from healthy donors either after confirmed SARS-COV2 infection or after mRNA vaccination. Overall, 22 treatment cycles were administered in 8 patients (median 2, range 1 to 7). For each patient the available plasma with the highest titers of neutralizing antibodies and matching blood type was administered. Results: Neutralizing antibody titers in plasma were median 1:320 (range 1:40 to 1:2560). Titers of neutralizing antibodies in convalescent plasma (n=10 treatments; median titer: 1:80) were lower than in vaccinated donor plasma (median 1:320; p=0.058, Mann-Whitney U test) (n=12 treatments). Median Ct-values of viral load before treatment were 20.5 (range 14.9 to 37.3). After treatment (median 5 days), the Ct-values changed to median 26.9 (range 19.5 to non-detectable). The median fold decrease in viral load was estimated to be 127-fold with a range from 0.8 to >2x104 (p<10-4, paired t-test). Similar reductions in viral load were achieved after administration of either plasma from convalescent (median 109) or vaccinated donors. SARS-COV2 virus was cleared in 7 of 8 (87.5%) patients with ongoing treatment in one patient. No specific adverse events were observed. Figure 1: Fold reduction in viral load after a single treatment with anti-SARS-COV2 containing plasma. Image:Summary/Conclusion: Plasma with high titers of neutralizing SARS-COV2 antibodies can clear persistent infection in patients with hematological malignancies and immunocompromised patients. Plasma obtained either from convalescent patients or vaccinated donors might constitute an effective and inexpensive treatment in this situation.

Examining the Long-Term Sequelae of SARS-CoV2 Infection in Patients Seen in an Outpatient Psychiatric Department.

BackgroundThe acute phase of Coronavirus disease-19 (COVID-19) is well known. However, there is now an increasing number of patients suffering from the post-acute sequelae of COVID-19 (PASC Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis), including neuropsychiatric symptoms. The purpose of this report is to describe the sociodemographic, diagnostic and treatment characteristics of patients evaluated in an outpatient psychiatric setting for PASC.MethodsA retrospective review of 30 individuals with documented COVID-19 illness treated at a university hospital-based Post-COVID-19 Recovery Program were referred to an outpatient psychiatric department for consultation and treatment from December 2020 to July 2021. All individuals complained of neuropsychiatric symptoms including anxiety, depression, fatigue and cognitive problems. Data on sociodemographic characteristics, psychiatric diagnosis, prominent psychological themes and treatment prescribed were described and, where applicable, analyzed with SPSS software.ResultsThe study population consisted of patients between 25 and 82 years old, with a predominance of women between 46 and 60 years. Approximately half of the patient population had a primary diagnosis of major depressive disorder, often combined with prominent anxiety. Over two-thirds of the patient population reported a combination of depression, fatigue and cognitive complaints, predominantly memory and slowed processing speed. Prominent stressors and psychological themes included social and occupational decline, isolation, lack of empathy and understanding from family, friends and employers, and apprehension about future ability to return to their baseline level of function. Treatments recommended included individual and group psychotherapy, medication and cognitive rehabilitation. Modafinil and antidepressants, often in combination, were the most commonly used medications, intended to target the pervasive fatigue, depressive, and anxiety these individuals were facing.ConclusionClinical experience from this patient population underscored the significant medical, emotional, neurocognitive and functional sequelae of PASC. Management of these individuals requires a collaborative approach with the availability of psychotherapeutic interventions, pharmacologic treatment, neurocognitive assessment and remediation to address these symptoms.

IMPACT OF ARTERIAL HYPERTENSION AND ANTIHYPERTENSIVE PHARMACOTHERAPY ON IN-HOSPITAL MORTALITY IN COVID-19 PATIENTS: THE CRACOV-HHS STUDY

Objective: Cardiovascular diseases including hypertension are common comorbidities in patients hospitalized due to COVID-19. We assessed the impact of hypertension on in-hospital mortality in patients hospitalized due to COVID-19. Design and method: We retrospectively analyzed the medical records of all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to confirmed SARS-CoV2 infection from March 2020 to May 2021. Results: Overall, data of 5191 patients (mean age 61.9 ± 16.7 years) were available for analysis. Patients with preexisting hypertension (58.3% of the study population) were older and had more comorbidities than patients without hypertension (p &lt; 0.05). In-hospital mortality was significantly higher in patients with hypertension compared to those without hypertension also after adjustment for age (22.2% vs 12.9%; P = 0.02). Age above median (64 years, odds ratio [OR] 3.93; 95% confidence interval [CI] 3.23–4.83), male gender (OR 1.19; CI 1.01–1.40), a history of heart failure (OR 2.01; CI 1.58–2.56) or chronic kidney disease (OR 2.35; CI 1.86–2.96) and increased C-reactive protein levels (OR 1.09; CI 1.08–1.10), but not preexisting hypertension (OR 0.90; CI 0.74–1.09) were significantly associated with a higher risk of in-hospital death after multivariate logistic regression analysis. However, hypertension (OR 1.45; CI 1.06–1.97) was an independent predictor of in-hospital death in patients without established cardiovascular disease and antihypertensive treatment. Treatment with any first-line antihypertensive drug class in patients with hypertension at the time of hospitalization was associated with a lower risk of in-hospital death (beta-blockers OR 0.52; CI 0.41–0.65; angiotensin converting enzyme inhibitors OR 0.52; CI 0.38–0.68; angiotensin receptor blockers OR 0.24; CI 0.12–0.41; calcium channel blockers OR 0.61; CI 0.44–0.84; thiazide diuretics OR 0.40; CI 0.24–0.64). Conclusions: Besides the high prevalence, hypertension was not an independent risk factor of in-hospital death in the overall group of hospitalized COVID-19 patients. Treatment with all first-line antihypertensive medications was associated with significant reduction of in-hospital death in patients with hypertension.

1222-P: Characteristics, Mortality, and Clinical Outcomes of Hospitalized Patients with COVID-and Diabetes: A Reference Single-Center Cohort Study from Poland

Introduction: Diabetes is a risk factor for severe COVID-course. In this one-center report, we assessed clinical characteristics and risk factors associated with unfavorable outcomes in diabetic patients (DP) hospitalized due to COVID-19. Methods: We retrospectively analyzed data from a cohort of patients with confirmed SARS-CoV2 infection admitted to the University Hospital in Krakow (Poland) , a regional reference center for COVID-19, between March 6th 2020 and May 15th 2021. The data was collected from electronic medical records. Results: We included 5191 patients, mean age 61.98±16.66 years, 2348 (45.2%) women, 1364 (26.3%) DP. DP were older as compared to non-diabetics (median age 70 vs. 62 years, IQR 62-77 and 47-72, p&amp;lt;0.001) with similar gender distribution. DP were characterized by higher mortality (26.4% vs. 15.6%, p&amp;lt;0.001) , longer hospital stay (median 15 vs. 13 days, IQR 10-24 and 9-20, p&amp;lt;0.001) , more frequent ICU admission (15.7% vs. 11%, p&amp;lt;0.001) and more frequent requirement for mechanical ventilation (15.5% vs. 11.3%, p&amp;lt;0.001) . When adjusted for sex and age, the relative risk for in-hospital death, ICU admission and mechanical ventilation was 1.32 (95%CI 1.13-1.54) , 1.4 (95%CI 1.17-1.69) and 1.3 (95%CI 1.08-1.57) , respectively. Multivariable logistic regression showed age, CRP and D-dimer level, history of heart failure, and loop diuretic use were associated with higher risk of death, whereas anticoagulation therapy, ACEI/sartan/mineralocorticoid receptor antagonist use and thiazide use were associated with lower risk. Conclusions: In this large COVID-cohort, DP constituted more than one fourth of hospitalized patients. Their risk of death was ca. 30% higher as compared to non-diabetics, as was the risk of other important clinical outcomes. We identified a number of clinical, laboratory and therapeutical variables associated with risk of hospital death in DP with COVID-19. Disclosure M.Kania: None. T.Klupa: Advisory Panel; Abbott, BIOTON S.A., Sanofi, Research Support; Medtronic, Speaker's Bureau; Ascensia Diabetes Care, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk. P.W.Witek: Other Relationship; Abbott, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Medtronic, Merck &amp; Co., Inc., Novo Nordisk, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH. B.Katra: None. M.W.Rajzer: Consultant; A. Menarini Diagnostics, Speaker's Bureau; Bayer AG, Boehringer Ingelheim International GmbH, EGIS Pharmaceuticals, Servier Laboratories. M.Malecki: Consultant; Abbott Diabetes, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk, Speaker's Bureau; Ascensia Diabetes Care, AstraZeneca, Bayer AG, Merck &amp; Co., Inc., Mundipharma, Servier Laboratories. K.Mazur: None. M.Terlecki: None. Z.Chaykivska: None. M.K.Fiema: None. M.A.Kostrzycka: None. M.Kopka: None. M.Wilk: None. J.Hohendorff: Advisory Panel; Abbott. Funding The authors were supported by the Polish National Center for Research and Development grant (grant number SZPITALE-JEDNOIMIENNE/18/2020) .

HDL-cholesterol concentration and risk of SARS-CoV-2 infection in people over 75 years of age: A cohort with half a million participants from the Community of Madrid

ObjectiveThe aim of this study was to analyze the relationship between HDL-cholesterol and the risk of SARS-CoV-2 infection in over 75-year-olds residing in the Community of Madrid. MethodsStudy of a population-based cohort, composed of all residents in Madrid (Spain) born before January 1, 1945 and alive on December 31, 2019. Demographic, clinical and analytical data were obtained from primary care electronic medical records from January 2015. Confirmed SARS-CoV-2 infection was defined as a positive RT-PCR or antigen test result. Infection data correspond to the period March 1, 2020 through December 31, 2020. ResultsOf the 593,342 cohort participants, 501,813 had at least one HDL-cholesterol determination in the past 5 years. Their mean age was 83.4 ± 5.6 years and 62.4% were women. A total of 36,996 (7.4%) had a confirmed SARS-CoV2 infection during 2020. The risk of infection [odds ratio (95% confidence interval)] for SARS-CoV2 according to increasing quintiles of HDL-cholesterol was 1, 0,960 (0,915–1,007), 0,891 (0,848–0,935), 0,865 (0,824–0,909) y 0,833 (0.792–0,876), after adjusting for age, sex, cardiovascular risk factors and comorbidities. ConclusionsThere is an inverse and dose-dependent relationship between HDL-cholesterol concentration and the risk of SARS-CoV2 infection in subjects aged over 75 years of age in the Community of Madrid.

Efficacy and Safety of Atazanavir/Ritonavir versus Lopinavir/Ritonavir in Hospitalized COVID-19 Patients: A Randomized Clinical Trial

While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir. Objectives This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral drug investigated in the previous studies. Methods This randomized, double-blind clinical trial was conducted on hospitalized patients with laboratory or confirmed SARS CoV-2 infection. Patients were randomly assigned (1:1) to receive either Lopinavir/Ritonavir (200mg Lopinavir+50mg Ritonavir, twice a day) or Atazanavir/Ritonavir (300mg Atazanavir+100 mg Ritonavir, once a day) for up to 14 days during their admission along with the standard care. The primary endpoint was total all-cause death in all patients during the hospitalization period. Secondary outcomes included length of hospitalization. Results Out of 103 adults included in the analysis 54 and 49 were assigned to Atazanavir/Ritonavir and Lopinavir/Ritonavir groups, respectively. The occurrence of adverse effects, defined as symptoms attributed to the drugs which no longer appear upon the cessation of the drug, was higher for cardiac side effects in Atazanavir/Ritonavir group. No statistically significant difference was observed between the two groups in terms of the length of hospitalization. After adjustment for other covariates in the study, treatment with Atazanavir/ritonavir did not result in a significant reduction in mortality compared to treatment with Lopinavir/Ritonavir. Conclusion The efficacy of Atazanavir/Ritonavir in this preliminary study was not superior to Lopinavir/Ritonavir in reducing mortality and length of hospitalization in COVID-19 patients. However, the limited efficacy of both compounds does not support their use in primary care for COVID-19 patients.

Predictors of biliary intervention in patients hospitalized for COVID-19.

BackgroundGastrointestinal complications of coronavirus disease-2019 (COVID-19) include abnormal liver function and acalculous cholecystitis. Cholecystostomy performed during the COVID-19 pandemic reflected a shift toward non-surgical treatment of cholecystitis and increased number of critically ill patients suffering from acalculous cholecystitis.Purpose(1) To determine demographic, clinical, laboratory, and ultrasound features associated with cholecystostomy placement during hospitalization for COVID-19. (2) To develop multivariable logistic regression modeling for likelihood of biliary intervention.MethodsThis retrospective review received institutional review board approval. Informed consent was waived. Between March 2020 and June 2020, patients with confirmed SARS-CoV2 infection admitted to New York-Presbyterian Hospital (NYP)/Weill Cornell Medical Center, NYP/Lower Manhattan Hospital, and NYP/Queens were evaluated for inclusion in this study. Inclusion criteria were (1) patient age ≥ 18, (2) confirmed COVID-19 infection by polymerase chain reaction testing of a nasopharyngeal swab, and (3) abdominal ultrasound performed during hospitalization. Exclusion criteria were (1) history of cholecystectomy and (2) biliary intervention performed prior to abdominal ultrasound. Patients were stratified into two groups based on whether they received cholecystostomy during hospitalization. Differences in demographics, medical history, clinical status, medications, laboratory values, and ultrasound findings between the two groups were evaluated using Chi-square test or Fisher’s exact test for categorical variables and t test or Wilcoxon-rank sum test for continuous variables. Multivariable logistic regression was used to model likelihood of biliary intervention.ResultsNine patients underwent cholecystostomy placement and formed the “Intervention Group.” 203 patients formed the “No Intervention Group.” Liver size and diuretics use during hospitalization were the only variables which were significantly different between the two groups, with p-values of 0.02 and 0.046, respectively. After controlling for diuretics use, the odds of receiving cholecystostomy increased by 30% with every centimeter increase in liver size (p = 0.03). ICU admission approached significance (p = 0.16), as did mechanical ventilation (p = 0.09), septic shock (p = 0.08), serum alkaline phosphatase level (p = 0.16), and portal vein patency (0.14).ConclusionPatients requiring biliary intervention during hospital admission for COVID-19 were likely to harbor liver injury in the form of liver enlargement and require diuretics use.

Impact of the COVID-19 pandemic on in-hospital cardiac arrests in the UK

AimsTo compare in-hospital cardiac arrest (IHCA) rates and patient outcomes during the first COVID-19 wave in the United Kingdom (UK) in 2020 with the same period in previous years. MethodsA retrospective, multicentre cohort study of 154 UK hospitals that participate in the National Cardiac Arrest Audit and have intensive care units participating in the Case Mix Programme national audit of intensive care. Hospital burden of COVID-19 was defined by the number of patients with confirmed SARS-CoV2 infection admitted to critical care per 10,000 hospital admissions. Results16,474 patients with IHCA where a resuscitation team attended were included. Patients admitted to hospital during 2020 were younger, more often male, and of non-white ethnicity compared with 2016–2019. A decreasing trend in IHCA rates between 2016 and 2019 was reversed in 2020. Hospitals with higher burden of COVID-19 had the greatest difference in IHCA rates (21.8 per 10,000 admissions in April 2020 vs 14.9 per 10,000 in April 2019). The proportions of patients achieving ROSC ≥ 20 min and surviving to hospital discharge were lower in 2020 compared with 2016–19 (46.2% vs 51.2%; and 21.9% vs 22.9%, respectively). Among patients with IHCA, higher hospital burden of COVID-19 was associated with reduced survival to hospital discharge (OR = 0.95; 95% CI 0.93 to 0.98; p < 0.001). ConclusionsIn comparison with 2016–2019, the first COVID-19 wave in 2020 was associated with a higher rate of IHCA and decreased survival among patients attended by resuscitation teams. These changes were greatest in hospitals with the highest COVID-19 burden.

Concentración de colesterol-HDL y riesgo de infección por SARS-CoV-2 en personas mayores de 75 años: una cohorte con medio millón de participantes de la Comunidad de Madrid

ObjectiveThe aim of this study was to analyze the relationship between HDL-cholesterol and the risk of SARS-CoV-2 infection in over 75-year-olds residing in the Community of Madrid. MethodsStudy of a population-based cohort, composed of all residents in Madrid (Spain) born before January 1, 1945 and alive on December 31, 2019. Demographic, clinical and analytical data were obtained from primary care electronic medical records from January 2015. Confirmed SARS-CoV-2 infection was defined as a positive RT-PCR or antigen test result. Infection data correspond to the period March 1, 2020 through December 31, 2020. ResultsOf the 593,342 cohort participants, 501,813 had at least one HDL-cholesterol determination in the past 5 years. Their mean age was 83.4±5.6 years and 62.4% were women. A total of 36,996 (7.4%) had a confirmed SARS-CoV2 infection during 2020. The risk of infection [odds ratio (95% confidence interval)] for SARS-CoV2 according to increasing quintiles of HDL-cholesterol was 1, 0.960 (0.915-1.007), 0.891 (0.848-0.935), 0.865 (0.824-0.909) and 0.833 (0.792-0.876), after adjusting for age, sex, cardiovascular risk factors and comorbidities. ConclusionsThere is an inverse and dose-dependent relationship between HDL-cholesterol concentration and the risk of SARS-CoV2 infection in subjects aged over 75 years of age in the Community of Madrid.

1192. Correlation Between SARS CoV 2 Viral Load and Clinical Evolution of Patients Under 15 Years of Age with COVID 19 in a General Hospital in the Province of Buenos Aires, Argentina

BackgroundSARS CoV2 infection produces clinical manifestations of different severity. The pediatric population represents less than 10% of cases, with a mortality of less than 1%. The severity of the condition and mortality are mainly associated with comorbidities. There is controversy about the correlation between the viral load of SARS CoV2 in respiratory samples and the evolution and severity of the clinical picture. The CT (cycle threshold) in the detection of the SARS CoV 2 genome in respiratory samples can be used as an indirect indicator of the viral load in the analyzed samples.Goalsto determine the correlation between the SARS CoV 2 CT values in the detection of the viral genome with the severity of the clinical picture. Describe the clinical, epidemiological, and laboratory characteristics of patients with PCR-confirmed SARS CoV2 infection in respiratory samples.MethodsA retrospective, observational and analytical study that included patients under 15 years of age with confirmed SARS CoV2 infection by PCR of respiratory samples treated at the Hospital Isidoro Iriarte in the city of Quilmes between March 1 2020 and April 30, 2021.Results485 patients (n) were included. The distribution by severity of the clinical picture was mild (84%, n = 408), moderate (12%, n = 59) and severe (4%, n = 18). Comorbidities were more frequent among patients with moderate and severe symptoms. Viral load was associated with severity of clinical manifestations. Patients with moderate and severe COVID19 required hospital admission more frequently for a longer time, the use of supplemental oxygen and antibiotics were more frequent in patients with moderate and severe symptoms. Symptoms of lower respiratory tract infection such as cough and respiratory distress were more frequent in patients with moderate and severe symptoms. No patient required admission to the ICU or mechanical ventilation. No patient died. ConclusionIn this study, patients with moderate and severe COVID19 infection had a higher viral load in respiratory samples, a higher frequency of comorbidities, a higher frequency of hospitalization and a longer hospital stay. Lower respiratory symptoms were associated with moderate and severe symptoms, while odynophagia, vomiting, and diarrhea were associated with mild clinical symptoms.Disclosures All Authors: No reported disclosures