Intensive Care Unit Admission Rate Research Articles

Differences in the clinical course, laboratory and radiological findings of COVID-19 infection between male, female and pregnant patients in demographically homogeneous groups

Objective: This study examines for any differences in the clinical course, laboratory and radiological findings of COVID-19 infection between male, female and pregnant patients in similar age groups. Materials and Methods: This retrospective study involved a review of the data of patients treated between March 2020 and May 2021, included a total of 528 cases (193 pregnant females, 170 non-pregnant females and 165 males) aged 18–40 years with RT-PCR-confirmed COVID-19. Results: A comparison of the three demographically homogeneous groups revealed more common symptomatic infection at admission in the male patient group than in the other two patient groups (p<0.001), as well as a longer hospital stay (p<0.001) and higher incidences of moderate and severe pneumonia (p<0.001) based on radiological findings. In contrast, no significant difference was noted in the intensive care unit admission and mortality rates of the three groups. Conclusion: The results of our study reveal that females have some degree of protection against severe presentations of COVID-19 infection when compared to men. The heterogeneity of immunocompetence and immune response can help to understand the different COVID-19 responses of males and females, and can be used as a guide for disease prognosis and gender-specific treatments.

Reduced Time to Procedure for Gastrointestinal Bleeding After Warfarin Reversal With Four-Factor Complex Concentrate as Compared to Plasma.

Bleeding is a serious adverse effect of vitamin K antagonists (VKAs). Anticoagulation reversal is required in some acute cases. This is usually accomplished by plasma transfusion or four-factor prothrombin complex concentrate (4F-PCC). The aim of this study was to gain insight into the clinical course of patients with gastrointestinal (GI) bleeding who require VKA reversal. Medical records were collected from two centers from patients who presented to the emergency department (ED) for GI bleeding and received 4F-PCC or plasma for VKA reversal between January 2015 and December 2020. ED, hospital, intensive care unit (ICU) length of stay (LOS) as well as time from admission to GI procedure were determined. 4F-PCC patients (n = 49) as compared to plasma (n = 63) patients were found to have a greater number of comorbidities (average of 4.2 vs. 2.7 comorbidities/patient) and more ICU admissions (47% vs. 21%). Time to GI procedure was significantly decreased in the 4F-PCC group (median (interquartile range (IQR)) 19.47 (9.23 - 30.25) vs. 27.88 (21.38 - 45.00) h; P = 0.01). When adjusting for comorbidities, differences in time to GI procedures were also significant in favor of 4F-PCC regardless of any comorbidities (P = 0.014), in atrial fibrillation (P = 0.045) and in hypertension (P = 0.02). The 4F-PCC patients had shorter LOS in the ED and ICU. Our study demonstrated that compared to plasma, 4F-PCC was utilized in more acutely ill patients with higher rates of comorbidities and ICU admission. Nevertheless, the patients who received 4F-PCC had faster access to GI procedure and shorter ED and ICU LOS.

Characteristics and Outcomes of Patient Transport to the Hospital by Emergency Medical Services (EMS); a Cross-sectional Study.

To enhance the efficiency, it is essential to understand the patterns of service users and develop policies that facilitate effective personnel and resource management. This study aimedto compare the characteristic and outcomes of patients who were transferred to emergency department (ED) by emergency medical services (EMS) and patients transported by other means. This retrospective cross-sectional study was conducted at Srinagarind Hospital, Thailand, over a 5-year period from 2017-2021. The baseline characteristics, treatment modalities, and outcomes of patients who were transported to ED using EMS and Non-EMS were gathered and compared using STATA software. The study included 15,501 patients with the median age of 51 (interquartile range (IQR): 23-71) years who were referred by EMS over the five-year period (51.72% male). EMS patients had significantly higher median age (51 (23 - 71) vs. 37 (21 - 60); p < 0.001) with male preference (p < 0.001). In the EMS group, the triage level 1 (need for resuscitation) was higher than the non-EMS group (p < 0.001), most of the patients referred following trauma (p < 0.001), and the frequency of cardiac arrest was considerably higher than non-EMS group (2.54% vs 0.05%; p < 0.001). Patients in the EMS group received a higher number of blood tests (p < 0.001), plain radiographic exams (p < 0.001), computerized tomography (CT) scans (p < 0.001), and complex procedures (p < 0.001) than the non-EMS group. The EMS group had a greater number of hospital admissions (p < 0.001) and intensive care unit (ICU) admissions (p < 0.001) compared to the non-EMS group. The EMS group exhibited a significantly higher mortality rate compared to the non-EMS group (p < 0.001). The population utilizing EMS services had higher median age, higher frequency of emergency cases and trauma related complaint, higher need for treatment interventions and imaging procedures, higher rate of hospital and ICU admissions, as well as higher rate of mortality compared to the non-EMS group.

Trends in drug poisoning of youth patients after the deregulation of over the counter drug sales

Since 15 November 2012, the South Korean government amended the law to make some medicines available at 24-hour convenient stores that had previously been sold at pharmacies only. The aim of this study was to evaluate the impact of this legislation on drug poisoning in youth patients, who may be affected by increased access. This study retrospectively analyzed data registered in the Emergency Department-based Injury In-depth Surveillance (EDIIS) database from January 2007 to December 2018. Patients aged 15 to 24 years old were selected to analyze the incidence and outcomes of acetaminophen (AAP) poisoning in youth patientsBefore the deregulation of over-the-counter (OTC) medication sales, 1994 youth patients visited the emergency department (ED) from 2007–2012. By contrast, 5440 youth visited the ED from 2013–2018 after deregulation. In particular, there were 263 (13.2%) and 820 (15.1%) cases of AAP poisoning intentionally before and after deregulation, respectively, which was not significantly different (p = 0.085). However, the number of patients who were admitted to the general ward (GW) due to AAP poisoning significantly increased from 93 (35.4%) to 339 (41.3%) (p = 0.041). Furthermore, the number of patients who were admitted to the intensive care unit (ICU) after ingesting AAP significantly increased from 9 (3.4%) to 93 (11.3%) (p &lt; 0.001).There was no significant difference in intentional AAP poisoning ratios following the deregulation of OTC drug sales; however, GW and ICU admission rates significantly increased. This study demonstrated that there is positive relationship between intentional AAP poisoning and severity in youth patients after the deregulation legislation.

Validation of the Rome proposal for severity of acute exacerbation of chronic obstructive pulmonary disease.

The Rome proposal provides an objective assessment tool for severity of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) but requires validation. We aimed to evaluate the predictive performance of the Rome proposal in patients with AE-COPD. This observational study assessed the patients who visited the emergency room (ER) or were hospitalized due to AE-COPD between January 2010 and December 2020. We compared the performance of the Rome Proposal with that of the DECAF score or GesEPOC 2021 criteria in predicting intensive care unit (ICU) admission, need for non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), and in-hospital mortality. A total of 740 events of ER visit or hospitalization due to AE-COPD were reviewed and classified into mild (30.9%), moderate (58.6%), or severe (10.4%) group according to the Rome proposal. The severe group had a higher rate of ICU admission, required more NIV or IMV, and had a higher in-hospital mortality than the mild and moderate groups. The predictive performance of the Rome proposal was significantly better for ICU admission [area under the receiver operating characteristic curve (AU-ROC) = 0.850 versus 0.736, p = 0.004] and need for NIV or IMV (AU-ROC = 0.870 versus 0.770, p = 0.004) than that of the GesEPOC 2021 criteria but better than that of the DECAF score only in female patients. There was no significant difference in predicting the in-hospital mortality between the Rome proposal and DECAF score or GesEPOC 2021 criteria. External validation of the Rome Proposal in Korean patients demonstrated excellent performance for ICU admission and need for NIV or IMV and an acceptable performance for in-hospital mortality.

Cerebral toxoplasmosis with neurological co-infection in people living with AIDS/HIV: results of a prospective cohort in São Paulo, Brazil

Concomitant neurological diseases in people living with HIV/AIDS (PLWHA) is a challenging subject that has been insufficiently evaluated by prospective clinical studies. The goal of the present study was to identify the clinical characteristics and outcomes of PLWHA with cerebral toxoplasmosis and neurological co-infections. We conducted a prospective observational cohort study at a tertiary teaching center in São Paulo, Brazil, from January to July 2017. Hospitalized PLWHA aged ≥ 18 years with cerebral toxoplasmosis were consecutively enrolled. A standardized neurological examination was performed at admission and weekly until discharge or death. Diagnosis and treatment followed institutional routines; neuroradiology, molecular diagnosis, neurosurgery, and the intensive care unit (ICU) were available. The main outcomes were neurological coinfections and in-hospital death. We included 44 (4.3%) cases among 1,032 hospitalized patients. The median age was 44 (interquartile range [IQR]: 35-50) years, and 50% (n = 22) of the patients were male. The median CD4+ T lymphocyte count was of 50 (IQR: 15-94) cells/mm3. Multiple lesions on computed tomography were present in 59% of the cases. Neurological coinfections were diagnosed in 20% (n = 9) of the cases, and cytomegalovirus was the most common etiology (encephalitis: n = 3; polyradiculopathy: n = 2). Longer hospital stays (30 versus 62 days; p = 0.021) and a higher rate of ICU admissions (14% versus 44%; p = 0.045) were observed among PLWHA with neurological coinfections in comparison to those without them. The rate of in-hospital mortality was of 13.6% (n = 6) (coinfection group: 33%; no coinfection group: 8.6%; p = 0.054). Neurological c-infections were common among PLWHA with cerebral toxoplasmosis, and cytomegalovirus was the main copathogen. The group of PLWHA with neurological co-infections underwent longer hospital stays and more frequent intensive care unit admissions. Additionally, this group of patients tended to have higher in-hospital mortality rate.

Characteristics of poisoning patients visiting emergency departments before and after the COVID-19 pandemic

Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion: The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.

Worse In-Hospital Outcomes Among Patients With Heart Failure (HF) and Concomitant Influenza Infection.

A sizable proportion of heart failure (HF) admissions is precipitated by respiratory infections. Influenza has been linked to higher rates of HF hospitalizations and in-hospital morbidity and mortality. We aimto describe the in-hospital outcomes of systolic HF vs. diastolic HF admissions with concomitant influenza infection in US hospitalizations from 2016 to 2017. Materials and Methods:We queried the National Inpatient Sample (NIS) from 2016 to 2017 for discharge diagnosis for SHF and DHF and influenza per ICD-10 CM codes. Using binominal logistic regression analysis and adjusting for demographic and comorbid conditions, we compared the outcomes of SHF vs. DHF admissions with concomitant influenza as an independent risk factor for inpatient mortality, acute respiratory failure, ICU admission,assisted ventilation, as well as length of stay, and total hospital costs. A total of 7,490,596 HF weighted admissions were analyzed, among which 0.9% had concomitant influenza infection. SHF and DHF admissions with influenza had higher mortality, ICU admission, ventilation assistance, and acute respiratory failure when compared to those without influenza. Among influenza admissions, those with SHF had higher mortality (6.6% vs. 5%, adjusted odds ratio - aOR 1.31, p<0.001) compared to DHF. While intensive care unit (ICU) admission(7.8% vs. 5.2%, aOR 1.30, p<0.001) and ventilation assistance rates (22.1% vs. 18.9%, aOR 1.15, p<0.001) were greater among SHF patients with influenza, acute respiratory failure was more common amongst diastolic HF with influenza (46.6% vs. 51.2%, aOR 0.86, p<0.001).Finally, SHF patients with concomitant influenza had higher inpatient costs ($82,788) when compared to diastolic HF patients ($66,373) and a longer in-hospital stay (7.29 days compared to 6.98 days in the diastolic HF group)p <0.001. Concomitant influenza infection in hospitalized patients with HF is associated with higher mortality, ICU admission, and the need for assisted ventilation, especially in those with SHF. A greater emphasis on vaccination against influenza may improve in-patient outcomes among HF patients.

Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study.

Respiratory failure is a severe complication in coronavirus disease 2019 (COVID-19) pneumonia that, in addition to oxygen therapy, may require continuous positive airway pressure (CPAP) support. It has been postulated that COVID-19 lung injury may share some features with those observed in hyperoxic acute lung injury. Thus, a correct target arterial oxygen tension (P aO2 ) during oxygen supplementation may be crucial to protect the lung from further tissue damage. The aims of this study were: 1) to evaluate the effects of conservative oxygen supplementation during helmet CPAP therapy on mortality and intensive care unit (ICU) admission in patients with COVID-19 and respiratory failure, and 2) to evaluate the effect of conservative oxygen supplementation on new-onset organ failure and secondary pulmonary infections. This was a single-centre, historically controlled study of patients with severe respiratory failure due to COVID-19 pneumonia, receiving either conservative or nonconservative oxygen supplementation during helmet CPAP. A cohort receiving conservative oxygen supplementation was studied prospectively in which oxygen supplementation was administered with a target P aO2 <100 mmHg. Results of this cohort were compared with those of a cohort who had received liberal oxygen supplementation. 71 patients were included in the conservative cohort and 75 in the nonconservative cohort. Mortality rate was lower in the conservative cohort (22.5% versus 62.7%; p<0.001). Rates of ICU admission and new-onset organ failure were lower in the conservative cohort (14.1% versus 37.3%; p=0.001 and 9.9% versus 45.3%; p<0.001, respectively). In patients with COVID-19 and severe respiratory failure, conservative oxygen supplementation during helmet CPAP was associated with improved survival, lower ICU admission rate and less new-onset organ failure.

Risk of death, hospitalization and intensive care unit admission by SARS-CoV-2 variants in Peru: a retrospective study

Peru has had the highest death toll from the pandemic worldwide; however, it is not clear what the effects of the different variants on these outcomes are. The study aimed to evaluate the risk of death, hospitalization, and intensive care unit (ICU) admission rates of COVID-19 according to the SARS-CoV-2 variants detected in Peru from March 2020-February 2022. Retrospective study using open-access databases were published by the Peruvian Ministry of Health. Databases of genomic sequencing, death, COVID-19 cases, hospitalization and ICU, and vaccination were used. Crude and adjusted Cox proportional hazards regressions with clustered variances were modeled to calculate the hazard ratio (HR) of outcomes by variant. Lambda variant had the highest risk of death (HR 1.92, 95% CI 1.37-2.68), whereas the Delta variant had the lowest risk (HR 0.50, 95% CI 0.31-0.82). Mu variant had the highest risk of hospitalization (HR: 2.39, 95% CI 1.56-3.67), Omicron the lowest (HR 0.45, 95%CI 0.23-0.90), and Gamma had the highest ICU admission rate (HR 1.95, 95%CI 1.40-2.71). SARS-CoV-2 variants showed distinctive risks of clinical outcomes, which could have implications for the management of infected persons during the pandemic.

Association between body-mass index, patient characteristics, and obesity-related comorbidities among COVID-19 patients: A prospective cohort study

ObjectiveObesity is a major risk factor for adverse outcomes after COVID-19 infection. However, it is unknown if the worse outcomes are due to the confounding effect of demographic and obesity-related comorbidities. The study objective is to analyze associations between body mass index, patient characteristics, obesity-related comorbidity, and clinical outcomes in COVID-19 patients. MethodsIn this prospective cohort study, we chose patient records between March 1st, 2020, and December 1st, 2022, in a large tertiary care center in southeast Wisconsin in the United States. Patients over the age of 18 who tested positive were included in the study. Clinical outcomes included hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and mortality rates. We examined the characteristics of patients who had positive clinical outcomes. We created unadjusted logistic regression models, sequentially adjusting for demographic and comorbidity variables, to assess the independent associations between BMI, patient characteristics, obesity-related comorbidities, and clinical outcomes. ResultsFrom a record of 1.67 million inpatients and outpatients at Froedtert Health Center, 55,299 (BMI: 30.5 ± 7.4 kg/m2, 62.5 % female) tested COVID-19 positive during the study period. 17,580 (31.8 %) patients were admitted to hospitals, and of hospitalized patients required ICU admission. 1038 (36.3 %) required mechanical ventilation, and 462 (44.5 %) died after a positive test for COVID-19. We found female patients show a higher hospitalization rate, while male patients have a higher rate of ICU admission, mechanical ventilation, and mortality. Obesity-related comorbidities are associated with worse outcomes compared to simple obesity without comorbidities. In logistic regression models, we found four similar V-shaped associations between BMI and four clinical outcomes. Patients with a BMI of 25 kg/m2 are at the lowest risk for clinical outcomes. Patients with a BMI lower than 18 kg/m2 or higher than 30 kg/m2 are associated with a higher risk of hospitalization, ICU, mechanical ventilation, and death. After adjusting the model for demographic factors and hypertension and diabetes as two common comorbidities, we found that demographic factors do not significantly increase the risk. Obesity alone does not significantly increase the risk of severe clinical outcomes. Obesity-related comorbidities, on the other hand, resulted in a significantly higher risk of outcomes. ConclusionObesity alone does not increase the risk of worse clinical outcomes after COVID-19 infection. It may suggest that the worse clinical outcomes of patients with obesity are mediated via hypertension and type 2 diabetes. Patients with obesity and comorbidities have a higher risk of poor outcomes. Obesity-related comorbidities, including hypertension and diabetes, are independently associated with poorer clinical outcomes among COVID-19 patients. At a BMI of more than 30 kg/m2 or less than 18 kg/m2, we found an increase in the risk of severe COVID-19 outcomes leading to hospitalization, ICU, mechanical ventilation, and death. The increased risk of severe outcomes is not attributed to patient characteristics but can be attributed to hypertension and diabetes.

In-hospital Outcomes for COVID-19 Patients in the Military Health System: Comparison of Military and Civilian Facility Treatment.

Beneficiaries of TRICARE, an insurance program of the military health system, can choose to receive care within the private sector (fee-for-service) or direct (budget-based facilities with salaried providers) care setting. Previous studies in several specialties have shown that there are disparities in both resource utilization and outcomes between the two settings. In this study, we sought to determine differences in outcomes between coronavirus disease 2019 (COVID-19) patients treated in the private sector versus direct care. Using TRICARE claims data, we identified patients admitted to the hospital for COVID-19 between March and September 2020. Cases were classified, according to the facility where they were admitted for treatment, as private sector or direct care. We abstracted patient sociodemographic characteristics, comorbid conditions, and outcomes including in-hospital mortality, intensive care unit (ICU) admission, ventilator use, in-hospital complications, and 30-day readmission. We used multivariable regression models, adjusted for covariates, to determine the association between health care settings and outcomes. A total of 3,177 patients were included. Of these, 2,147 (68%) and 1,030 (32%) received care in the private sector and direct care settings, respectively. The average age of the study cohort was 52 years (SD=21), and 84% had at least one medical comorbidity. In adjusted analyses, we found significant differences in the rates of ICU admission, with patients treated in private sector care having lower odds of being admitted to the ICU (odds ratio, 0.64; 95% CI, 0.53-0.76). There were no significant differences in the rates of in-hospital mortality, ventilator use, in-hospital complications, and 30-day readmissions. With the exception of ICU admission rates, which are higher in the direct care setting, we encountered comparable hospital-based outcomes for patients treated for COVID-19 within the military health system, whether care was received under private sector or direct care.

270: IMPACT OF COVID-19 PANDEMIC IN ICU AND HOSPITAL RESOURCE UTILIZATION: A CANCER CENTER EXPERIENCE

Introduction: A recent global study including 81 reports reported a significant drop in healthcare utilization mostly outpatient visits, admissions, diagnostics, therapeutics, and emergency services after the COVID-19 pandemic. Interestingly, these reports seldomly address intensive care utilization or mortality. We hypothesized that the pandemic significantly affected the ICU and hospital utilization rates in a comprehensive cancer center located in Houston, Texas. Methods: We conducted an observational study comparing two periods, pre-pandemic (period-A, from 3/01/2019 to 2/28/2020) and first year of the pandemic (period-B, from 3/01/2020 to 2/28/2021). We reviewed the hospital metrics in our electronic health record (EHR). Results: During the two study periods we found a 22% decrease in the overall number of hospital admissions from 46,725 admissions (period-A) to 36,615 admissions (period-B). Emergency service visits (period-A 28,357 versus period-B 21,229) dropped by 25% in period-B. There was a 15% drop in the absolute number of intensive care unit (ICU) non-COVID admissions from 2,511 (period-A) to 2,147 (ICU admission rate period-B), as well as a 15% drop in surgeries and invasive interventions from 48,687 (period-A) to 41,650 interventions (period-B). However, the ICU admission rate increased from 5.4% (period-A) to 5.9% (period-B) (p=0.001). ICU mean length-of-stay (LOS) (4.14 vs 3.82, p=0.001) and mean intubation days (5.8 vs 4.7, p=0.001) were higher in period-A. The mean hospital LOS was 8 days, the same in both periods. ICU mortality was 14.9% during period-A and 14.2% in period-B (p=0.5). Hospital mortality was 2.6% in both periods. Conclusions: Our results confirmed that overall hospital utilization rates decreased during the first year of the COVID-19 pandemic. However, despite the lower numbers of patients the proportion of ICU admissions increased, the LOS and ventilator days decreased, and mortality remained the same. These findings highlight the complexity of critical care dynamics during the pandemic.

1092. Management of Transplant Graft and Role of Immunosuppression in the Outcome of Covid-19 Infection in Solid Organ Transplant Recipients

Abstract Background COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Little is known how the immunosuppressive medications impact the mortality rate in Solid Organ Transplant (SOT) recipients. There is also minimal data regarding the incidence of transplanted graft failure or rejection that could be attributed to the COVID-19 infection itself or its complications and management. Our study aims to investigate the management of COVID-19 infection, outcome of the infection, transplant failure and rejection rates in SOT recipients. Methods We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. Table 1Characteristics of the Population in the two groups Table 2 Type of Transplants in the two groups Results A total of 135 patients met the inclusion criteria. After the diagnosis of COVID -19 infection, 31% recipients had decrease in the dose of immunosuppressive medications (change group) and 69% had no changes in the dose (no change group). Out of the 73 Kidney Transplant recipients 33% were in the change group compared to 14% of liver, 25% of heart and 27% of lung transplant recipients. Of the total 42 recipients in the change group, 28.6% required Intensive Care Unit (ICU) level care significantly higher compared to 7.5% in the no change group (p-value &amp;lt; 0.005). Mechanical ventilation was required in 14.3% of the patients in the change group and 6.5% in the no change group (p-value &amp;lt; 0.5). Out of the total, 85.7% patients in the change group survived compared to 94.6% in the no change group (p-value &amp;lt; 0.1). Overall, the transplant rejection rate was higher in the change group compared to the no change group (p-value &amp;lt; 0.5). Table 3Comparison of the Outcomes in the two groups Figure 1 Kaplan – Meier Curve for survival Figure 2 Kaplan – Meier Curve with Cox Regression for survival Conclusion Our study showed a significantly higher ICU admission rate and mortality in SOT recipients who had their immune suppression reduced at the time of COVID-19 diagnosis. The same group also had a higher risk of rejection of transplanted graft. More studies with larger sample size needs to be done to further understand the management of immunosuppressive drugs in the SOT recipients with COIVD-19 infection. Disclosures All Authors: No reported disclosures.

1105: PHENOBARBITAL VERSUS LORAZEPAM FOR THE MANAGEMENT OF ALCOHOL WITHDRAWAL IN HOSPITALIZED PATIENTS

Introduction: Alcohol withdrawal syndrome (AWS) is a potentially life-threatening medical condition and even though benzodiazepines (BZDs) are the standard of care in the treatment of AWS, therapy-associated complications like respiratory depression requiring ventilatory support and the use of adjunctive pharmacotherapy persist. Studies have shown promising results with phenobarbital (PB), but have been limited to use in the emergency department or as an agent of choice for refractory AWS in the intensive care unit (ICU). Our study aims to compare the ICU admissions rate between lorazepam versus PB in treating AWS in hospitalized patients. Methods: We conducted a retrospective cohort study on patients hospitalized for AWS from 2019 to 2022. Patients were categorized into those who received lorazepam using the revised Clinical Institute Withdrawal Assessment of alcohol scale (CIWA-Ar) and those who received PB based on the Richmond Agitation- Sedation scale (RASS). The primary outcome was the rate of admission to the ICU. Secondary outcomes included total length of hospital and ICU stay, mechanical ventilation rate, use of adjunctive medications and mortality. Results: 300 patients met the inclusion criteria, of whom 148 received lorazepam and 152 received PB. The mean patient age was 56 years and 51 years in the PB and lorazepam groups, respectively (p=0.001). There were significant differences between lorazepam and PB in terms of ICU admission (13.5% vs 5.3%, p=0.014), mechanical ventilation rate (9.5% vs 0.7%, p=0.0004), need for adjunctive dexmedetomidine (9.5% vs 1.3%, p=0.0016) and mean length of hospital days (6.16 vs 4.89 days, p value =0.004), and ICU days (1.07 vs 0.21 days, respectively, p value=0.003). Conclusions: AWS patients treated with PB per protocol were found to have a significantly decreased rate of ICU admission, need for invasive ventilation and adjunctive dexmedetomidine treatment, along with reduced ICU and total length of hospital stay as compared to those treated with lorazepam. We conclude that our results support the growing evidence of efficacy of PB over lorazepam as the primary treatment for AWS patients, due to its mechanism of action that better targets AWS pathophysiology. Prospective, randomized controlled studies that compare PB vs BDZs for AWS are needed.

1052. Characteristics and Outcomes in Hospitalized Adult Patients Infected with the SARS-CoV-2 Omicron Variant at a Large Healthcare System in South Florida, January 1–14, 2022

Abstract Background The SARS-CoV-2 Omicron variant has been rapidly spreading worldwide. We aimed to characterize Omicron severity by assessing in-hospital deaths and intensive care admissions in a large healthcare system in South Florida during an Omicron predominant surge. Methods Laboratory-confirmed COVID-19 adult patients hospitalized during January 1—14, 2022 were retrospectively reviewed. Risks of in-hospital mortality and intensive care admission were estimated using logistic regression models. Analyses were stratified by age ≥ 65 years and vaccination status, and further adjusted for sex, comorbidities, and history of a previous COVID-19 infection. Results 500 consecutively hospitalized COVID-19 Omicron patients were included. The median age was 69 (IQR, 53-80) years, and 271 (54.2%) were women. The most common comorbidities were hypertension (65.5%), diabetes (32%), and chronic kidney disease (24%). 260 (52%) patients were fully vaccinated (defined as a patient who received 2-dose vaccines), and 32 (6.4%) were previously infected with COVID-19. 252 (50.4%) patients required supplemental oxygen, 54 (10.8%) required intensive care unit (ICU) admission, and 44 (8.8%) patients required mechanical ventilation. At study closeout of March 7, 2022, case fatality rates among patients aged 18–29 years, 30–39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and ≥ 80 years were 0%, 2.2%, 6.4%, 5.3%, 8.0%, 5.7%, and 15.4% respectively (p&amp;lt; 0.001), with the median time from hospital admission to death being 13 days (IQR, 6.5-20.5) (Figure 1). Patients aged ≥ 65 years had 2.6 times higher rates for in-hospital mortality (OR, 2.63; 95% CI, 1.29-5.33; p=0.007) than those aged &amp;lt; 65 years, but were comparable for ICU admission (OR, 0.85; 95% CI, 0.49-1.52; p=0.586). Past vaccination offered no protection against in-hospital mortality (OR, 1.18; 95% CI, 0.64-2.19; p=0.599) or ICU admission (OR, 1.16; 95% CI, 0.66-2.06; p=0.6) (Figure 2). In multivariable-adjusted models, patients aged ≥ 65 years had a higher in-hospital mortality than those aged &amp;lt; 65 years (Figure 2). Figure 1.Left: Distributions of survivors and non-survivors among hospitalized COVID-19 Omicron patients at different age groups; Right: Death curve of non-survivors with COVID-19 omicron in the South Florida area, January 1-14, 2022.Figure 2.Forest plots showing association of age and vaccination status with COVID-19 Omicron patient outcomes. Results were reported as odds ratios (OR,•) with 95% confidence intervals (CIs, horizontal lines), adjusted for sex-, diabetes, hypertension, COPD, chronic kidney disease, coronary heart disease, active malignancy, history of malignancy, history of solid organ transplantation, history of bone marrow transplantation, HIV, and previous SARS-CoV-2 infection. A-B. In-hospital mortality (death); C-D. ICU admission. ICU, intensive care unit. Conclusion This case series provides characteristics and outcomes of hospitalized adult patients with COVID-19 Omicron variant. Past COVID-19 vaccination did not impact ICU admission rate nor in-hospital mortality. Disclosures All Authors: No reported disclosures.

Rib fracture-related morbidity and mortality for older persons in the era of fascial plane blocks: A cohort study

Introduction Analgesia is key to successful conservative, nonsurgical management of patients admitted to the hospital with multiple rib fractures. Recently, new fascial plane regional anesthesia techniques have become widely available. We hypothesized that since the introduction of these new regional analgesia techniques, for patients over the age of 65 years, the effect of increasing numbers of rib fractures has been mitigated. Methods A retrospective study of patients admitted for the management of rib fractures between 2017 and 2020 was performed. Patients not admitted to the hospital, under the age of 65 years, or with chest trauma other than rib fractures were not eligible for inclusion. The primary outcome of interest was mortality. The secondary outcomes were the incidence of pneumonia and intensive care unit admission. Results were reported as the odds ratio and its 95% confidence interval and associated p-value. Statistical significance was set at [Formula: see text] &lt; 0.05. Results Overall, 252 patients were included and 142 patients received a regional anesthesia. The mortality rate was 4% (n = 10) with no association between mortality and number of rib fractures ( p = 0.215). Twenty-four patients (9.5%) developed pneumonia during their hospital stay, again with no association with an increasing number of rib fractures. The intensive care unit admission rate was 13.1% (n = 33) and correlated with an increasing number of fractures (odds ratio = 1.15; 95% confidence interval = 1.01 to 1.31; p = 0.038). Conclusion Management including liberal utilization of regional anesthesia for at-risk patients appears to mitigate the effect of increasing numbers of rib fractures on the incidence of mortality and pneumonia.

Severe Intrahepatic Cholestasis Pregnancy Is Associated With Maternal Endothelial Dysfunction: A Case-Control Study.

The aim of the present study was to evaluate maternal serum endocan levels, which are markers of vascular pathologies andstrongly associated with vascular inflammationand endothelial dysfunction, in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). The study comprised 30 pregnant women with mild ICP, 30 pregnantwomen with severe ICP, and 30 healthy pregnant women as a control group. The inclusion criteria were women with ICP, which was diagnosed based upon the presence of pruritus associated with elevated total bile acid (TBA) levels (> 10 μm/L), elevated aminotransferases, or both, and the absence of diseases that may produce similar laboratory findings and symptoms. Severe ICP was defined as TBA > 40 μmol/L. After diagnosis for ICP, blood samples were obtained before medication during hospitalization to analyze maternal serum endocan levels. Gestational age at delivery, delivery induction rates, birth weight, and newborn intensive care unit (NICU) admission rates were significantly higher in the severe ICP group than in the control group and mild ICP group. Gestational age for all groups when blood was sampled was similar. Maternal serum TBAsand aminotransferase levels were significantly higher in the severe ICP group than in the control group and mild ICP group. The mean serum endocan levels were 10.9 ± 2.6 ng/mL in the control group, 12.5 ± 2.8 ng/mL in the mild ICP group, and 24.3 ± 4.8 ng/mL in the severe ICP group (p < 0.001). Our results indicated that maternal serum endocan levels were increased in the presence of severe ICP and it can be speculated that increased bile acid levels were associated with maternal endothelial dysfunction.

Epidemiological Features, Risk Factors, and Disease Burden of Respiratory Viruses among Hospitalized Children with Acute Respiratory Tract Infections in Xiamen, China.

Well-established surveillance and monitoring systems for respiratory viruses need to be improved, and epidemiological data on respiratory viruses in China are scarce. This study aimed to investigate the epidemiological characteristics of respiratory viruses among hospitalized children aged ≤2 years with acute respiratory tract infections (ARTIs) in Xiamen, China, from October 2014 to September 2017. The clinical records of 7,248 children hospitalized for ARTIs were retrospectively analyzed. Respiratory syncytial virus (RSV) (22.3%) was the most common virus among hospitalized children aged ≤2 years, followed by parainfluenza (5.0%), adenovirus (3.5%), and influenza (1.7%). RSV-infected children had a higher disease burden, including a higher intensive care unit (ICU) admission rate (12.7%) and higher hospital charges ($635.36). Particularly, infants aged <6 months had the highest risk of RSV infection (odds ratio = 2.4; 95% CI, 1.9-2.9) and a higher ICU admission rate (12.1% vs. 4.5%, 4.6%) and hospital cost ($923.3 vs. $785.5, $811.7) than the other age groups. Therefore, infants aged 0-6 months, particularly premature infants and children with congenital diseases, should receive more attention. There is an urgent need to develop effective immunization strategies to protect these infants during the first 6 months of life and in the RSV season.

Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: Retrospective Cohort Study.

Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. Additionally, posthospitalization follow-up transitioned to a predominantly telemedicine model. It is unknown whether the shift to telemedicine impacted disparities in posthospitalization follow-up or HF readmissions. The aim of this paper is to determine whether the shift to telemedicine impacted racial and ethnic as well as socioeconomic disparities in acute decompensated heart failure (ADHF) follow-up and HF readmissions. We additionally sought to investigate the impact of the COVID-19 pandemic on the severity of ADHF hospitalizations. This was a retrospective cohort study of HF admissions across 8 participating hospitals during the initial peak of the COVID-19 pandemic (March 15 to June 1, 2020), compared to the same time frame in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and intensive care unit (ICU) admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed. From March 15, 2019, to June 1, 2020, there were 1162 hospitalizations for ADHF included in the study. There were significantly fewer admissions for ADHF in 2020, compared with 2019 (442 vs 720; P<.001). Patients in 2020 had higher rates of ICU admission, compared with 2019 (15.8% vs 11.1%; P=.02). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89% vs 10.99%; P=.02). While there was a trend toward higher inpatient mortality in 2020 versus 2019 (4.3% vs 2.8%; P=.17), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 81.6% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (40.5% vs 29.6%; P<.001). Inequities in 7-day follow-up for patients from non-Hispanic Black racial backgrounds compared to those from non-Hispanic White backgrounds decreased during the pandemic. Additionally, those with telemedicine follow-up were less likely to be readmitted in 30 days when compared to no follow-up (13.8% vs 22.4%; P=.03). There were no major differences in HF ICU admissions or inpatient mortality for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission rates for those who had telemedicine follow-up.