Ochsner Medical Center Research Articles

Use of a New Standardized Unfractionated Heparin Protocol for Left-Sided Ablation Procedures Improves Time in the Therapeutic ACT Range

Objectives: This study evaluated whether a novel standardized heparin dosing protocol used during atrial fibrillation catheter ablation resulted in a higher percentage of therapeutic activated clotting time (ACT) values compared to historic nonstandardized procedures. DesignA retrospective cohort study SettingThis study was conducted at Ochsner Medical Center, the largest tertiary care teaching hospital in New Orleans, LA ParticipantsPatients undergoing catheter-based atrial fibrillation ablation InterventionsWe implemented a standardized heparin protocol and enrolled patients between November 2020 and March 2021. The historic controls consisted of patients who underwent atrial fibrillation ablation between April 2020 and September 2020. Heparin administration in the control group was based on physician preference and was nonstandardized. Measurements and Main ResultsThe primary endpoint was the percentage of intraprocedural ACTs in therapeutic range (≥300 to <450 s). Secondary endpoints included first measured ACT at ≥300 s and percent of measured ACTs in the supratherapeutic range (>450 s). Comparisons were performed using chi-squared tests or Fisher exact tests. Patients in the intervention group had a higher mean percentage of ACTs in the therapeutic range compared to the control group (84.9% vs. 75.8%, p<0.001). More patients in the intervention group reached therapeutic ACT on the first measurement compared to the control group (70.3% vs. 31.2%, p<0.001). Conclusion: During catheter-based cardiac ablation procedures, a novel standardized unfractionated heparin dosing protocol resulted in a higher percentage of ACTs in the target range and a higher proportion of initial ACTs in the therapeutic range compared with baseline nonstandardized heparin dosing.

260 Breast Cancer Biopsy Triage with Ex-Vivo Microscopy for Downstream Analysis

OBJECTIVES/GOALS: In this study, the ability of a pathologist to detect malignancy on digital pseudo-H&amp;E slides obtained via structured illumination microscopy (SIM) imaging of fresh diagnostic breast biopsies was assessed. The speed of imaging and processing was also assessed for potential clinical implementation. METHODS/STUDY POPULATION: This study was conducted in accordance with an Ochsner Medical Center of New Orleans IRB. 200 patients undergoing either stereotactic or ultrasound-guided diagnostic breast biopsies were consented and an additional core from the suspicious lesion was collected for research use. Research biopsies were transported to the lab and stained with DRAQ5 and Eosin-Y and imaged with SIM before being submitted for histology processing. Imaging and digital processing times were recorded. The resulting SIM images and histology slides were given to a pathologist for blind review to assess accuracy. RESULTS/ANTICIPATED RESULTS: The ex-vivo structured illumination microscopy images and subsequent histology slides from 79 research cores have been assessed to date. Some samples were excluded from the total data set and not included in the final assessment due to technical failures of the imaging protocol. Of the current set, the pathologist has a specificity of 88% and a sensitivity of 65%, as well as an NPV of 88% and a PPV of 65%. Staining time for each biopsy was completed within 3 and a half minutes and imaging at 20x magnification took between 4 and 12 minutes, depending on size and implementation of autofocus to the imaging system. Image processing took approximately 5 minutes per biopsy and is a direct function of biopsy size. DISCUSSION/SIGNIFICANCE: Decreased time between cancer suspicion and treatment will improve the prognosis of breast cancer patients. SIM imaging of fresh breast biopsies could ultimately allow primary and secondary histology to be performed simultaneously and minimize histopathology time, thus allowing clinicians and patients to implement treatment course more quickly.

The Clinical Utility of Acoustic Tweezing Thromboelastometry in Monitoring Blood Coagulation during Liver Transplantation

Introduction Patients with end-stage liver disease have a very low amount of pro- and anticoagulants in their blood, and therefore they may develop both bleeding and thrombotic complications during liver transplant surgery. These patients are in need for optimized intraoperative transfusion to keep their coagulation system in balance, which is currently managed by whole-blood viscoelastic assays such as TEG. However, TEG is not standardized for coagulation analysis because of its high variability and requires a relatively large blood volume per test. Here, we demonstrate that our noncontact drop-of-blood technique, referred to as "integrated quasi-static acoustic tweezing thromboelastometry" (i-QATTTM), can accurately assess changes in the coagulation system during liver transplantation. Method We have conducted side-by-side coagulation measurements by TEG and i-QATTTM. Whole blood samples (3-5mL each) were collected from liver transplant patients at the following time points: 1) immediately after induction of anesthesia (baseline), 2) after arterial reperfusion (artery), and 3) during biliary reconstruction (final). The samples were first used for TEG analysis, and their leftovers (waste blood) were analyzed by i-QATTTM. i-QATTTM has two graphical outputs: mechanical tweezograph showing sample firmness change with time (similar to TEG tracing, Fig 1A) and photo-optical tweezograph showing sample turbidity change with time. The following parameters extracted from these curves were analyzed: clot initiation time (CIT), time to firm clot formation (TFCF), maximum clot firmness (MCF), and maximum fibrin level (MFL). Correlation analysis was performed between these parameters and the corresponding TEG output. The study was approved by Tulane University and Ochsner Medical Center IRBs. Results Figure 1A (left) shows the mechanical tweezographs of the WB sample from a liver transplant patient at the artery stage, exposed to intrinsic and extrinsic pathway activators, and a combination of Cytochalasin-D and intrinsic pathway activator. These tests correspond to CK, CRT, and CFF assays in TEG. Fig 1A (right) shows the mechanical tweezographs of the PPP sample from the same patient, triggered by intrinsic and extrinsic pathway activators. Noted that the WB treated with Cytochalasin-D has the MCF value reduced dramatically from that of untreated blood and nearly equal to the MCF level of the PPP. In Fig. 1B, there were a strong linear correlation (Pearson correlation coefficient r > 0.72) between CIT and R-time of TEG (CK assay) and between TFCF and K-time of TEG (CK assay) for WB samples triggered via intrinsic pathway. Strong correlation also exists between MCF and MA values of TEG (CRT assay) for WB triggered via extrinsic pathway. MCF and MFL of PPP triggered by either pathway were strongly correlated (r > 0.74) with MA values of TEG (CFF assay). Strong correlation was also observed (r=0.7) between MCF and MA of TEG (CFF assay) for Cytochalasin-D treated WB triggered via intrinsic pathway. For both activation pathways, CIT at the artery stage (3.7±0.6 min and 1.5±0.3 min, respectively) is slightly lower than at the baseline (4.0±0.5 min and 1.7±0.4 min) and final stages (3.9±0.4 min and 1.9±0.3 min) while TFCF was stable across the stages (~12 min for intrinsic and ~5.5 min for extrinsic pathways). In the intrinsic pathway, MCF significantly reduced from the baseline (1.18±0.02) to 1.12±0.02 at the artery stage and slightly increased to 1.14±0.02 at the final stage; meanwhile, MCF in the extrinsic pathway decreased from 1.17±0.03 at the baseline to 1.13±0.02 at the artery stage and remained at the same value at the final stage (same trends observed in TEG). For PPP samples triggered via intrinsic pathway, MCF reduced from 1.13±0.02 (baseline) to 1.08±0.01 (artery) and increased to 1.12± 0.01 (final). In extrinsic pathway, the MCF values were 1.15±0.03 (baseline), 1.1±0.02 (artery), and 1.14±0.01 (final). We see that blood samples at the artery stage are less stiff than the samples at the baseline and final stages due to reduction in fibrinogen concentration, as seen for most liver transplant patients. Conclusions Using a single drop of blood per test, the i-QATTTM technique provides comprehensive information on blood coagulation status in liver transplant patients undergoing blood transfusion. This technique can be potentially adopted for transfusion guidance in perioperative settings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Pneumarthrosis After Diagnostic Arthrocentesis.

1Department of Rheumatology. Ochsner Medical Center. 1514 Jefferson Highway, New Orleans, LA 70121. 2Department of Rheumatology. Mayo Clinic Health System. 1400 Bellinger Street, Eau Claire, WI – 54701. Financial Support Information: All authors declare no competing interests and none of the authors have any financial interests which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work presented in this manuscript. There was no funding for the work associated with this publication. None of the authors have been paid by any agency or pharmaceutical company to write this article. All authors have full access to the manuscript and all the data in the study, contributed to the study design, critically reviewed the first draft, approved the final version, and agreed to be accountable for the work, and the corresponding author has the final responsibility for the decision to submit for publication. Corresponding Author: Pankaj Bansal, MD, Department of Rheumatology. Mayo Clinic Health System. 1400 Bellinger Street, Eau Claire, WI – 54701. Phone: 773-899-4590, ORCID ID 0000-0001-6315-6879 [email protected]

High-Frequency, Low-Tidal-Volume Mechanical Ventilation Safely Improves Catheter Stability and Procedural Efficiency During Radiofrequency Ablation of Atrial Fibrillation

High-Frequency, Low-Tidal-Volume Mechanical Ventilation Safely Improves Catheter Stability and Procedural Efficiency During Radiofrequency Ablation of Atrial Fibrillation

External Validation of a Clinical Score for Patients With Neuroendocrine Tumors Under Consideration for Peptide Receptor Radionuclide Therapy

Despite the benefit of peptide receptor radionuclide therapy (PRRT) for patients with well-differentiated neuroendocrine tumors (WD NETs), no clinical metric to anticipate benefit from the therapy for individual patients has been previously defined. To assess whether the prognostic ability of the clinical score (CS) could be validated in an external cohort of patients with WD NETs. This multicenter cohort study's analysis included patients with WD NETs who were under consideration for peptide receptor radionuclide therapy (PRRT) with lutetium-177 (177Lu)-dotatate between March 1, 2016, and March 17, 2020. The original cohort included patients from Vanderbilt-Ingram Cancer Center. The validation cohort included patients from Ochsner Medical Center, Markey Cancer Center, and Rush Medical Center. Patients with paragangliomas, pheochromocytomas and neuroblastomas were excluded. Statistical analysis was performed from June to November 2021. PRRT with 177Lu-dotatate or alternate therapies such as everolimus, sunitinib, or capecitabine plus temozolomide. The primary outcome was progression-free survival (PFS) and was estimated by the Kaplan-Meier method; a Cox proportional-hazards model adjusting for primary tumor site, tumor grade, and number of PRRT doses administered was used to analyze association between CS and outcomes. A total of 126 patients (median age [IQR] age: 63.6 [52.9-70.7] years; 64 male individuals) were included in the validation cohort, and the combined cohort (validation and original cohorts combined) had a total of 248 patients (median [IQR] patient age: 63.3 [53.3-70.3] years; 126 male individuals). In the validation cohort, on multivariable analysis, for each 2-point increase in CS, PFS decreased significantly (hazard ratio, 2.61; 95% CI, 1.64-4.16). After finding an association of the CS with PFS in the validation cohort, the original and validation cohorts were combined into the cohort for this analysis. On multivariable analysis, for each 2-point increase in CS, PFS decreased significantly (hazard ratio, 2.52; 95% CI, 1.89-3.36). Increases in CS were associated with worsening PFS in the validation cohort, validating findings from the original cohort. These findings suggest that the CS, to our knowledge, represents the first clinical metric to estimate anticipated benefit from PRRT for patients with WD NETs and may be a clinical tool for patients being considered for PRRT.

Evaluation of Outcomes in Patients Receiving Modafinil to Improve Alertness after Traumatic Brain Injury

Background: Modafinil is used for improving wakefulness associated with narcolepsy, obstructive sleep apnea, and shift work sleep disorder. The goal of this study is to evaluate alertness and participation in physical therapy and occupational therapy in patients with a first-time diagnosis of traumatic brain injury using modafinil. Methods: This was a single-center, retrospective, chart review, cohort study of Ochsner Medical Center patients from January 2016 to December 2018. Patients included in the study were 18 years of age or older who were hospitalized due to a traumatic brain injury and received modafinil either by mouth, nasogastric, or enteral feeding tube to help improve alertness. The primary outcome is the change in Glasgow Coma Scale (GCS) score from baseline to 72 hours after initiating modafinil. Results: One-hundred and Forty patients were included with a mean age of 67.8 years and 59.3% were male. The majority of the patients (52.9 %) were predominantly patients who suffered ischemic stroke. The mean change in GCS score in 72 hours was +0.35 (95% CI [-0.16, 0.88], p=0.177). One of the secondary endpoints was the mean change in course of therapy GCS score which showed significant improvement in neurological function after initiation of modafinil: +1.22 (95% CI [0.64, 1.80], p=0.0001). The percent physical therapy/occupational therapy (PT/OT) session participation at 72-hour post-modafinil initiation was 96.7% compared to 95.7% during the course of therapy. The correlation between increase in GCS score and percent PT/OT therapy session participation was analyzed at 72 hours and throughout the course of therapy, which revealed no significant association (r=0.14 [p=0.0911] and -0.06 [p=0.4881], respectively). Conclusion: Our study did not find a significant increase in the mean change of GCS score at 72 hours of modafinil use. Although, there were high percentage of patients participated in PT/OT in 72 hours and course of therapy (96.7% and 95.7%), there was no significant statistical correlation between increase in GCS score and PT/OT participation. Randomized studies are needed to further assess the impact of modafinil for treating traumatic brain injury associated sleep-wake disturbances while considering factors such as medication initiation time, appropriate dosage, GCS score, and long-term outcomes.

Lessons from pandemic bolster response to weather emergency.

Ochsner Health’s experience with remote work during the COVID-19 pandemic helped the health system weather Hurricane Ida, which made landfall Sunday, August 29, 2021, approximately 100 miles from New Orleans in Port Fourchon, LA. Deborah Simonson, system vice president of pharmacy services for the health system, and Ryan Pepper, assistant vice president for the pharmacy supply chain, remained onsite at Ochsner Medical Center in New Orleans throughout the storm. But other system pharmacy leaders who normally ride out weather emergencies were positioned far from Ida’s path to provide continuous remote support. “Before COVID-19, we had a lot more people come onsite,” Simonson said. “With Hurricane Ida, we had to follow COVID-19 safety protocols, so we could not have our entire Team A on site. We really depended on support that we’d moved outside the impact zone.” She said the leadership team functioned as a command center to handle urgent requests from hospitals for supplies, staffing, and other assistance. Despite some storm-related communication issues, the overall process worked well, and Simonson said she wants to refine this model and use it during future emergencies.

HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

An important goal of the Ending the HIV Epidemic in the U.S. initiative is the timely diagnosis of all people with HIV as early as possible after infection. To end the HIV epidemic, health departments were encouraged to propose new and innovative HIV testing strategies and improve the reach of existing programs. These activities were divided into 3 core strategies: expansion of routine screening in healthcare settings, locally tailored HIV testing initiatives in nonhealthcare settings, and specific efforts to increase the frequency of testing for individuals with increased potential for acquiring HIV. Because HIV testing is such a crucial part of the core activities of the Centers for Disease Control and Prevention's HIV prevention programs, there are many examples of evidence-based programs and best practices for HIV testing in both clinical and nonclinical settings. This article reviews the evidence base for these strategies and some of the activities proposed under the Diagnose pillar to achieve the goal of diagnosing all HIV infections as early as possible. All other Ending the HIV Epidemic in the U.S. activities start with an awareness of HIV status, which is actually the indicator for which most health departments are closest to the proposed targets. There are both proven and emerging approaches to increasing HIV screening and increasing the frequency of HIV screening available. The Ending the HIV Epidemic in the U.S. initiative provides the motivation, the resources, and a coordinated plan to bring them to scale.

Validation of a clinical score (CS) for patients (pts) with well-differentiated neuroendocrine tumors (WD NETs) under consideration for peptide receptor radionuclide therapy (PRRT) with Lu 177 dotatate.

4109 Background: Questions remain regarding when to sequence PRRT and how to categorize pts being considered for the treatment (tx). We previously developed a CS (comprised of 5 categories: available non-PRRT tx for tumor type, prior systemic tx, pt symptoms, tumor burden in critical organs and peritoneal carcinomatosis presence) at Vanderbilt Ingram Cancer Center (VICC) for pts being considered for PRRT to help answer these questions and demonstrated the score to be associated with progression-free survival (PFS) in pts receiving PRRT. Herein, we present the performance of the CS in a validation cohort (VC) and combined cohort (CC). Methods: Our original cohort (OC) included pts with progressive WD NETs (N = 122) under consideration for PRRT between 3/1/2016-3/17/2020 at VICC while our VC included pts under consideration for PRRT (N = 126) between 1/25/2017-11/18/2019 at Ochsner Medical Center (OMC) (N = 51), Markey Cancer Center (MCC) (N = 51) and Rush Medical Center (RMC) (N = 24). All pts in the OC were prospectively scored while pts in the VC were scored retrospectively, with the CS-assigning investigator blinded to patient outcomes. The primary outcome PFS, was estimated by the Kaplan‐Meier method; a Cox proportional‐hazards model adjusting for primary tumor site, tumor grade and number of PRRT doses administered (0, 1-2 or 3-4) was used to analyze effect of CS. Overall survival (OS) was a key secondary outcome. Results: In our VC, on multivariable (MV) analysis, for each 2-point increase in CS, the hazard ratio (HR) for PFS was 2.58 (95% confidence interval (CI) 1.62-4.11). On MV analysis, for each 2-point increase in CS, the HR for OS was 3.89 (95% CI 1.8-4.83). We combined the OC and VC for this analysis in order to increase the predictive power of our originally developed Cox proportional-hazards models. In our CC, of the 248 total pts, median pt age, CS and number of prior tx were 63.3 years, 4 (range 0-8) and 1 (range 0-7), respectively. The most represented primary tumor sites were small intestinal (N = 136), pancreatic (N = 58), unknown primary (N = 26) and lung (N = 14). A total of 140, 82 and 26 pts received 3-4, 0 or 1-2 doses of PRRT, respectively. On MV analysis, for each 2-point increase in CS, the HR for PFS was 2.52 (95% CI 1.90-3.35). On MV analysis, for each 2-point increase in CS, the HR for OS was 3.48 (95% CI 2.33-5.18). No interaction between PRRT doses administered and CS was observed. Conclusions: Increases in CS were strongly associated with worsening PFS and OS in our VC and CC, validating findings from our OC. Although we cannot determine whether the CS specifically predicts PRRT response or is prognostic based upon these data, it is the first presented clinical metric which can categorize pts with WD NETs under consideration for PRRT and estimate anticipated benefit from PRRT for pts.

Clinical Characteristics of Suspected COVID-19 in Pediatric Patients

This study reviews patients aged 21 and younger, who presented to the Ochsner Medical Center's Pediatric Emergency Department during the COVID-19 pandemic. A retrospective analysis was completed comparing demographics, symptomology, and laboratory analysis between COVID positive and negative patients.

Festival atmosphere prevails in New Orleans during Vax Fest.

In a nod to the upbeat spirit for which the New Orleans area is famous, Ochsner Health ended March with Vax Fest, a 24-hour COVID-19 mass vaccination drive-through event in Metarie featuring live music, great local food, and a festival flair. The health system announced that nearly 5,000 people received a dose of Moderna Inc.’s investigational COVID-19 vaccine during the event, which started at 10 am March 29 and continued until the next morning. It was billed as the biggest COVID-19 vaccination event in the state. Myra Thomas, assistant vice president for pharmacy at Ochsner Medical Center in New Orleans, said the event offered a glimpse of normalcy for a community whose notable celebrations have been curtailed by the pandemic. “People were getting out of cars and dancing,” said Thomas, who worked 2 shifts as pharmacy lead for the event. “When there wasn’t live music, there was a D.J. ....

Preoperative Body Mass Index < 45 Kg/m2 Predicts Clinical Success after Bariatric Surgery in Patients with Ventricular Assist Devices

Purpose Although the outcomes of bariatric surgery (BS) in patients with ventricular assist devices (VADs) are promising, the evidence is limited to case reports or very small retrospective cohorts. Hence, no study has tried or been able to identify potential predictors of successful outcomes in this high-risk population, which could aid patient selection. Methods This study combined the individual participant data (IPD) of patients with VADs who underwent BS at Ochsner Medical Center (OMC) and patients of references identified through a systematic search in ClinicalTrials.gov, Cochrane, Embase, and PubMed. Patients who underwent BS during VAD support, as staged interventions, were included if their IPD for post-BS BMI were available. Datasets from the literature search and OMC were merged in an IPD meta-analysis to identify predictors of the composite outcome: body mass index (BMI) Results Among the 38 patients, 18 (58%) were male, the mean age was 42 (±12.5) years, and 33 (86.9%) underwent sleeve gastrectomy, while 5 (13.2%) had Roux-en-Y gastric bypass. During a follow-up of 20 (12-30) months, 30 patients achieved the composite outcome, among whom 22 were listed for HT, 17 underwent HT, and 3 experienced recovery and VAD explantation. Time to composite outcome was 10 (3-17) months. Among all baseline variables, preoperative BMI was the only statistically significant predictor for achieving the composite outcome (p Conclusion Preoperative BMI was the only statistically significant predictor for the composite clinical outcome due to its impact in postoperative BMI during follow-up. Most patients received HT. This reflects the important role of a BMI ≥35 kg/m2 as a contraindication for HT. It is likely that more patients, especially those with shorter follow-up, would have reached the composite outcome after primary references were published or conclusion of this study. Future larger studies may be able to identify additional predictors of clinical outcomes.

Optimizing cardiovascular imaging in Staphylococcus aureus endocarditis.

The shift toward value-based health care drives physicians to examine opportunities to optimize use of healthcare resources. There is discordance between providers' use of cardiovascular imaging (CVI) in assessing patients for infective endocarditis (IE) with Staphylococcus aureus bacteremia (SAB). An evidence-based algorithm was created to minimize variation of CVI use. The primary objective was to ensure sensitivity of the algorithm to recommend CVI in patients suspected of IE. A retrospective review evaluated patients at Ochsner Medical Center who developed SAB between 1/1/13 and 12/31/14. Predefined patient demographics, use of CVI, outcomes, and 12-week follow-up for readmission after first positive blood culture were collected from chart review. The created algorithm was applied retrospectively to determine its sensitivity and specificity in recommending the right CVI test. 181 patients admitted were admitted with SAB, of which 114 (63%) were male. There were 115 TTEs and 55 TEEs performed. Out of 15 patients diagnosed with IE, 3 were found on TTE and 12 were found on TEE. The algorithm would have recommended a TEE in all 15 patients who had high-risk features for IE and a true diagnosis of IE, suggesting a sensitivity of 100% and specificity of 74.7% for the algorithm to have recommended a highly sensitive CVI modality. This algorithm optimizes CVI for diagnosing IE in patients with SAB. As healthcare adapts to a value-based system, use of best-practice algorithms will promote consistency in practice among providers and help optimize patient outcomes and use of resources.

Abstract 15016: Peak Oxygen Consumption Achieved at the End of Cardiac Rehabilitation Predicts Survival in Patients With Coronary Heart Disease

Introduction: Several patients with coronary heart disease (CHD) present reduced survival despite completing cardiac rehabilitation (CR), suggesting that the level of cardiorespiratory fitness (CRF) achieved might remain suboptimal. The purposes of this study were: 1) to examine the independent association of peak oxygen consumption (VO 2 ), a measure of CRF, at post-CR with long-term survival; and 2) to establish an optimal cut-off for peak VO 2 at post-CR that best predicts mortality risk. Methods: 853 patients with CHD (mean age of 64±10 years old) who were referred to CR between January 1, 2000, and June 30, 2013, at Ochsner Medical Center were analyzed for this study. We measured pre- and post-CR peak VO 2 . Mortality data were collected using National Death Index. Cox proportional hazard regression model was used to examine the risk of all-cause mortality associated with peak VO 2 at post-CR, independent of peak VO 2 at pre-CR and related changes during CR. Contal and O’Quigley’s method were used to determine the optimal cut-off for peak VO 2 at post-CR based on a split-sample approach. Results: Mean peak VO 2 at post-CR was 21.01±6.25 mL/kg/min (75% and 51% predicted peak VO2 using Wasserman and FRIEND Registry equations, respectively). During a mean follow-up of 6.55 years, 106 subjects (12.4%) died. Peak VO 2 at post-CR independently predicted mortality (Hazard Ratio: 0.82 [0.77-0.87], p&lt;0.001). We identified peak VO 2 of ≥17.6 kg/mL/min as optimal cut-off best predicting survival ( Figure 1, Panel A ) and the %predicted peak VO2 at post-CR ≥62.1% using Wasserman ( Figure 1, Panel B ) and ≥41.4% using FRIEND Registry ( Figure 1, Panel C ) as the alternative optimal cut-offs. Conclusions: In patients with CHD undergoing CR, post-CR peak VO 2 independently predicts long-term survival. These results suggest that patients with CHD presenting a peak VO 2 lower than the cut-off identified herein may benefit from additional sessions of CR or higher intensity exercise training.

COVID-19 in Relation to Hematological Events (Thrombosis/Bleeding) and Mortality in Inpatient Setting

COVID-19 is a newly diagnosed entity that has been identified for about 6 months. With the US now being the prevalent nation affected, we aimed to identify factors that were relevant to survival and hematological events in COVID patients. Our group had primarily been assessing COVID-19 confirmed patients as per PCR at Ochsner Medical Center in Louisiana; we primarily studied patients who were admitted between January 2020 to May 2020. Our main events that are currently being studied include factors such as mortality, length of stay, and bleeding or thrombotic events. Secondary endpoints included factors such as influence on blood type and also amount of transfusions required by these patients.Our overall analysis of 1773 patients yielded a number of 60 patients who were able to identify as having an active cancer diagnosis. This disproportionate number of patients may be related to factors such as reluctance to visit the hospital among cancer patients, a phenomenon noted similarly in Cardiology where the number of admissions for cardiac causes had declined suddenly during this pandemic timeline. Our half of our population was African American and included an even proportion of males and females. The age range of patients was between 35-93 years old.The most common malignancies that were noted to co-occur with COVID-19 in our population seemed to be lung, prostate, and hematological malignancies. Although final analyses regarding mortality are to be completed, the proportion of patients who had died with a diagnosis of cancer was around 50% per collection of our current data. Twenty three out of 60 (38%) patients required blood transfusions. In comparison to other reports which had reported bleeding events and thrombotic events, our report had revealed a much less rate of bleeding events (5/60) and thrombotic events (5/60). We plan to repeat our analysis to assess for any confounders in identifying these events, as noted, since some earlier literature had reported between ¼ to ⅔ of patients having a thrombotic event.Our analysis also looks at other descriptive variables such as use of anticoagulant and antiplatelet agents, absolute counts of neutrophils and lymphocytes, platelets, and coagulation markers. Also, our assessment includes a study in assessment of any delays noted in chemotherapy dates for these patients. Analysis of assessment of bleeding, thrombosis, and mortality for the entire patient group is currently in process.DisclosuresNo relevant conflicts of interest to declare.

Abstract PO-079: COVID-19 in relation to hematologic events and mortality in subset of inpatient cancer patients

Abstract COVID-19 is a newly diagnosed entity that has been identified for about 6 months. With the US now being the prevalent nation affected, we aimed to identify factors that were relevant to survival and hematologic events in COVID patients. Our group had primarily been assessing COVID-19-confirmed patients as per PCR at Ochsner Medical Center in Louisiana; we primarily studied patients who were admitted between January 2020 to May 2020. Main events that are currently being studied include factors such as mortality, length of stay, and bleeding or thrombotic events. Secondary endpoints included factors such as influence on blood type and also amount of transfusions required by these patients. Our overall analysis of 1,773 patients yielded a number of 60 patients whom we were able to identify as having an active cancer diagnosis. This disproportionate number of patients may be related to factors such as reluctance to visit the hospital among cancer patients, a phenomenon noted similarly in Cardiology, where the number of admissions for cardiac causes had declined suddenly during this pandemic timeline. One half of our population was African American and included an even proportion of males and females. The age range of patients was between 35-93 years. The most common malignancies that were noted to co-occur with COVID-19 in our population seemed to be lung, prostate, and hematologic malignancies. Although final analyses regarding mortality are to be completed, the proportion of patients who had died with a diagnosis of cancer was around 50% per collection of our current data. Twenty three out of 60 (38%) patients required blood transfusions. In comparison to other reports that had reported bleeding events and thrombotic events, our report revealed a much lower rate of bleeding events (5/60) and thrombotic events (5/60). We plan to repeat our analysis to assess for any confounders in identifying these events, as noted, since some earlier literature had reported between one quarter to two thirds of patients having a thrombotic event. Our analysis also looks at other descriptive variables such as use of anticoagulant and antiplatelet agents, absolute counts of neutrophils and lymphocytes, platelets, and coagulation markers. Also, our assessment includes a study in assessment of any delays noted in chemotherapy dates for these patients. Citation Format: Saikrishna Gadde, Ambuga Badari, John Cole, Nikhil Manjunath. COVID-19 in relation to hematologic events and mortality in subset of inpatient cancer patients [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-079.

Effects of Medical Comorbidities on the Surgical Outcomes of Deep Brain Stimulation for Parkinson Disease: A Retrospective, Single-Institution Study

Advancing age and greater number of medical comorbidities are well-known risk factors for higher rates of surgical complications and undesirable outcomes. We sought to determine the risk of increasing medical comorbidities on surgical outcomes for patients with Parkinson disease undergoing deep brain stimulation (DBS) surgery. We retrospectively reviewed 107 consecutive patients who underwent DBS for Parkinson disease at Ochsner Medical Center in 2008-2018. Patients were stratified into 3 groups based on Elixhauser comorbidity index (ECI) at the time of surgery: 0, 1, or ≥2. Outcome measures were changes in Unified Parkinson's Disease Rating Scale III scores, changes in medications, and surgical complications. Analysis of variance, paired t test, and nonparametric equivalents were used for statistical analysis. Of patients, 31 (29.0%) had ECI score 0, 44 (41.1%) had ECI score 1, and 32 (29.9%) had ECI score ≥2. For all groups, Unified Parkinson's Disease Rating Scale III scores decreased significantly postoperatively (P= 0.0014, P < 0.0001, P < 0.0001). All groups had a reduction in mean levodopa equivalent daily dose after surgery; however, only the group with ≥2 comorbidities achieved statistical significance (P= 0.0026). The rate of postoperative complications was significantly correlated with comorbidity score on univariate logistic regression analysis (P= 0.0425). Our findings indicate that DBS is efficacious in patients with multiple medical comorbidities. However, patients with ≥1 medical comorbidities may be more likely to have complications. The most common observed complication was wound infection. Patients with medical comorbidities may still benefit significantly from DBS when performed at experienced centers.

Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans.

AKI is a manifestation of COVID-19 (CoV-AKI). However, there is paucity of data from the United States, particularly from a predominantly black population. We report the phenotype and outcomes of AKI at an academic hospital in New Orleans. We conducted an observational study in patients hospitalized at Ochsner Medical Center over a 1-month period with COVID-19 and diagnosis of AKI (KDIGO). We examined the rates of RRT and in-hospital mortality as outcome measures. Among 575 admissions (70% black) with COVID-19 [173 (30%) to an intensive care unit (ICU)], we found 161 (28%) cases of AKI (61% ICU and 14% general ward admissions). Patients were predominantly men (62%) and hypertensive (83%). Median body mass index (BMI) was higher among those with AKI (34 versus 31 kg/m2, P<0.0001). AKI over preexisting CKD occurred in 35%. Median follow-up was 25 (1-45) days. The in-hospital mortality rate for the AKI cohort was 50%. Vasopressors and/or mechanical ventilation were required in 105 (65%) of those with AKI. RRT was required in 89 (55%) patients. Those with AKI requiring RRT (AKI-RRT) had higher median BMI (35 versus 33 kg/m2, P=0.05) and younger age (61 versus 68, P=0.0003). Initial values of ferritin, C-reactive protein, procalcitonin, and lactate dehydrogenase were higher among those with AKI; and among them, values were higher for those with AKI-RRT. Ischemic acute tubular injury (ATI) and rhabdomyolysis accounted for 66% and 7% of causes, respectively. In 13%, no obvious cause of AKI was identified aside from COVID-19 diagnosis. CoV-AKI is associated with high rates of RRT and death. Higher BMI and inflammatory marker levels are associated with AKI as well as with AKI-RRT. Hemodynamic instability leading to ischemic ATI is the predominant cause of AKI in this setting.

Acute thrombotic thrombocytopenic purpura in Louisiana: Seasonal distribution and evaluation of an ADAMTS13 order screening protocol.

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder caused by inactivation of ADAMTS13. It is characterized by thrombocytopenia and microangiopathic hemolytic anemia. Previous studies have produced conflicting data regarding seasonal association of TTP diagnoses. This study evaluated the seasonal distribution of acute TTP in southern Louisiana. Additionally, this study timeline overlapped with the initiation of a new screening protocol for ADAMTS13 testing. A retrospective analysis of patients receiving ADAMTS13 testing at Ochsner Medical Center from January 2010 to December 2017 was performed. TTP patient episodes were defined by ADAMTS13 activity <10%. Episodes were plotted according to season of presentation and a chi-square analysis was performed. Data of identified TTP patients was analyzed to evaluate for confounding variables. ADAMTS13 order volumes and results before and after screening protocol implementation were compared. Two hundred and fifty-two ADAMTS13 tests were ordered on 245 unique patients. Twenty-five patients had ADAMTS13 activity <10%. No significant differences in seasonal TTP case distribution were identified. Patients with confirmed TTP were younger and more likely to be Black or African American. A screening protocol did not decrease the number of annual ADAMTS13 test orders in our time frame, but was associated with a nonsignificant increase in the percentage of positive results. No significant seasonal distribution of TTP was identified in our population. This analysis provides previously unexamined regional information regarding this diagnosis. The number of tests ordered after the implementation of the screening protocol increased, corresponding with our facility's expanding reach.