ICU Admission Rate Research Articles

Incidence and outcomes of hospital-associated respiratory virus infections by viral species.

Although the incidence of hospital-associated respiratory virus infection (HARVI) is well recognized, the risk factors for infection and impact on patient outcomes are not well characterized. We identified a cohort of all inpatient admissions ≥24 hours duration at a single academic medical center from 2017 to 2020. HARVI were defined as respiratory virus detected in a test ordered after the 95th percentile of the virus-specific incubation period. Risk factors for HARVI were assessed using Cox proportional hazards models of the competing outcomes of HARVI and discharge. The associations between time-varying HARVI status and the rates of ICU admission, discharge, and in-hospital death were estimated using Cox-proportional hazards models in a competing risk framework. HARVI incidences were 8.8 and 3.0 per 10,000 admission days for pediatric and adult patients, respectively. For adults, congestive heart failure, renal disease, and cancer increased HARVI risk independent of their associations with length of stay. HARVI risk was also elevated for patients admitted in September-June relative to July admissions. For pediatric patients, cardiovascular and respiratory conditions, cancer, medical device dependence, and admission in December increased HARVI risk. Lengths of stay were longer for adults with HARVI compared to those without, and hospital-associated influenza A was associated with increased risk of death. Rates of ICU admission were increased in the 5 days after HARVI identification for adult and pediatric patients. HARVI was not associated with length of stay or death among pediatric patients. HARVI is associated chronic health conditions and increases morbidity and mortality.

Three-Year Analysis of the Rectal Cancer Care Trajectory after the COVID-19 Pandemic.

The global pandemic period from 2020 to 2022 caused important alterations in oncology care. This study aimed to describe the trends and variations in patient characteristics, comorbidities, and treatment approaches during this time in Romania. We conducted a retrospective database search to identify patients with rectal cancer who underwent surgical intervention between 2020 and 2022 and the year 2019, which served as a pre-pandemic period control. This study included 164 patients, with a yearly increase of approximately 10% in surgical interventions noted from 2020 (1709 interventions) to 2022 (2118 interventions), but an overall 34.4% decrease compared with the pre-pandemic period. Notable shifts were observed in the type of surgeries performed, with laparoscopic procedures doubling from 2020 (25%) to 2022 (47.5%), confirming the decrease in emergency presentations during the last year of the COVID-19 pandemic and a recovery to normality with planned, elective interventions. Elective interventions increased significantly in 2022 (79.7%) compared with the previous years (p = 0.043), with a concurrent rise in neoadjuvant therapy uptake in 2022 (35.6%). However, significant alterations in the TNM staging, from 12.5% stage IV cases in 2020 to 25.4% in 2022 (p = 0.039), indicated an increased diagnosis of advanced stages of rectal cancer as the years progressed. There was a significant difference in albumin levels over the years (p = 0.019) and in the American Society of Anesthesiology (ASA) scores (from 6.2% ASA stage IV in 2020 to 16.9% in 2022), denoting an increase in case complexity (p = 0.043). This study reveals a trend of increasing surgical interventions and the prevalence of more advanced stages of rectal cancer during the pandemic years. Despite the subtle fluctuations in various patient characteristics and treatment approaches, notable shifts were documented in the severity at diagnosis and surgery types, pointing toward more advanced disease presentations and changes in surgical strategies over the period studied. Nevertheless, the trends in ICU admission rates and mortality did not alter significantly during the pandemic period.

Impact of Comorbidities on Patients with COVID-19: A Cross-Sectional Study

Introduction: The COVID-19 pandemic has emerged as a global health crisis, affecting millions of individuals worldwide. As the pandemic has evolved, a critical aspect that has garnered significant attention is the impact of comorbidities on the severity and outcomes of COVID-19. Aim of the study: The aim of this study was to explore the impact of comorbidities on patients with COVID-19. Methods: This cross-sectional study was conducted in Department of Reproductive and Child Health, National Institutes of Public Health and Social Medicine in Mohakhali, Dhaka, Bangladesh, during the period from January to December 2020. Total 202 women diagnosed with Covid-19 were included in this study. The patients were divided into two groups; patients with comorbidities and patients without comorbidities, each containing 101 patients. Result: Patients with comorbidities were older and had higher BMI compared to those without comorbidities. Common symptoms like fever and cough showed no significant difference between groups, but shortness of breath and dyspnea were more prevalent in patients with comorbidities. Hypertension (64.4%) and diabetes (51.5%) were the most frequent comorbidities. Laboratory findings indicated higher inflammation and organ stress in comorbid patients, with elevated white blood cell count, C-reactive protein, D-dimer, ferritin, and liver enzymes. Clinical outcomes were more severe in the comorbid group, with higher rates of hospitalization (94.1% vs. 74.3%), ICU admission (39.6% vs. 19.8%), and mortality (19.8% vs. 5.0%). Conclusion: This study concludes that patients with comorbidities are in higher risk. Patients with comorbidities manifests more severe symptoms and clinical feature with higher mortality rate.

Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa

BackgroundRecent studies show that aspirin for pre-eclampsia prevention is underutilized despite it's effectiveness in preventing pre-eclampsia in patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. ObjectiveTo determine the missed opportunity for ASA prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. Study DesignThis was a cross-sectional study on pregnant women complicated by preeclampsia who were managed at St. Paul's Hospital Millennium Medical College (Ethiopia) over 6 months (April 1, 2023-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was proportion of women who had an indication for ASA prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for ASA) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. An intention-to-treat (ITT) analysis was used. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. ResultsA total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded according to the inclusion and exclusion criteria. Among the 395 preeclamptic pregnant women included in the final analysis, 195(50.6%) had an indication for ASA prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressures at presentation were 153.8(±12.8) and 100.6(±8.5) mm Hg, respectively. Most patients had proteinuria (51.7% had urine dip-stick protein +2 while another 18.5% (74/395) had urine dip-stick protein +1 and 10.9% had 24-hour urine protein in the pre-eclampsia range). Among these women who had indication for ASA prophylaxis, in only 1.1 % was ASA utilized (the missed opportunity for ASA prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9 % while neonatal ICU admission rate was 20.5%. The 5th minute low Apgar score rate was 8.9% Eight mothers (2.1%) were complicated by HELLP syndrome while another 3(0.8%) mothers developed pulmonary edema. ConclusionIn this study, the missed opportunity for administration of ASA prophylaxis for the prevention of preeclampsia was unacceptably high though more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates adverse perinatal outcomes and serious maternal morbidity.

Predictors of Intensive Care Admission Among Adult Patients with Sickle Cell Disease in Eastern Province of Saudi Arabia.

Sickle cell disease (SCD) comprises a complex group of hematologic disorders that are collectively the most common monogenic disorder and are associated with increased risk of intensive care unit admission (ICU). The purpose of this study is to investigate factors that predict admission of adult patients with SCD to the ICU. This was a cross-sectional study that enrolled adult patients with SCD from Saudi Arabia. A total of 107 patients with SCD, with a median age 31.9±12.1 years, were evaluated retrospectively. Regarding predictors of ICU admission, patients who indicated a history of blood transfusions were at 8.047-fold higher risk of ICU admission (OR=8.047; 95% CI=2.392-27.07; p=0.001). Patients who started hydroxyurea were at least 3.071 times more likely to be admitted than those who did not (OR=3.071; 95% CI=1.164-8.104; p=0.023). We also observed three or more hospitalizations per year to be associated with increased risk of ICU admission (OR=3.393; 95% CI=1.285-8.960; p=0.014), with those making 3 to 5 visits annually having at least 10.4 times higher risk (OR=10.38; 95% CI=10.098-98.19; p=0.041) and those with 6 to 10 ER admissions having 18 times higher risk (OR=18.00; 95% CI=2.149-150.8; p=0.008). Finally, patients with high WBC were predicted to have at least 3.34 times higher risk of ICU admission (OR=3.337; 95% CI=1.131-9.846; p=0.029). SCD is a multi-systemic disease associated with increased morbidity and mortality. Recognition of high-risk features in patients helps to eliminate subjectivity in ICU referral decision. Frequent hospitalization and emergency visits, multiple blood transfusions, and elevated white blood cell count were significantly associated with a higher rate of ICU admission despite hydroxyurea usage.

Complications of COVID-19 and possible role of angiotensin converting enzyme inhibitors and anti-platelet medications in lowering the risk of COVID -19 infection

COVID-19, the worldwide pandemic which effected the entire health care system, particularly showed its ill effects on patients with many comorbidities. Among the COVID-19 patients admitted in hospital, are with cardiovascular diseases and hypertension where associated with increased risk of mortality. Angiotensin converting enzyme inhibitors (ACEI) and Angiotensin receptor-II blockers (ARB) were used in the management of hypertension and these medications revealed their beneficiary actions in the conditions of COVID -19 with Hypertension. On the other hand, COVID -19 also lead to thromboembolic complications which also required Intensive Care Unit admission within patients representing a unique condition termed as Covid Associated Coagulopathy (CAC). The impact of dual anti-platelet therapy reduced the risk of mechanical ventilation, ICU admission and mortality rate among individuals effected by Covid.

Evolving trends among Pseudomonas aeruginosa: a 12-year retrospective study from the United Arab Emirates.

Pseudomonas is a group of ubiquitous non-fermenting Gram-negative bacteria (NFGNB). Of the several species associated with humans, Pseudomonas aeruginosa (PA) can acclimate to diverse environments. The global frequency of PA infections is rising and is complicated by this organism's high intrinsic and acquired resistance to several clinically relevant antibiotics. Data on the epidemiology, levels, and trends of antimicrobial resistance of PA in clinical settings in the MENA/GCC region is scarce. A retrospective 12-year analysis of 56,618 non-duplicate diagnostic Pseudomonas spp. from the United Arab Emirates (UAE) was conducted. Data was generated at 317 surveillance sites by routine patient care during 2010-2021, collected by trained personnel and reported by participating surveillance sites to the UAE National antimicrobial resistance (AMR) Surveillance program. Data analysis was conducted with WHONET (https://whonet.org/). Among the total isolates (N = 56,618), the majority were PA (95.6%). Data on nationality revealed 44.1% were UAE nationals. Most isolates were from soft tissue (55.7%), followed by respiratory tract (26.7%). PA was more commonly found among inpatients than among outpatients, followed by ICUs. PA showed a horizontal trend for resistance to fluoroquinolones, 3rd- and 4th-generation cephalosporins, and decreasing trends of resistance for aminoglycosides and meropenem. The highest percentage of multidrug resistant (MDR) isolates was reported in 2011 at 35.6%. As an overall trend, the percentage of MDR, extensively drug-resistant (XDR), and possible pandrug-resistant (PDR) isolates generally declined over the study period. Carbapenem-resistant PA (CRPA) were associated with a higher mortality (RR: 2.7), increased admission to ICU (RR: 2.3), and increased length of stay (LOS) (12 excess inpatient days per case), as compared to carbapenem-susceptible PA (CSPA). The resistance trends in Pseudomonas species in the UAE indicated a decline in AMR and in percentages of Pseudomonas isolates with MDR and XDR profiles. The sustained Pseudomonas spp. circulation particularly in the hospital settings highlights the importance of surveillance techniques, infection control strategies, and stewardship to limit the continued dissemination. This data also shows that CRPA are associated with higher mortality, increased ICU admission rates, and a longer hospitalization, thus higher costs due to increased number of in-hospital and ICU days.

2624. The Usual Suspects: A Retrospective Analysis of Pediatric Respiratory Viral Testing During the Pandemic

Abstract Background Contention measures implemented during the pandemic drastically changed the epidemiology of viral respiratory infections. Some reports have shown a sharp decrease in Emergency department visits for respiratory illnesses in the first months of the pandemic with an increase in Respiratory Syncytial Virus (RSV) and Enterovirus (EV) in subsequent months. The concern caused by COVID-19 during the beginning of the pandemic may have led healthcare professionals to underdiagnose other respiratory viral infections. The aim of this study is to evaluate the behavior of viral infection through the pandemic. Methods A retrospective analysis was conducted to determine temporal changes in respiratory panel use and viral epidemiology in the pediatric ED from 2018 to 2022. Medical records were used to determine ICU admission and mortality in those with a positive respiratory panel. Results During the study period, a total of 10,000 respiratory PCR panels were performed in the pediatric ED. There was a significant increase in mean number of panels performed per year during the pandemic period compared to two years prior (2899 vs 198 panels/year). However, the Positivity rate decreased considerably during the pandemic (38.27% vs. 63.54%). Of the 10,000 panels performed, COVID-19 was identified in in 993 cases (9.93%), while other respiratory viruses were identified in 31.27% of cases. The most prevalent virus identified were EV (n=1411, 14.9%) and RSV (n=483, 5.1%). These viruses also had the highest rate of ICU admission and mortality. Patients that tested positive for COVID-19 had a lower rate of ICU admission compared to those infected by other viruses (RR=0.88; CI95%=0.78-0.99). Additionally, the mortality rate associated with COVID-19 was significantly lower than that of other viruses (RR=0.62; CI95%=0.49-0.79). PCR Panel Positivity Rate and Viral Infections in Pediatrics ED from 2018-2022 PCR viral panel tests performed, positive tests, and viral isolates from 2018 to 2022 Conclusion The pandemic increased the use of PCR testing for respiratory illnesses, providing a better picture of seasonal epidemiology of viral infections. Although COVID-19 infection in children was a major of concern, this report shows that throughout the pandemic other viruses were more prevalent and significantly more severe. This study serves as a reminder than even in times of emerging infections, healthcare professionals shouldn’t forget the usual causes of infection. Disclosures All Authors: No reported disclosures

271. Epidemiology of ESBL Klebsiella pneumoniae Clonal Group 307 in Stony Brook, NY

Abstract Background According to the most recent CDC threat report infections caused by ESBL and carbapenem-resistant Klebsiella pneumoniae (CRKp) remain a persistent challenge. In the US dissemination of CRKp has been largely attributed to clonal group (CG) 258 with recent evidence that CG307, a dominant Klebsiella Extended Spectrum Beta-Lactamase (ESBL-Kp) clone is also emerging as CRKp. CG307 strains uniformly express a wzi-173 type capsular polysaccharide (CPS) whereas other Klebsiella strains including those of the CG258 express a wide variety of wzi-type CPS. A paper from Houston, TX provided evidence of divergent evolution between CG258 and CG307. CG258 evolves upfront as carbapenem resistant whereas CG307 may initially emerge as ESBL. CR-Kp that belong to the CG307 have also been identified in SBU. Our objective was to determine if among ESBL-Kp CG307 is a common clone and to characterize the demographics of the infected patient population. Methods Molecular typing of the wzi gene alleles of 78 sequentially collected ESBL-Kp was performed. Demographic, microbiological and clinical data were extracted from the medical record. Results Wzi typing indicated that 43% of ESBLKp strains express a wzi173 type CPS indicating they belong to CG307 the remainder of ESBL strains expressed variable wzi-types. Preliminary data analysis showed that wzi173 expressing ESBL strains were predominantly derived from urine. The median age of patients was 64 years old with male predominance (60.8% males). The average length of stay is 41.6 days. Among these patients, 30.4% required ICU admission. Sepsis criteria were met in 56.5% of these patients within 2 days of positive culture. The mortality rate was 21.7%. Conclusion Our data provides evidence that CG307 is the most dominant ESBL Kp clone in hospitalized patients at Stony Brook University. Although the majority of cultures were from urinary source, ICU admission rates and mortality rates were also elevated. These data raise concern that high prevalence of ESBL CG307 in hospitalized patients may ultimately lead to emergence of carbapenem resistant CG307 strains especially if they emerge in patients who are treated with broad spectrum antibiotics. Disclosures All Authors: No reported disclosures

2779. Early Administration of Ceftazidime-Avibactam for Carbapenem-Resistant Enterobacterales Is Associated with Improved Clinical Success

Abstract Background Carbapenem-resistant Enterobacterales (CRE) are a significant public health threat. Ceftazidime-avibactam (CZA) retains activity against most carbapenemase-producing CRE and demonstrates favorable health outcomes compared to historically best available therapy. While early initiation of effective therapy is critical in serious infections, the impact of time to CZA initiation on CRE infection-related outcomes has yet to be assessed. Aim: to evaluate clinical outcomes of patients with CRE infections receiving early vs. late CZA as the first active β-lactam. Methods Multicenter, retrospective cohort of hospitalized adult patients from 2019-2022 with culture-positive CRE and infectious symptoms receiving early vs. late CZA as the first active β-lactam. Early and late CZA were defined as CZA administration within or after 48 hours of index culture collection, respectively. Primary outcome was a composite of clinical success defined as i) the absence of all-cause mortality or microbiological recurrence requiring therapy within 30 days from the end of CZA therapy and ii) continued infectious symptoms during CZA therapy. Results In total, 174 patients were included (≤48 hours n=52, >48 hours n=122). Median (IQR) age was 61 (53, 73) years and 56.3% were male. ICU admission rates were similar between early vs. late CZA (73.1% vs. 72.1%; P=0.921). Most common infection sources were respiratory (59.8%) and skin and skin structure (9.2%). Klebsiella pneumoniae was the most common CRE isolated (66%). The overall median (IQR) of CZA MIC was 2 (1,4). and there was no difference in the receipt of package insert CZA doses in the first 48 hours of CZA therapy between the early vs. late groups, respectively (1.9% vs. 5.2%; P=0.311). In total, 40/52 (76.9%) early and 68/122 (55.7%) late CZA patients met the clinical endpoint of clinical success (P< 0.001). The early and late CZA groups demonstrated similar ICU length of stay (LOS) (26 [9, 46] vs. 22 [12, 40]; P=0.431, respectively). Table 1. Baseline and Clinical Characteristics Conclusion In hospitalized adult patients with CRE infections, CZA administration within 48 hours of culture collection was associated with a higher rate of clinical success compared to CZA administered after 48 hours. Further studies in a larger patient cohort are warranted to verify these results. Disclosures Wesley D. Kufel, Pharm.D., BCPS, BCIDP, AAHIVP, Merck: Grant/Research Support Bryan White, PharmD, BCPS, BCIDP, Gilead Sciences: Advisor/Consultant Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Merck, Paratek, Shionogi, Entasis, La Jolla, T2 Biosystems: Advisor/Consultant

235. Investigation of the relationship between the number of positive blood cultures and patient prognosis

Abstract Background The relationship between the number of positive blood cultures (NPBCs) and clinical outcomes has not been well-studied. The purpose of this study was to assess the impact of NPBCs (one set or two) on clinical outcomes. Methods We conducted a retrospective study comparing the clinical features of two sets of positive blood cultures (NPBCs=2) and one set of positive blood culture (NPBCs=1) in adult patients with bacteremia and fungemia from 2004 to 2021 at a tertiary hospital in Tokyo, Japan. We focused on four pathogens commonly encountered in clinical practice, including Staphylococcus aureus (S. aureus), Streptococci, gram-negative rods (GNR) (Enterobacterales and Pseudomonas aeruginosa), and Candida species, as the true causative pathogens in bacteremia and fungemia. The primary outcome was in-hospital mortality, and secondary outcomes were ICU admission and use of vasopressor drugs. Results In univariate analysis, NPBCs=2 for S. aureus was associated with vasopressor use, and NPBCs=2 for Streptococci was linked to a higher rate of ICU admission. However, these differences were not significant in multivariate analysis. Interestingly, NPBCs=2 for S. aureus had a positive impact on in-hospital mortality compared with NPBCs=1 (OR 0.574, 95%CI 0.376–0.877, p < 0.05). NPBCs for Candida species did not affect clinical outcomes. Furthermore, NPBCs=2 for GNR was associated with vasopressor use (OR 1.62, 95%CI 1.27–2.07, p < 0.05) in both univariate and multivariate analysis. We performed logistic regression analysis using the five items with the highest clinical significance: NPBCs=2, serum Cr > 1.2 mg/dL, Hb < 12 g/dL, heart rate > 90 beats/min, and platelet count < 150,000/μL. Based on the β coefficient, we assigned scores to each item and created a STAT-2 (S: Serum Cr, T: Thrombocytopenia, A: Anemia, T: Tachycardia, 2: NPBCs=2) score for the use of hypertensive drugs for GNR. The receiver operating characteristic (ROC) curve for the STAT-2 score with a cutoff of 6 points or higher had an area under the curve (AUC) of 0.763. The specificity was 90.8%, with a positive likelihood ratio of 4.13 (95% CI 3.40-5.02). Conclusion Our study suggests that NPBCs can predict clinical outcomes in patients with certain pathogenic infections. Disclosures All Authors: No reported disclosures

Influenza vaccination mitigates severe complications in hospitalized patients: A ten-year observational study, Spain, 2009-2019

Influenza epidemics annually impact a substantial portion of adults worldwide, leading to numerous hospitalizations and fatalities. While the primary goal of vaccination is to prevent influenza virus infection, breakthrough infections can still occur despite vaccination. Evaluating the vaccine effectiveness in preventing severe cases among hospitalized patients is crucial for enhancing vaccination strategies. This single-center, observational, cross-sectional, and retrospective study analyzed data from 1,357 patients admitted to La Paz University Hospital for influenza infection between 2009 and 2019. Patients' demographics, clinical variables, comorbidities, vaccination status, and influenza-related outcomes were assessed. Logistic regression analysis was performed to determine the vaccine-independent protective effects. Influenza vaccination independently prevented severe complications, including pneumonia, bacterial superinfection, acute respiratory distress syndrome, and multiple organ failure in hospitalized patients (odds ratio=0.61, 95% confidence interval: 0.47-0.76). Vaccinated patients had significantly lower intensive care unit admission rates (odds ratio=0.42, 95% confidence interval: 0.18-0.92). However, there were no significant differences in mortality rates between vaccinated and unvaccinated patients (P=.385). Our study provides robust evidence supporting the influenza vaccine protective effect against severe outcomes in hospitalized patients during epidemic flu. Vaccination is associated with a significant reduction in severe complications and intensive care unit admissions, emphasizing its importance as a preventive measure. Improving vaccination coverage, especially in specific comorbidities and age groups, could further enhance the vaccine effectiveness in preventing severe influenza cases.

Progressive disseminated histoplasmosis: The experience in one non-endemic medical center.

Histoplasmosis, the most common endemic mycosis in North America, presents in a myriad of ways, spanning the spectrum from self-limiting pneumonia to progressive disseminated histoplasmosis (PDH). Toward better describing contemporary histoplasmosis syndromes, risks, and outcomes, this single-center retrospective cohort study was performed (2009-2019). The population who developed PDH was similar to that with other forms of histoplasmosis (OFH) except for higher rates of preexisting immunocompromising conditions (91.3% vs. 40%, P<.001) and a trend toward receiving more chronic immunosuppression (65.2% vs. 33.3%, P=.054) compared to those with OFH. Diagnosis was most frequently achieved by urinary or serum antigen positivity. People with PDH more frequently tested positive compared to those with OFH, but negative tests did not rule out histoplasmosis. Median time to diagnosis was prolonged among people with both PDH and OFH (32 vs. 31 days, respectively). Following diagnosis, people with PDH received more liposomal amphotericin (78.3% vs. 20%, P<.001). Subsequent survival at 90 and 365 days and treatment response were similar in both groups. Patients with PDH were more often hospitalized (95.7% vs. 60%, P=.006); however, once admitted, there were no differences in hospital length of stay or intensive care unit admission rate. The challenges of diagnosing histoplasmosis based on clinical presentation alone highlight the need for heightened awareness of these entities especially given the recent reports on expanded endemicity and delays in diagnosis.

Effect of ursodeoxycholic acid on preventing SARS-CoV-2 infection in patients with liver transplantation: a multicenter retrospective cohort study.

Immunosuppressed recipients of liver transplantation (LT) are more likely to develop coronavirus disease 2019 (COVID-19) and may have an increased risk of developing worse outcomes. To assess the effect of ursodeoxycholic acid (UDCA) on preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients. Adult patients (aged ≥ 18 years) who underwent LT between 1 January 2015 and 31 December 2022 were included and categorized into two groups according to their use of UDCA. The prevalence and severity of COVID-19 among transplantation patients between the UDCA and non-UDCA groups were estimated and compared. Among the 897 LT patients who met the inclusion criteria, infection rate of SARS-CoV-2 was 78.4%, and the rate of severe illness was 5.1% from January 2022 to January 2023 in China. In the multivariate analysis, only UDCA treatment (P = 0.006) was found to be a protective factor against SARS-CoV-2 infection. After propensity score matching, the SARS-CoV-2 infection rate in the UDCA group was lower than that in the non-UDCA group (74.1% vs. 84.6%, P = 0.002). This rate was further reduced to 62.1% (P = 0.002) when the oral administration dose was >15 mg/kg/day. There was no difference in the rates of severe COVID-19 illness, ICU admission, or ventilation rate or length of hospital stay with or without UDCA treatment (all P > 0.05). The use of UDCA in LT patients significantly reduced the SARS-CoV-2 infection rate and showed a dose-dependent protective effect.

Streptococcus pneumoniae associated hemolytic uremic syndrome in children.

Previous small-scale, single-center investigations of Streptococcus pneumoniae associated hemolytic uremic syndrome (SpHUS) have shown increased disease severity among SpHUS relative to non-SpHUS patients. Our study compares the impact of S. pneumoniae on patient outcomes between SpHUS cases and non-SpHUS controls using the national, multicenter retrospective Pediatric Health Information Systems (PHIS) Database. Children <18 years of age with a diagnosis of HUS were included. Univariate analyses and multivariable linear and logistic regressions were utilized to assess the impact of S. pneumoniae on mortality, length of stay (LOS), intensive care unit admission (ICU), and mechanical ventilation use. Models were adjusted for demographic and clinical characteristics, including cardiac, neurologic, pulmonary, gastrointestinal, immunologic and renal clinical complications. Of 3,952 index HUS hospitalizations, 231 (5.8%) were due to SpHUS. SpHUS patients had worse outcomes, including longer hospital stays, increased rate of ICU admission, and increased use of mechanical ventilation (p < 0.001 for all). There was a strong positive relationship between clinical complications and adverse outcomes. After adjusting for covariates, SpHUS was associated with an increase in hospital LOS by 3.47 days (p = 0.009) and overall ICU-LOS by 4.21 days (p < 0.001). SpHUS was also associated with increased likelihood of mechanical ventilation (OR: 3.08; p < 0.001), with no increase in ICU admission (p = 0.070) and in-hospital mortality (p = 0.3874). Our study highlights that SpHUS patients are at increased risk of multiple adverse outcomes likely due to the summative impact of pneumococcal infection and HUS as well as more frequent clinical complications.

Analyzing real-world data to understand COVID-19 vaccination effects on hospitalization rates in patients with solid malignancies

The impact of COVID-19 vaccination on hospitalizations in individuals with solid malignancies remains uncertain. This nationwide retrospective study aims to clarify this issue. We analyzed data from 1,126,946 confirmed COVID-19 cases between March 2020 and June 2022, obtained from the Ministry of Health’s United Information Portal. Outcomes were compared between fully vaccinated and non-vaccinated cohorts, stratified by sex, age and viral variant. Among the 1,126,946 confirmed COVID-19 cases, 0.53% (n = 6025) had solid malignancies and comorbidities. Of these, 31.3% (n = 1797) had sole solid malignancies. In this subgroup, 40% (n = 764) required hospitalization, with a median age of 63 years. Unadjusted univariate analysis showed a significant reduction in hospitalization rates among COVID-19 vaccinated patients with isolated solid malignancies [OR 0.2776 (95% CI 0.1621 to 0.4753); p < 0.0001], especially in those aged over 63 [OR 0.5981 (95% CI 0.4244 to 0.8429); p = 0.0033]. Lower ICU admission rates favored vaccinated cohorts [OR 0.3418 (95% CI 0.2023 to 0.5777); p = 0.0001]. These reductions were observed exclusively with mRNA-based vaccines [OR 0.5845 (95% CI 0.4333 to 0.7884); p = 0.0004]. Statistically significant vaccination benefits were found only within the omicron cohort [OR 0.2307 (95% CI 0.13687 to 0.3890); p < 0.0001]. The results from the analysis suggest that individuals with sole solid malignancies face an increased risk of hospitalization and ICU admission. However, these risks can be mitigated through vaccination, particularly with an mRNA-based vaccine, especially in those aged 63 years or older.

Abstract 17932: Smoking History is Associated With Worse Outcomes in Patients With Sarcopenia Admitted for Acute Decompensated Heart Failure

Background: Sarcopenia and smoking are independently associated with worse heart failure (HF) outcomes; therefore, their combined effect is likely even more detrimental. Research Questions: We studied the impact of sarcopenia and smoking on outcomes in patients admitted for acute decompensated HF (ADHF). Methods: We conducted a retrospective cohort study of 406 consecutive patients hospitalized at our tertiary care center for ADHF from 2017 to 2020 with computed tomography of the chest one month before the discharge date. Semi-automatic measurements were made at T12 (Figure 1A) and adjusted for height squared to obtain skeletal muscle index (SMI). To compare survival, patients were divided into four groups: nonsarcopenic nonsmokers (controls, 22.4%), sarcopenic nonsmokers (10.6%), nonsarcopenic smokers (44.3%), and sarcopenic smokers (22.7%). Sarcopenia was the lowest sex-stratified SMI tertile (cutoffs of 29.6 cm 2 /m 2 in males and 25.7 cm 2 /m 2 in females), and smokers were those who had ever smoked. Results: The mean admission age of our cohort was 70±14 years, 44.3% were female, and 67.0% had a smoking history (191 former and 81 active). Compared to nonsmokers, patients with a smoking history had more COPD (53.3% vs. 18.7%, p&lt;0.001) and higher all-cause mortality (HR 1.41, 95%CI 1.05-1.90, p=0.021), but did not differ in SMI. When further stratified by sarcopenia, during a median 22.9 (3.0-33.5) months of follow-up, all groups had higher all-cause mortality when compared to controls (figure 1B); the highest rate was seen in sarcopenic smokers, which remained significant when adjusted for age, male sex, Caucasian race, CAD, and COPD (HR 1.71, 95%CI 1.12-2.60, p=0.013). Sarcopenic smokers also had the highest rate of ICU admissions (50.0%). Conclusions: Sarcopenia and smoking portend worse prognoses in patients admitted for ADHF, with sarcopenic smokers having the worst outcomes, independent of COPD history.

Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes

Background: Volatile and intravenous anesthetics have substantial effects on physiological functions, notably influencing neurological function and susceptibility to injury. Despite the importance of the anesthetic approach, data on its relative risks or benefits during surgical clipping or endovascular treatments for unruptured intracranial aneurysms (UIAs) remains scant. We investigated whether using volatile anesthetics alone or in combination with propofol infusion yields superior neurological outcomes following UIA obliteration. Methods: We retrospectively reviewed 1001 patients who underwent open or endovascular treatment for UIA, of whom 596 had short- and long-term neurological outcome data (modified Rankin Scale) recorded. Multivariable ordinal regression analysis was performed to examine the association between the anesthetic approach and outcomes. Results: Of 1001 patients, 765 received volatile anesthetics alone, while 236 received propofol infusion and volatile anesthetics (combined anesthetic group). Short-term neurological outcome data were available for 619 patients and long-term data for 596. No significant correlation was found between the anesthetic approach and neurologic outcomes, irrespective of the type of procedure (open craniotomy or endovascular treatment). The combined anesthetic group had a higher rate of ICU admission (p &lt; 0.001) and longer ICU and hospital length of stay (LOS, p &lt; 0.001). Similarly, a subgroup analysis revealed longer ICU and hospital LOS (p &lt; 0.0001 and p &lt; 0.001, respectively) in patients who underwent endovascular UIA obliteration under a combined anesthetic approach (n = 678). Conclusions: The addition of propofol to volatile anesthetics during UIA obliteration does not provide short- or long-term benefits to neurologic outcomes. Compared to volatile anesthetics alone, the combination of propofol and volatile anesthetics may be associated with an increased rate of ICU admission, as well as longer ICU and hospital LOS.

The Impact of Melphalan Conditioning Schedule on Post-Transplant Outcomes in AL Amyloidosis: A Multicenter Study with 1718 Patients

Introduction: High dose chemotherapy and autologous stem cell transplantation (ASCT) is one of the most effective therapies in light chain (AL) amyloidosis. It is associated with a high hematologic response rate and leads to durable remissions. High dose melphalan is the most frequently used conditioning chemotherapy, as has been used in multiple myeloma (MM). Melphalan dose is based on renal function, age, degree of cardiac involvement and patients' frailty and is predictive of outcomes. While studies that assessed the conditioning schedule have been conducted in MM, with variable results, no such studies were done in AL amyloidosis. Methods: In this retrospective study, we explored the impact of the conditioning schedule on post-transplant outcomes in a large multicenter study. Patients with AL amyloidosis who underwent ASCT for the primary diagnosis of AL amyloidosis between January 1, 2003, and December 31, 2020, were included in this study. Results: One thousand seven hundred and eighteen (n=1718) patients from 9 centers are included. The median age was 58 years, and 61% were male. Most patients had one (43%) or two (33%) involved organs, with the most involved organs were the kidneys (69%) followed by the heart (52%). Induction therapy was given to 52% of patients. The conditioning regimen was almost exclusively melphalan (99.2%), with 65% receiving full dose melphalan (≥170 mg/m 2). Melphalan was given over two days in most patients (80%). A rest day between conditioning and stem cell infusion was provided in 53% of patients, mostly in those who received melphalan on a single day rather than over 2 days (87% vs 44%, P&amp;lt;0.001). Post-transplant hematologic response was available for 1569 patients (91% of patients) and were assessed from baseline. Complete response (CR) and very good partial responses (VGPR) were achieved post-ASCT in 33.7% of patients each. Low dFLC-partial response (PR) was achieved in 2.7% and PR in 18% of patients. Altogether, satisfactory post-ASCT response (CR, VGPR, or low-dFLC PR combined) was achieved in 70% of patients. Compared to no induction, less than a PR to induction was associated with a lower probability of achieving satisfactory post-ASCT response, while PR or better to induction had higher chances of satisfactory post-ASCT response (65% vs 46% vs 84%, P&amp;lt;0.001). A single day of melphalan conditioning was associated with a higher probability of satisfactory post-ASCT response compared to two days of conditioning (82% vs 67%, P&amp;lt;0.001). Omitting a day of rest between conditioning and stem cell infusion was also associated with higher satisfactory post-ASCT response compared to having a rest day (76% vs 65%, P&amp;lt;0.001). The Table lists other predictors for a post-ASCT satisfactory hematologic response. In a nominal multivariate logistic regression analysis, independent predictors for higher post-ASCT satisfactory hematological response rate included: PR or better to induction therapy, female gender, kappa light chain isotype, lower dFLC at baseline, and kidney and liver involvement. In addition, full dose melphalan, conditioning given over a single day and having no rest day between conditioning and stem cell infusion were also associated with a higher likelihood of satisfactory post-ASCT response. Post-ASCT hematologic CR rate was higher in those receiving full dose conditioning (36% vs 28%, P&amp;lt;0.001), in those having no rest day (40% vs 28%, P&amp;lt;0.001) but not in those who received one day of conditioning versus two days (35% vs 33%, P=0.5). The rate of ICU admission was higher in those receiving no day rest (17.7% vs 12.6%), P=0.003) and among those who received reduced dose melphalan (18.1% vs 13.3%, P=0.008) but not based on number of conditioning days (P=0.56). Day 100 mortality was significantly higher in the no rest day group (5.6% vs 3.2%, P=0.01) and among those receiving reduced dose melphalan (6.8% vs 3.1%, P=0.004) compared to their counterparts, but not based on the number of days of conditioning (P=0.89). The median follow-up in the entire cohort was 104 months (95% CI 98-110). In a multivariate analysis for overall survival (OS), the conditioning dose but not the conditioning schedule was independently associated with OS. Conclusions: This study is the first to demonstrate the effect of melphalan conditioning schedule on post-transplant response. This study supports a single day melphalan conditioning in AL amyloidosis to improve post-ASCT response.

Real World Results of Brexucabtagene Autoleucel for Patients with Relapsed/Refractory Mantle Cell Lymphoma - First German/Swiss Analysis

Background: Chimeric antigen receptor T-cells have revolutionized treatment in many B-cell neoplasias. In MCL, brexucabtagene autoleucel (brexu-cel) has been the first product approved based on results of the ZUMA-2 trial for patients failing prior chemoimmunotherapy and BTK-inhibitor. However, in ZUMA-2, strict criteria have been used for patient selection, e.g. no use of intensive bridging/holding treatment was allowed, excluding patients with high treatment needs. In contrast to this, in the real-world scenario patient selection is much more diverse questioning whether the results of controlled trials can be reproduced in the regular treatment landscape. In this intent, we have analyzed the results obtained with brexu-cel as standard-of-care treatment (SOC) of r/r MCL in Germany and Switzerland. Patients/methods: Eligible for this first analysis of an ongoing registry study were all German and Swiss patients with r/r MCL who have been treated with SOC brexu-cel since 09/2020 and were registered with the German Stem Cell Registry (DRST) and the Registry of the European Mantle Cell lymphoma (EMCL), respectively. Of note, some patients have received more than one CAR-T-treatment. Data were analyzed for patient and disease characteristics, prior treatment history, response to treatment, and complications as well as post treatment outcomes. Due to the character of this analysis based on real world data, with heterogeneous surveillance strategies we have used primarily time to next treatment (TTNT) instead of progression-free survival, due to the potential biases for the latter. While still adding patients to the analysis, an additional follow-up data cut is planned 10/2023. Results: 111 patients have been identified: median age at diagnosis was 64.3 years (range 42.3-79.5; 19/99 patients ≥ 70), 18% female (not known (nk) 2.7%); ethnicity 66.7% Caucasian (nk 30.6%). Disease characteristics: 80/88 had stage 3/4 (91%), histology was classical in 34/57 cases (60%) and blastoid in 19/57 (33%), respectively. MIPI score was low 14/53 (26%), intermediate 17 (32%), high 21 (40%). TP53 alteration was present in 13/58 (22%), Ki67-expression was ≤ 30% in 18/50 (36%). TTNT for last treatment preceding CAR-T-treatment was 7.7 months. Overall survival (OS) for the entire patient population from diagnosis was 12.8 years. Preceding CAR-T, median number of treatments was 3 (range 1-9), all patients had prior Rituximab and Ibrutinib, 62 patients (56%) had received autologous stem cell transplantation (SCT) and 11 patients had received an allogeneic SCT. Median age at this time point was 68.1 years (range 49-82y). 50/110 patients were &amp;gt;70 years. Bridging treatment had been used in 88/112 (79%) preceding CAR. Based on investigator evaluation ORR was 86%, best response to CAR-T was CR in 47/76 patients (62%) and PR in 18/76 (24%). Time to death or new treatment after CAR-T was 8 months (mo) for patients ≤ 70y and 12 mo for patients &amp;gt; 70y. There was no difference for the number of prior lines (≤ 3 vs. &amp;gt; 3). The estimated median OS was 1.9 years. 26 patients have received at least 1 additional line of treatment after progression. Safety: Post-CAR CRS was seen in 95/114 (83%), Grade 1/2 77/95 (81%), Grade 3/4 (18%), Grade 5 (1%); ICANS was noted in 57/111 (51%), Grade 1/2 43/57 (75%), all other Grade 3/4. The rate of ICU admissions was 25/106 (24%). However, within 28 days after CAR-T-cell treatment 9/98 (9%) patients have died. Overall, in the post CAR-T-period 20 patients died of reasons other than progression: 4 CAR-related, 11 infections, 5 other/unknown. Discussion: In this real-world analysis, we could demonstrate, despite a more heterogeneous pre-treated patient population, a high overall and complete response rate. Median post CAR-T-cell survival was promising with 1.9 years. While CRS and ICANS risks seem to be comparable to trial data, the high non-relapse mortality (NRM) observed after SOC brexu-cel for r/r MCL is a concern and warrants refinement of anti-infectious surveillance and prophylaxis. Further work focusses on the identification of potential risk factors, e.g. using risk scores such as CAR-HAEMATOTOX, EASIX, and Severe4.