Intensive Care Unit Admission Rate Research Articles

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.

Lost in Translation: Evaluation of Subcutaneous Interferon-β Treatment for SARS-CoV-2 Infection in Real Life.

Despite in vitro activity of interferon-β (IFN-β) against SARS-CoV-2 infection, its clinical efficacy remains controversial. We evaluated the impact of IFN-β treatment in a cohort of 3590 patients hospitalized with COVID-19 during March−April 2020. The primary endpoint was a composed variable of admission to intensive care unit (ICU)/death. Overall, 153 patients (4%) received IFN-β. They were significantly more severely ill, with a worse clinical and analytical situation, explaining a higher ICU admission (30% vs. 17%; p < 0.01), and a shorter time to the composed variable. In a Cox regression analysis, older age, lymphopenia, renal failure, or increased neutrophil-to-lymphocyte ratio were associated with a greater hazard ratio (HR) of admission at ICU/death. Notably, the HR of IFN-β for the outcome variable was no longer significant after adjustment (HR, 1.03; 95% CI, 0.82−1.30), and different sensitivity analysis (early IFN use, ICU admission) showed no changes in the estimates. A propensity score matching analysis showed no association of IFN-β therapy and outcome. In conclusion, in this large cohort of hospitalized COVID-19 patients, IFN-β was used mainly in patients with advanced disease, reflecting an important bias of selection. After adjusting by severity, IFN-β was not associated with a higher rate of ICU admission or mortality.

Protection of Two and Three mRNA Vaccine Doses Against Severe Outcomes Among Adults Hospitalized With COVID-19-VISION Network, August 2021 to March 2022.

We assessed coronavirus disease 2019 (COVID-19) vaccination impact on illness severity among adults hospitalized with COVID-19, August 2021-March 2022. We evaluated differences in intensive care unit (ICU) admission, in-hospital death, and length of stay among vaccinated (2 or 3 mRNA vaccine doses) versus unvaccinated patients aged ≥18 years hospitalized for ≥24 hours with COVID-19-like illness and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular testing. We calculated odds ratios (ORs) for ICU admission and death and subdistribution hazard ratios (SHR) for time to hospital discharge adjusted for age, geographic region, calendar time, and local virus circulation. We included 27 149 SARS-CoV-2-positive hospitalizations. During both Delta- and Omicron-predominant periods, protection against ICU admission was strongest among 3-dose vaccinees compared with unvaccinated patients (Delta OR, 0.52 [95% CI, .28-.96]; Omicron OR, 0.69 [95% CI, .54-.87]). During both periods, risk of in-hospital death was lower among vaccinated compared with unvaccinated patients but ORs overlapped across vaccination strata. We observed SHR >1 across all vaccination strata in both periods indicating faster discharge for vaccinated patients. COVID-19 vaccination was associated with lower rates of ICU admission and in-hospital death in both Delta and Omicron periods compared with being unvaccinated.

Severity of COVID‐19 infection in pregnancy and adverse maternal and neonatal outcomes: A retrospective study in a tertiary center

AbstractIntroductionTo estimate the association between the severity of maternal SARS‐CoV2 disease and adversity of maternal and neonatal outcomes.MethodsA retrospective single‐site descriptive study was conducted, where the records of pregnant women, universally screened for COVID‐19 infection, with laboratory‐confirmed SARS‐CoV2 disease during the period from March 2020 to March 2021 were reviewed. Patients were divided into two groups: an asymptomatic/mild disease group and a moderate/severe disease group. Maternal outcomes, including the incidence of pregnancy‐induced hypertension (PIH)/pre‐eclampsia, cesarean section (CS) rates, maternal intensive care unit (ICU) admission rates, and neonatal outcomes, including preterm birth, low birth weight, and neonatal ICU (NICU) admission rates, were compared in both study groups.ResultsA total of 352 patients were included with 87 (24.7%) having a moderate/severe disease. In this group, the incidence of preterm birth (&lt;37+6 weeks) was 25.3% (n = 22) and that of low birth weight was 23.0% (n = 20) compared to 12.8% (n = 34) and 13.6% (n = 36) respectively in the asymptomatic/mild disease group. The rates of maternal and NICU admissions were also higher in the former group. Moreover, the rates of development of PIH/pre‐eclampsia in the former and latter groups were 9.2% (n = 8) and 4.9% (n = 13), respectively.ConclusionThere is likely an association between the severity of maternal SARS‐CoV2 disease and adverse maternal and neonatal outcomes.

Therapeutic Efficacy and Outcomes of Remdesivir versus Remdesivir with Tocilizumab in Severe SARS-CoV-2 Infection.

The infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) generated many challenges to find an effective drug combination for hospitalized patients with severe forms of coronavirus disease 2019 (COVID-19) pneumonia. We conducted a retrospective cohort study, including 182 patients with severe COVID-19 pneumonia hospitalized between March and October 2021 in a Pneumology Hospital from Cluj-Napoca, Romania. Among patients treated with standard of care, 100 patients received remdesivir (R group) and 82 patients received the combination of remdesivir plus tocilizumab (RT group). We compared the clinical outcomes, the inflammatory markers, superinfections, oxygen requirement, intensive care unit (ICU) admission and mortality rate before drug administration and 7 days after in R group and RT group. Borg score and oxygen support showed an improvement in the R group (p &lt; 0.005). Neutrophiles, C-reactive protein (CRP) and serum ferritin levels decreased significantly in RT group but with a higher rate of superinfection in this group. ICU admission and death did not differ significantly between groups. The combination of remdesivir plus tocilizumab led to a significantly improvement in the inflammatory markers and a decrease in the oxygen requirement. Although the superinfection rate was higher in RT group than in R group, no significant difference was found in the ICU admission and mortality rate between the groups.

Assessment of labor progress by ultrasound vs manual examination: a randomized controlled trial

Assessment of labor progress via digital examination is considered the standard of care in most delivery rooms. However, this method can be stressful, painful, and imprecise, and multiple examinations increase the risk for chorioamnionitis. Intrapartum ultrasound was found to be an objective, noninvasive tool to monitor labor progression. This study aimed to investigate whether, among nulliparous women, the use of intrapartum ultrasound can reduce the rate of intrapartum fever by reducing the number of digital examinations. This was a prospective, randomized controlled trial in term nulliparas admitted with prelabor rupture of membranes, induction of labor, or in latent phase of labor with a cervical dilation of <4 cm. Women were randomized into 1 of the following 2 arms: (1) labor progress assessed by ultrasound, avoiding digital examinations as much as possible; and (2) control group in which labor progression was assessed according to the regular protocol. Before the study, all labor ward physicians underwent training in intrapartum ultrasound. A total of 90 women were randomized to the ultrasound group and 92 were randomized to the control group. When compared with the control group, the ultrasound group had significantly lower rates of intrapartum fever (11.1% vs 26.1%; P=.01), clinical chorioamnionitis (3.3% vs 16.5%; P>.01), and histologic chorioamnionitis (2.2% vs 9.8%; P=.03). The median number of digital examinations was significantly lower in the ultrasound group (5; interquartile range, 4-6) than in the control group (8; interquartile range, 6-10; P<.01). The median number of digital examinations per hour in the ultrasound group was significantly lower than in the control group (0.2 vs 0.4; P<.01). The induction rates, time from admission to delivery, mode of delivery, Apgar score at 5 minutes, and neonatal intensive care unit admission rates did not differ significantly between the groups. The use of intrapartum ultrasound lessens the total number of digital examinations needed to be performed during labor and, consequently, the incidence of intrapartum fever and chorioamnionitis are reduced. No adverse effects on labor progression and short-term maternal or neonatal outcomes were noted.

Measures of Structural Racism Predict ICU Admission Following Intensive Chemotherapy for AML

INTRODUCTION: Recent observational studies have revealed that real-world complications of intensive chemotherapy for frontline treatment of acute myeloid leukemia (AML) far exceed those reported in clinical trials. A 2017 analysis of over 40,000 AML patients found that 26% of patients who received induction chemotherapy were admitted to the intensive care unit (ICU), with increased mortality for non-white patients (Halpern, JAMA Oncology 2016). In a newly created Chicago AML registry (Abraham, Blood 2022), higher ICU admission rate was noted following induction chemotherapy for non-white patients. The current study aims to i) describe treatment complications based on race/ethnicity and ii) examine structural racism (SR) measures as risk factors for ICU admission following intensive chemotherapy in a diverse real-world patient population. METHODS: Using the Chicago AML registry, we compared ethnoracial differences in treatment complications including infections, thrombosis, renal or liver dysfunction (defined as peak creatinine >1.5 g/dL or peak bilirubin >1.2 mg/dL), respiratory failure requiring ventilatory support and hemodynamic instability needing pressor support. We then examined associations of race/ethnicity and previously published measures of census tract disadvantage, affluence, and segregation (referred to as SR measures) with ICU admission. These structural barriers were examined alongside known predictors of treatment mortality including disease characteristics and comorbidities. Additional outcomes included duration of ICU stay and mortality. RESULTS: In this cohort of 573 patients who underwent intensive induction chemotherapy for AML, 30-day complications differed based on race/ethnicity. Renal dysfunction was highest in non-Hispanic black (NHB) patients with an incidence of 27.8% with 6% initiating dialysis compared to 17.6% of non-Hispanic white (NHW) and 11.3% of Hispanic patients with 2% needing dialysis. Hepatotoxicity was highest in Hispanic patients (64%) vs. NHB (51%) and NHW (47%). Infectious complications were highest in NHB with microbiologically documented infections in 50.6% compared to 39.7% in NHW and 32.6% in Hispanic. Venous thrombosis occurred in 14.5% of NHB patients, compared to 14.7% of NHW and 13.3% Hispanic patients. In total, 141 (24.6%) patients required ICU admission during intensive induction with rates differing significantly by race and ethnicity (p = 0.014). Average length of stay in the ICU was 7.8 days for NHB patients, 6.7 days for NHW and 6.0 days for Hispanics. Due to low 30-day mortality, we were unable to detect differences between ethnoracial groups. Mechanical ventilation was utilized in 32% of NHB compared to 26% of NHW and 20% of Hispanic patients admitted to the ICU. Vasopressor were required in 31% of NHB patients vs. 27% of NHW patients. Predictors of ICU admission in our dataset included non-white race, unmarried status, living in a neighborhood with lower % of NHW residents, and WBC > 50,000/µL at diagnosis. Additional census tract variables including higher disadvantage and lower affluence conferred nonsignificant risk. Interestingly, comorbidities, ELN Score and baseline creatinine > 1.5 g/dL were not predictors of ICU admission. CONCLUSIONS: In a real-world population of AML patients, we show variation in the spectrum of treatment complications based on race/ethnicity. Moreover, with detailed individual and neighborhood socioeconomic position (SEP) data, measures of SR predicted ICU admission following induction chemotherapy. Other significant predictors include marital status - an individual measure of SEP, and hyperleukocytosis, which may indicate delay in medical presentation. High comorbidity index did not predict increased rate of ICU admission similar to prior studies (Tawfik, J Geriatr Oncol, 2016), while renal dysfunction was a non-significant predictor. Collectively our results suggest that there is a need to incorporate individual and neighborhood SR measures to identify patients at risk of clinical decline when stressed with intensive therapies. An algorithmic approach to identify 'high risk’ patients based on clinical/molecular and structural factors could prompt more detailed assessment of fitness prior to initiation of chemotherapy and directly influence leukemia outcome disparities. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Hospital admissions with influenza and impact of age and comorbidities on severe clinical outcomes in Brazil and Mexico.

The risk of hospitalization or death after influenza infection is higher at the extremes of age and in individuals with comorbidities. We estimated the number of hospitalizations with influenza and characterized the cumulative risk of comorbidities and age on severe outcomes in Mexico and Brazil. We used national hospital discharge data from Brazil (SIH/SUS) from 2010-2018 and Mexico (SAEH) from 2010-2017 to estimate the number of influenza admissions using ICD-10 discharge codes, stratified by age (0-4, 5-17, 18-49, 50-64, and ≥65 years). Duration of hospital stay, admission to the intensive care unit (ICU), and in-hospital case fatality rates (CFRs) defined the severe outcomes. Rates were compared between patients with or without pre-specified comorbidities and by age. A total of 327,572 admissions with influenza were recorded in Brazil and 20,613 in Mexico, with peaks period most years. In Brazil, the median hospital stay duration was 3.0 days (interquartile range, 2.0-5.0), ICU admission rate was 3.3% (95% CI, 3.2-3.3%), and in-hospital CFR was 4.6% (95% CI, 4.5-4.7). In Mexico, the median duration of stay was 5.0 days (interquartile range, 3.0-7.0), ICU admission rate was 1.8% (95% CI, 1.6-2.0%), and in-hospital CFR was 6.9% (95% CI, 6.5-7.2). In Brazil, ICU admission and in-hospital CFR were higher in adults aged ≥50 years and increased in the presence of comorbidities, especially cardiovascular disease. In Mexico, comorbidities increased the risk of ICU admission by 1.9 (95% CI, 1.0-3.5) and in-hospital CFR by 13.9 (95% CI, 8.4-22.9) in children 0-4 years. The SIH/SUS and SAEH databases can be used to estimate hospital admissions with influenza, and the disease severity. Age and comorbidities, especially cardiovascular disease, are cumulatively associated with more severe outcomes, with differences between countries. This association should be further analyzed in prospective surveillance studies designed to support influenza vaccination strategy decisions.