Smoking Status Research Articles

Association of plasma aldosterone concentration with arterial stiffness progression in hypertensive patients: insights from a longitudinal analysis

ABSTRACT Purpose Limited studies have examined the relationship between plasma aldosterone concentration (PAC) and arterial stiffness progression. This study aimed to investigate the longitudinal association between baseline PAC and arterial stiffness progression in hypertensive patients. Patients and methods This was a longitudinal study conducted at the Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region between April 2020 and October 2023. The study included 1,138 hypertensive patients who had completed two measurements of brachial-ankle pulse wave velocity (baPWV) over the study period. Arterial stiffness was quantified using baPWV, and progression was assessed by the baPWV change rate, calculated as the absolute difference between baseline and follow-up baPWV divided by the follow-up time in years. The primary outcome was the association between baseline PAC and baPWV change rate. Results Multivariate linear regression analyses indicated that a 10-unit increase in baseline PAC was significantly associated with a 19.60 cm/s/year increase in baPWV change rate (95% CI, 9.93 to 29.21). This association remained significant after adjusting for potential confounders, including age, sex, body mass index, smoking status, systolic and diastolic blood pressure, total cholesterol, and the use of antihypertensive medications. Multivariable restricted cubic splines analysis confirmed a significant dose-response relationship between baseline PAC and baPWW change rate (P for overall trend = 0.002). Conclusion Higher baseline PAC levels were associated with faster progression of arterial stiffness in hypertensive patients, suggesting a potential role for aldosterone in vascular health. These findings warrant further investigation.

The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003-2018.

There is growing evidence that individuals with cardiovascular disease (CVD) are more likely to develop depression.The timing of food intake can significantly alter the body's circadian rhythm and affect the occurrence of depression. Currently, it is unknown whether and how energy or macronutrient intake times are associated with depression in adults with CVD. To evaluate dietary energy or macronutrient intake (across three meals) associations with depression in adults with CVD in a nationally representative sample. The study population consisted of 3,490 U.S. adults with CVD (including 554with depression) from the National Health and Nutrition Examination Survey 2003-2018. Energy and macronutrient intake was measured by a 24-h dietary recall, and depression was diagnosed by the Patient Health Questionnaire (PHQ-9, score ≥ 10). According to dietary energy or macronutrient intake across three meals, adults with CVD were divided into five groups. Logistic regression analysis was performed to examine associations between energy or macronutrient intake and depression after adjusting for a series of confounding factors,including age, gender, education level, household income, smoking status, drinking status, physical activity, marital status, skipping breakfast/lunch/dinner, total energy, carbohydrate, protein,dietary fiber, SFA, MUFA, and PUFA intake, T2DM and hypertension status, and BMI. Dietary substitution models were used to explore changes in depression risk when 5% dietary energy intake at dinner or lunch was substituted with energy intake at breakfast. When compared with participants in the lowest quintile of breakfast energy intake, those who received energy intake in the highest quintile at breakfast were associated with lower depression risk in those with CVD, and the adjusted odds ratio (OR) was0.71 (95% CI, 0.51 to 0.91).When compared with participants in the lowest quintile of lunch or dinner energy intake, the risk of depression did not exhibit statistical significance when lunch or dinner energy intake was in the highest quintile, and the adjusted ORswere1.08 (95% CI,0.65 to 1.83) and 0.92(95% CI,0.62to1.37), respectively. Isocalorically replacing 5% of total energy at dinner or lunch with breakfast was associated with 5% (OR: 0.95, 95% CI 0.93 to 0.97) and 5% (OR: 0.95, 95% CI 0.93 to 0.96) lower risk of depression, respectively. High energy intake at breakfast may be associated with a lower risk of depression in those with CVD.We should focus on the potential role of breakfast energy intake in preventing the onset of depression.

Association between endodontic, patient-related factors and severe odontogenic infections; a South Australian retrospective audit.

Endodontic conditions are associated with severe odontogenic infections. However, no studies have explicitly explored their role in the infectious process. This study aimed to assess associations between tooth-related and patient-related factors resulting in severe odontogenic infections and clinical care needs. A retrospective audit was conducted of all records of patients who presented with severe odontogenic infections requiring admission between 2018 and 2023, at the largest public hospital in South Australia. Pericoronitis, postoperative, and non-odontogenic infections were excluded. Associations between tooth-related factors (type, location, presence/absence of caries, restorations, root canal filling, apical periodontitis, and space of infection), patients-related factors (diabetes and smoking statuses), clinical management (length of admission, intensive care unit admission number of days, and need for general anaesthesia) were explored. χ2, Mann-Whitney's test and Fisher's exact test were used for statistical analysis, and the level of statistical significance was set at 5%. Of 382 records identified, 189 met the inclusion criteria. Mandibular (95.8%) molars (92.1%) were the most commonly offending teeth. Eight (4.2%) were root canal filled, 27 (14.3%) restored, 166 carious (87.8%), and 181 (95.8%) were associated with an apical radiolucency. Over half the sample were smokers (56.9%) and 16.4% were diabetics. The most common infection involved the submandibular space (56.1%). Intensive care unit admission was required for 157 patients (83.1%), and stay depended on the space of infection, with buccal space having the shortest duration (median 1 day) compared with submandibular (median 4 days) (p < .001). Need for general anaesthesia was associated with Ludwig's angina (n = 3, 100%) (p = .04) and submandibular space infection (n = 104, 98.1%) (p < .001), plus intensive care unit admission (p < .001). Conversely, for buccal space infection, the need for general anaesthesia was lower (n = 5, 23.8%). No further significant differences were found. Untreated mandibular molars with apical periodontitis were the most frequent tooth-related findings. Results from the present study suggest associations between the most severe clinical presentations (Ludwig's angina and submandibular infection) and complexity in clinical care. Buccal space infections required the least complex management.

Relationship Between Cigarette Smoking and Awake Bruxism: Does Smoking Increase the Frequency of Masticatory Muscle Activities?

Despite the aetiology of awake bruxism (AB) being prevalently linked to psychological factors, several studies suggested that the use of certain substances, such as tobacco smoking, can contribute to the increase in masticatory muscle activities (MMA) during wakefulness. The aim of this study is to assess whether there is a correlation between the frequency of awake bruxism behaviours and smoking habits. Participants were recruited, without gender or ethnic restriction, at the University of Siena, Siena, Italy, by advertising. Participants completed a questionnaire containing the four-item patient health questionnaire for anxiety and depression (PHQ-4) and some items from the Global Adult Tobacco Smoking (GATS) questionnaire. Moreover, they performed one week of awake bruxism behaviours monitoring via the ecological momentary assessment (EMA). A total of 100 participants (university employees, dentists, undergraduate and post-graduate students) were included in the study (34 males and 66 females, mean age 24.5 years). Of them, 39% were smokers and 61% were non-smokers. The multiple variable linear regression analysis results showed a statistically significant correlation between the frequency of awake bruxism behaviours and the PHQ-4 scores. Specifically, for every 1% increase in PHQ-4 score, the mean frequency of the AB behaviours increases 5-fold. Awake bruxism behaviours did not show any statistically significant correlation with the number of smoked cigarettes (p > 0.05). Mandible bracing significantly correlated with the number of years of smoking (B = 1.58, p = 0.002). According to the present study's findings, the frequency of awake bruxism behaviours correlated with symptoms of anxiety and depression but not with smoking status.

국내 중고등학교 여학생의 흡연 영향요인: 제19차 청소년 건강행태조사 이용

Objectives This study aimed to analyze the smoking level and influencing factors according to the female students. Methods A total of 26,110 female students were selected and analyzed using the 19th Korean Youth Risk Behavior Survey. The Rao-Scott chi-square test was conducted to examine the differences in demographic characteristics, health behavior characteristics, and mental health characteristics according to female students' smoking status, and complex sample logistic regression was performed to determine the factors affecting female students' smoking. Results As a result of analyzing data from 26,110 female students, 3.5% of female students were currently smoking. Female students with ‘high’ economic status were 0.81 times less likely to smoke than students with ‘low’ economic status, and students who responded that sleep was enough to recover from fatigue were 0.79 times less likely to smoke than students who responded that it was not. Female students who had experienced sexual intercourse were 13.07 times more likely to smoke than those who had not, and female students who had experienced hospital treatment due to violence were 4.89 times more likely to smoke than female students who had not. Female students who felt happy were 0.83 times more likely to smoke than female students who felt un happy, and female students who felt sad, hopeless, and lonely were 1.91 and 1.42 times more likely to smoke than female students who did not felt. Female students who thought about or planned suicide were 1.54-1.63 times more likely to smoke than those who did not. Conclusions Based on the results of this study, careful and differentiated smoking cessation education is needed by identifying the factors that affect female students' smoking, and continuous attention from home and school is needed to help female students grow into healthy and balanced adults.

Protein biomarkers of interstitial lung abnormalities in relatives of patients with pulmonary fibrosis.

First-degree relatives of patients with pulmonary fibrosis (relatives) are at high risk for interstitial lung abnormalities (ILA), highlighting the need for biomarkers for risk prediction. We aimed to identify blood proteins associated with and predictive of ILA among relatives of patients with pulmonary fibrosis. Relatives enrolled in two independent cohorts had protein levels measured using an aptamer-based proteomic platform. ILA was assessed with CT scans per Fleischner Society recommendations. Protein associations with ILA were assessed using regression, and significant proteins were used with clinical variables to detect ILA. Of 237 relatives from two independent cohorts, 26% had ILA. Seven proteins were associated with ILA in the discovery cohort after FDR-adjustment, and all remained significant after adjusting for age, gender, and smoking status. Six of seven were significant in the validation cohort including GDF15, SFTPD, and SFTPB. In a multivariable model, six proteins combined with basic demographics in the discovery cohort had AUC=0.92 (0.88 in validation cohort). LASSO modelling identified three proteins and age as predictors with an AUC=0.89. When applied to the combined cohorts, this simple model would reduce the need for CT imaging in one of every three relatives screened. Peripheral blood proteins are associated with ILA in relatives of patients with pulmonary fibrosis and can be used to detect ILA. Our findings demonstrate the potential utility of blood biomarkers in this high-risk group and suggests molecular targets for future investigation.

Community-based model for management and follow-up by non-physician healthcare workers to improve awareness, treatment, and control of hypertension: The COTRACO study protocol.

Cardiovascular diseases are the leading cause of death and morbidity worldwide, with a significantly higher burden in low- and middle-income countries. Hypertension, a major risk factor for cardiovascular morbidity and mortality, remains under-diagnosed and poorly controlled, especially in regions such as Latin America. The HOPE-4 study demonstrated that the involvement of non-physician health workers (NPHWs), the use of standardized treatment algorithms, the provision of free antihypertensive drugs and home follow-up can significantly improve hypertension control and reduce cardiovascular risk, as demonstrated in Colombia and Malaysia. On this basis, the COTRACO study aims to address the barriers to hypertension treatment in low- and middle-income countries by implementing a similar standardized treatment approach delivered by non-specialist health workers. The COTRACO study is a quasi-experimental, parallel-group, non-randomized, before-and-after study. A community-based model will be implemented in 600 patients in Colombia and the Dominican Republic, involving NPHWs to: 1) apply standardized treatment algorithms, 2) promote adherence to healthy lifestyles, and 3) provide standardized pharmacological treatment. Propensity Score Matching will be used to select 300 patients in Chile and 1200 in Spain for comparison with standard care in these populations. The primary outcome at 12 months of follow-up is the percentage of patients achieving controlled hypertension (defined as systolic BP<140mmHg and diastolic BP<90mmHg, or<130mmHg, and diastolic BP<80mmHg for diabetic patients), ensuring it is not inferior to that achieved in the control countries. Secondary outcomes include changes in BP levels, cholesterol levels, BMI, handgrip strength, waist-to-hip ratio, smoking status, Interheart risk score, diet, and physical activity at 6 and 12 months. If this model demonstrates superior outcomes compared to usual care, it is recommended that health authorities in low- and middle-income regions adopt and implement this approach. Using non-medical health professionals, standardized treatment algorithms and free access to antihypertensive medications, these regions can significantly improve awareness, diagnosis and management of hypertension. This strategy has the potential to reduce cardiovascular morbidity and mortality, thereby improving overall public health outcomes.

Trimethylamine N-Oxide (TMAO) and TNF-α Levels in Periodontal Disease Associated With Smoking.

Trimethylamine N-oxide (TMAO) is a compound involved in the pathogenesis of various systemic inflammatory diseases, including cardiovascular conditions. The aim of this study was to determine differences in saliva and serum levels of TMAO between periodontitis and healthy patients according to smoking status. The study included four systemically healthy groups: periodontally healthy non-smokers (NS-Control; n = 25), non-smokers with Stage-III-Grade-B periodontitis (NS-Periodontitis; n = 25), periodontally healthy smokers (S-Control; n = 25), and smokers with Stage-III Grade-C periodontitis (S-Periodontitis; n = 25). Periodontal parameters were recorded. TMAO levels were determined in saliva and serum samples using liquid chromatography-mass spectrometry (LC-MS/MS). TNF-α levels were measured by the ELISA method. Salivary TNF-α and TMAO levels were significantly elevated in the smoking periodontitis group compared to other groups (p < 0.001 and p = 0.003, respectively). Serum TMAO levels were also significantly higher in the smoking periodontitis group compared to non-smoking controls and non-smoking periodontitis. TMAO/SFR ratios were notably higher in the smoking periodontitis group compared to other groups, and a strong positive correlation was observed between salivary TMAO and TNF-α levels (r = 0.892, p < 0.001). The data suggested that TMAO and TNF-α are associated with inflammatory mechanisms of periodontitis in cases where periodontitis coexists with smoking. NCT06580431.

P-1435. Association between Social Determinants of Health and Modifiable Cardiovascular Risk Factors in People with HIV in the V-EXTRA-CVD Study

Abstract Background Despite viral suppression on antiretroviral therapy (ART), people with HIV (PWH) are twice as likely to have cardiovascular disease (CVD) as those without. Here we aim to understand the association between SDH and modifiable CVD risk factors in PWH enrolled in Veterans Health Administration (VHA) healthcare, the largest US provider of HIV care with comprehensive social services.Table 1:List of patient level and area level predictor variables and the associated measures used in the study. Methods Virally suppressed PWH on ART from 4 VHA facilities completed validated questionnaires on education level, employment status, financial stability, housing and food insecurity, tobacco use, social isolation, and life instability. Demographic and laboratory data were obtained from the electronic medical record. Census block groups were used to determine area deprivation index (ADI). Baseline BP control, lipid control, and smoking status were primary outcome variables. SDH were described with medians where applicable and analyzed according to these categorical outcome measures. Comparisons were tested using Chi-square statistic and Kruskal-Wallis.Table 2:Summary of predictor variables in the overall cohort. Results Of 301 Veterans, most were cis-gender men (92%) and identified as Black (77%), with a mean age of 62 years. Overall, 30% completed college or higher, 24% were unemployed, 10% reported no financial troubles, but 26% reported housing or food insecurity. Most were current or former smokers, 37% had uncontrolled BP, and 33% had uncontrolled lipids. Smoking status was associated with difference in educational attainment (p=0.001), life instability (p=0.03), social isolation (p=0.05), and state ADI (p=0.001), with current smokers less likely to have completed college or higher education, experiencing more instability, being more socially isolated, and living in more disadvantaged neighborhoods versus never smokers. Age differed by smoking status and lipid control (both p=0.0001), with former smokers and those with lipid control trending older. No SDH were associated with BP and lipid control.Figure 1:Patient-level SDH variables that correlate with smoking status. Conclusion PWH who utilize the VHA have a high burden of CVD risk factors, but other than smoking, traditional SDH do not predict modifiable risk factors in this population. Further work is needed to understand whether VHA services mitigate the effects of factors such as race, finances, and housing insecurity that are often cited as sources of disparities.Figure 2:Neighborhood level SDH correlates with smoking status. Disclosures Hayden Bosworth, PhD, BeBetter therapeutics: Grant/Research Support|Boehringer Ingelheim: Advisor/Consultant|Boehringer Ingelheim: Grant/Research Support|Elton John Foundation: Grant/Research Support|Esperion: Grant/Research Support|Hilton foundation: Grant/Research Support|Improved Patient Outcomes: Grant/Research Support|Merck: Grant/Research Support|NHLBI: Grant/Research Support|Novo Nordisk: Grant/Research Support|Otsuka: Grant/Research Support|Pfizer: Grant/Research Support|Preventric Diagnostics: Board Member|sanofi: Advisor/Consultant|sanofi: Grant/Research Support|Veterans Health Administration: Grant/Research Support|Walmart: Advisor/Consultant

P-676. Risk Factors Associated with Longer Hospital Stay in Elderly Patients with Respiratory Syncytial Virus Infections

Abstract Background Annually, 3-7% of healthy older patients and 4-10% of high-risk adults develop respiratory syncytial virus (RSV) infections. Elderly patients above 65 years of age, with congestive heart failure, chronic lung disease, or weakened immune systems are at high risk for severe RSV infections. Little is known about the factors that are associated with the length of hospital stay (LOS) among these elderly individuals. Methods A multicenter historical cohort study was conducted on elderly patients ( &amp;gt;65 years of age) hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2022. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Electronic medical records were reviewed after IRB approval. LOS was categorized as below the mean LOS or at the mean and above. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0. Results Of 239 patients, the mean (sd) age of the cohort was 78.3 + 8.4 years, 157 (65.7%) were female and 176 (73.6%) were white. The mean body mass index (BMI) was 29.5 + 8.8 kg/m2. The mean Charlson Weighted Index of Comorbidity (CWIC) score was 2.4 + 2.0. The mean hospital LOS was 7.5 + 5.1 days. Prolonged LOS was noted in 89 (37.2%) patients. Factors associated with longer LOS ( &amp;gt;7.5) in univariable analysis were chronic lung disease, solid tumors, CWIC score, smoking status, home oxygen, oxygen requirement during hospitalization, qSOFA, abnormal admission chest x-ray (CXR), lower respiratory tract infection, and respiratory failure requiring intubation. The multivariable logistic regression revealed that predictors for prolonged LOS among elderly patients were smoking status (OR, 2.2; 95% CI 1.2-4.0), abnormal admission CXR (OR, 2.1; 95% CI 1.2-3.7), and respiratory failure requiring intubation (OR, 9.4; 95% CI 2.6-34.4). Conclusion Our study finds that patient’s smoking status, abnormal admission CXR and respiratory failure requiring intubation were significantly associated with prolonged LOS among elderly patients with RSV infections. Knowing these risk factors may help identify patients who would benefit from early interventions to mitigate the duration of hospitalization. Disclosures All Authors: No reported disclosures

P-725. Incidence and Severity of Influenza-like Illness in Cigarette Users: A Prospective Study

Abstract Background Influenza-like illness (ILI) causes significant morbidity. This study aims to compare ILI incidence and severity of current tobacco smokers, former smokers, and non-smokers enrolled in a randomized clinical trial, comparing influenza vaccine effectiveness in a military population over 4 influenza seasons (2018-2022).Table 1.Selected characteristics of the PAIVED study population who responded to &amp;gt;50% of surveillance, by smoking status as reported at enrollment into the study. Methods Participants in the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study responded to weekly surveillance and reported ILIs. Demographic information was collected at enrollment and the Influenza Patient-Reported Outcome (FLU-PRO) instrument was used to measure ILI severity. Analyses included Pearson’s Chi-squared test, ANOVA, and Kruskal-Wallis to compare selected characteristics (Table 1) and FLU-PRO scores based on smoking status. Poisson regression was used to assess the impact of smoking on ILI.Table 2:Risk of ILI was compared using a modified Poisson approach. Models were run separately for each variable, and the adjusted model includes all the variables listed in the table. Results Over half (56%) of PAIVED participants (8,596/15,432) responded to ≥50% of the ILI surveys and had complete demographic data. The demographic characteristics were different among current smokers, former smokers, and non-smokers (p&amp;lt; 0.001) (Table 1), with smokers more likely to be male and have lower educational levels, among other differences. Over one third (36%) of participants experienced an ILI during the influenza season in which they were enrolled. After adjusting for sex, age, military status, influenza season, and healthcare worker status, former smokers were 14% more likely to report an ILI (aRR 1.14, 95% CI 1.05-1.25) compared to non-smokers, while no difference was observed for current smokers (aRR 0.98, 95% CI 0.84-1.14) (Table 2). Among those with ILIs (N=3,117) who filled out a FLU-PRO survey (N=2,111), FLU-PRO severity scores in the respiratory and eye symptoms domains were different by smoking status, with current smokers reporting the highest scores (p&amp;lt; 0.02) (Table 3).Table 3:Maximum FLU-PRO scores (mean (SD)) by smoking status for ILIs reported in the PAIVED study. Conclusion Former smokers were more likely to report ILI compared to non-smokers. Current and former smokers diagnosed with ILI reported higher respiratory and eye symptom scores than non-smokers. Future analysis will include smoking history (number in the past 7 days, years of smoking), reported electronic cigarette use, and an exploration of asthma and COPD as contributing factors. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support Mark Simons, PhD, Astrazeneca: Grant/Research Support Simon Pollett, MBBS, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response Timothy Burgess, MD, MPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response

P-1688. Differences in Guideline-Concordant Antibiotic Prescribing Based on Age, Sex, Race, and Ethnicity for the Management of Inpatients with Community-Acquired Bacterial Pneumonia (CABP) due to Pseudomonas aeruginosa: a Retrospective Cohort Analysis of the All of Us Database

Abstract Background This is one of the first studies to evaluate health disparities in antibiotic prescribing for inpatients with community-acquired bacterial pneumonia (CABP) from Pseudomonas aeruginosa.Table 1.Patient Baseline Characteristics, by Guideline-Concordant and Discordant Antibiotics * Bold italics indicates statistically significant findings. + Some groups contain non-exact participant counts to prevent displaying any participant count that is less than 20 and to comply with the All of Us data and statistic dissemination policy. Methods Inpatients with CABP due to P. aeruginosa (SNOMED: 41381004) were identified in the All of Us database (2016-2022). Patients with treatment settings other than inpatient, other pathogens, and other pneumonia types were excluded. Patients were grouped by age, sex, race, and ethnicity. The proportion of patients prescribed guideline-concordant and guideline-discordant anti-pseudomonal antibiotics (GCAB and GDAB) were compared with chi-square. GCAB (2019 IDSA/ATS CABP guidelines), were: aztreonam, cefepime, ceftazidime, imipenem, meropenem, and piperacillin-tazobactam. Significant associations between patient characteristics and prescribing (p &amp;lt; 0.05) were assessed using multivariate logistic regression, with subgroup as the independent variable, anti-pseudomonal prescribing as the dependent variable, and divergent baseline characteristics as confounders. Odds ratios (OR) and 95% confidence intervals (95% CI) for receipt of GCAB were calculated.Table 2.Antipseudomonal Medications, by Race and Ethnicity * Bold italics indicates statistically significant findings. + Some groups contain non-exact participant counts to prevent displaying any participant count that is less than 20 and to comply with the All of Us data and statistic dissemination policy. Results A total of 119 patients with CABP from P. aeruginosa were included, and 79% received GCAB. Age (p=0.02), race (p &amp;lt; 0.01), ethnicity (p=0.01), and smoking status (p &amp;lt; 0.01) differed between GCAB and GDAB groups. Non-Hispanic White (NHW) patients were more likely to receive GCAB than Black patients (adjusted OR, 6.60; 95% CI 1.75-29.60; p &amp;lt; 0.01). Non-Hispanic (NH) patients were less likely to receive GCAB than Hispanic patients (aOR, 0.12; 0.006-0.65; p = 0.04). Smokers were less likely to receive GCAB than nonsmokers (aOR, 0.20; 0.06-0.61; p &amp;lt; 0.01). Black patients were less likely to receive levofloxacin (aOR, 0.01; &amp;lt; 0.01-0.19) than NHW patients and NH patients were less likely to receive aztreonam (aOR, 0.07; &amp;lt; 0.01-0.52), imipenem (aOR, 0.08; &amp;lt; 0.01-0.72), meropenem (aOR, 0.24; 0.09-0.64), and tobramycin (aOR, 0.13; 0.05-0.35) than Hispanic patients.Table 3.Logistic Regression Analysis of Race and Guideline-Concordant Antipseudomonal Prescribing * Bold italics indicates statistically significant findings. ** Patients who did not provide an indication for any of the above characteristics were excluded from this model (n=38). Conclusion Significant differences in prescribing patterns existed by age, race, ethnicity, and smoking status. Evaluation of the implementation of current guidelines is necessary to ensure timely administration of effective therapy and improve patient outcomes.Table 4.Logistic Regression Analysis of Ethnicity and Guideline-Concordant Antipseudomonal Prescribing * Bold italics indicates statistically significant findings. ** Patients who did not provide an indication for any of the above characteristics were excluded from this model (n≤20). Disclosures Christopher R. Frei, PharmD, FCCP, BCPS, AstraZeneca: Grant/Research Support

Healthy Lifestyle in the First 1000 Days and Overweight and Obesity Throughout Childhood.

Investigate associations of different family healthy lifestyle scores (HLS) during the first 1000 days with childhood overweight and obesity (OWOB). Cohort-specific analyses were conducted on participants (n = 25 006) from 4 European birth cohorts (The study on the pre- and early postnatal determinants of child health and development [EDEN], Elfe, France; Generation R, the Netherlands; and Lifeways, Ireland). Three composite HLSs were calculated: a maternal pregnancy HLS based on prepregnancy body mass index (BMI) and diet quality, physical activity, smoking status, and alcohol consumption during pregnancy; a parental pregnancy HLS additionally considering paternal BMI and smoking status; and an infancy HLS based on breastfeeding duration, age of solid food introduction, and exposure to passive smoking. Associations with child BMI (primary outcome) and waist-to-height ratio (WHtR, available in 2 cohorts) in early (5-5.5years), middle (7-8years), and late childhood (9-12years) were assessed using linear (BMI and WHtR z-scores) and robust Poisson (International Obesity Task Force [IOTF] categories) regression analyses adjusted for sociodemographic confounders. Only a small proportion of families had favorable lifestyle factors during pregnancy and early infancy, with 3.4% to 10.0%, 1.9% to 3.7%, and 12.2% to 23.6% scoring maximum for maternal, parental, and infancy HLS, respectively. Associations between higher HLSs and a lower risk of OWOB when measured by BMI z-scores or IOTF categories were found for maternal HLS and early (3/4 cohorts with available data), middle (1/2), and late childhood (2/4); parental HLS and early (3/4), middle (2/2), and late childhood (4/4). Associations between infancy HLS and childhood OWOB were less consistent and did not remain significant after additional adjustment for parental HLS. Associations with WHtR were solely significant in EDEN at 5.5years. Greater maternal and parental adherence to healthy lifestyle behaviors during pregnancy was associated with a lower risk of offspring OWOB throughout childhood, illustrating the importance of promoting healthy lifestyle behaviors at the family level during pregnancy.

Preliminary insights into cardiovascular risk and erterial stiffness in patients with ankylosing spondylitis and psoriatic arthritis: a comparative study

Abstract Introduction Chronic inflammation has long been considered as a driving factor for accelerated atherosclerosis and cardiovascular events in patients with rheumatic diseases like Ankylosing Spondylitis and Psoriatic Arthritis. Ultrasound examination of the carotid artery can reveal signs of early asymptomatic stage of atherosclerosis. Aim The study aimed to investigate the cardiovascular risk factors and arterial stiffness in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) compared to healthy controls. Patients and Methods: 180 participants, of which 109 with AS, 41 with PsA, and 30 healthy controls, were evaluated; 99 men and 81 women, (mean age 49±20). Cardiovascular risk was assessed using the Framingham score, SCORE2, and QRISK3 scales. Biochemical markers (cholesterol, triglycerides, LDL, HDL, ESR, CRP), hypertension, and smoking status were analyzed. Ultrasound examination of the carotid artery, using Aloka Prosound α7, with measurement of the carotid intima-media thickness (CIMT), beta stiffness, augmentation index (AI), pulse wave velocity (PWV), elastic modulus (Ep), and arterial compliance (AC), were analyzed. Statistical analyses included descriptive statistics, Pearson Chi-Square tests for categorical variables, and Mann-Whitney U and Kruskal-Wallis tests for continuous variables. Results All subjects were comparable in terms of age, hypertension, smoking status, lipid indices and risk scores. The ultrasound examination of the carotid artery revealed significant differences in carotid intima-media thickness (CIMT) between controls and patients with AS (p = 0.013) and PsA (p = 0.005), with elevated values in both patient groups, but no significant difference between AS and PsA (p = 0.370). Beta stiffness was markedly higher in both AS (p &amp;lt; 0.001) and PsA (p &amp;lt; 0.001) patients compared to controls, with no significant disparity between AS and PsA (p = 0.322). Pulse wave velocity (PWV) showed significant increases in AS (p &amp;lt; 0.001) and PsA (p = 0.001) patients compared to controls, but no variation between AS and PsA (p = 0.844). No significant differences were noted in the augmentation index (AI) across groups (p = 0.507). Elastic modulus (Ep) was significantly increased in AS (p &amp;lt; 0.001) and PsA (p = 0.001) patients compared to controls, with no significant difference between AS and PsA (p = 0.740). Arterial compliance (AC) did not show significant differences across groups (p = 0.094). (table.1). Conclusion This study reveals significant increase in parameters of arterial stiffness as a marker of premature atherosclerosis in patients with rheumatic diseases as ankylosing spondylitis and psoriatic arthritis in comparison with healthy subjects. Ultrasound examination of the carotid artery – indeces of PWV, AI, EP, AC, beta-stiffness, is an easy and accessible method for diagnosing early vascular impairment in rheumatic patients.

P-679. Risk Factors Shared Among Common Respiratory Viruses

Abstract Background Upper respiratory infections affect patients of all ages, with severity influenced by demographics, comorbidities, and immunosuppression. Studies often determine risk factors associated with severe disease, but rarely are multiple upper respiratory pathogens compared within the same cohort. Using electronic health record (EHR) phenotyping of 267,031 participants with relevant EHR data enrolled in the National Institute of Health’s All of Us Research Program (All of Us), we identified and validated cohorts of participants, and revealed shared risk factors for severity among upper respiratory viruses. Methods We developed EHR phenotype algorithms for eight respiratory viruses using pathogen-specific billing codes, test results, and treatment-dose antivirals. We identified episodes of infection over 90-day periods and validated these using CDC national detection rates over the same period. We then used multivariable logistic regression to compare demographics and identify predictors of hospital admission, adjusting for age, sex, self-identified race and ethnicity, BMI, smoking status, and EHR record length. Results Scaled episode and testing counts paralleled CDC data, with expected seasonal trends observed for influenza, parainfluenza, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus (hMPV), SARS-CoV-2, and human coronavirus (hCOV) (RSV, hCOV, influenza, and SARS-CoV-2 shown in Figure 1). Across viruses, hospital admission was associated with older age, male sex, underweight, severe obesity, self-identified Black race, and smoking (Table 1). Notably, significant predictors of admission included COPD, asthma, heart failure, ischemic heart disease, hypertension, diabetes, chronic kidney disease, and immunodeficiency, even after adjusting for confounding variables (Figure 2). Conclusion In this study we established and validated an EHR phenotyping algorithm, and demonstrated that clinical risk factors — particularly cardiopulmonary, metabolic, and immunological comorbidities — are associated with severe outcomes among multiple upper respiratory viruses. These results suggest that universal prevention interventions may mitigate the impact of respiratory viral infections in high-risk populations. Disclosures All Authors: No reported disclosures

Impact of the treatment with TNF inhibitors and JAK Inhibitors on arterial stiffness and lipid parameters in rheumatoid arthritis patients: a cross-sectional study

Abstract Introduction Rheumatoid arthritis (RA) is a chronic inflammatory joint disease associated with an increased cardiovascular risk. Treating disease activity with biologic and synthetic disease-modifying antirheumatic drugs (DMARDs) diminishes cardiovascular risk, but the vascular effects of different biologic and targeted synthetic drugs are poorly understood. Echo-tracking parameters of carotid artery can reveal arterial stiffness as a marker of subclinical atherosclerosis. Methods Patients with RA of at least 6 months of duration, treated with TNF inhibitors or JAK inhibitor - upadacitinib(UPA) and healthy subjects underwent ultrasound examination of carotid artery using the Aloka ProSound Alpha 7. The measurements included pulse-wave velocity (PWVβ), beta-stiffness, augmentation index (AI), arterial compliance (AC), and Ep (Elastic Modulus) and laboratory examination of lipid parameters. Disease activity of RA was measured using Disease activity scores - DAS28-CRP, DAS28-ESR, and Clinical Disease Activity Index (CDAI). Data were analyzed with SPSS v29 and the Kruskal-Wallis test was used to determine statistical differences among the three groups. Results 97 subjects, mean age 55.36±11.84, 83% females. Of them 38 on TNF inhibitors, 36 on UPA, and 23 controls. The three groups were similar in age, BMI, smoking status, and Framingham risk score. Disease activity and disease duration did not differ between the two patients groups. PWV was significantly higher in the UPA group compared to controls but not significantly different from the TNF group. (6.825 vs. 5.8022 vs. 6.468, p=0.034 UPA vs. Control, p=0.59 UPA vs. TNF) (fig.1). AC was lower and Ep was higher in the UPA group compared to controls (0.6511 vs. 0.8678, p=0.032 and132 kPa vs. 92.3, p=0.04 respectively). Total cholesterol levels were higher in the UPA group compared to TNF treated patients and to the control group (fig.2). Conclusion Echo-traching examination of the carotid artery is an easily perfomed, non-invasive and highly informative method of detecting early signs of vascular impairment in patients with RA treated with TNF inhibititors and JAK inhibitor. Treatment with UPA increases the levels of total cholesterol.

One-minute sit-to-stand test: Reference values for the Chilean population.

The one-minute sit to stand test (1min-STST) is a field test used to assess functional capacity. It is easily implementable and of significant clinical utility; however, no reference values are currently available for the Chilean population. The objective of this study was to establish reference values for the 1min-STST in a healthy Chilean population. A multicenter cross-sectional study involving data collection from six locations in Chile was conducted. Healthy adults between 18 and 80 years of age were recruited. The anthropometric variables, levels of physical activity, smoking status, Borg scale ratings, and number of repetitions during the 1min-STST were recorded. Reference values were determined according to sex and age range. Four hundred ninety-nine healthy subjects (57.5% women, n = 287; median height, 1.63 (0.14) m; weight, 72.8 (20) kg; average BMI, 27.3 ± 4.1 kg/m2) were included in the study. The median (and the lower limit of normality (LLN) values) for the 1min-STST in men ranged from 18-29 years, with 38 (LLN 27) repetitions and 23 (LLN 15) repetitions for 70-80 years. For women aged 18-29 years, 38 (LLN 28) repetitions were performed, and for women aged 70-80 years, 24 (LLN 17) repetitions were performed. This study established reference values for the healthy adult Chilean population.

The Modified Frailty Index Predicts Outcomes in Immediate Implant-Based Breast Reconstruction.

Risk stratification is a crucial tool to help in surgical planning and counseling. Historically, this has been measured by age, BMI, smoking status, or medical comorbidities. Frailty, the combined burden of the patient's comorbidities and risk factors, has gained traction as a method of combining disparate risk factors into one number. The modified 5-factor frailty index (mFI-5) is simple to calculate and takes only moments to assign a risk level to a patient. This study aimed to study the application and efficacy of the mFI-5 as a measurement of operative risk in immediate breast reconstruction. A total of 650 patients undergoing breast reconstruction at our institution were identified. Patients were divided into 5 mFI-5 groups based on their associated comorbidities. Surgical outcomes were compared using the χ2 or Fisher exact tests for categorical variables and t tests for continuous variables. There were 452 patients stratified into the mFI-5 0 group, 155 patients into the mFI-5 1 group, 40 patients into the mFI-5 2 group, and 3 patients into the mFI-5 3 group. There were no patients in our cohort in either the mFI-5 4 or 5 groups. In comparison of the mFI-5 0 group to 1 group, there was a significant difference in postoperative day of infection (32.06 vs. 21.5 days. respectively; P = 0.049). When comparing to the mFI-5 2 group, there was a significant difference in overall complications on univariate analysis (P = 0.012), minor infections on univariate and multivariate analysis (P = 0.050 and P < 0.001), seroma formation on univariate analysis (P = 0.017), hematoma formation (P < 0.001), return to OR (P < 0.001), and replaced implant (P < 0.001) on multivariate analysis. When comparing the mFI-5 1 group to the mFI-5 2 group, there was a significant difference between overall complications on both univariate and multivariate analyses (P = 0.012 and P = 0.041) and minor infections on univariate analysis (P = 0.032). The modified 5-factor frailty index is effective in predicting increased complication risks seen after IBR and may be helpful for surgeons when counseling patients and assessing overall operative risk.

P-730. Risk Factors for Severe Influenza and Respiratory Syncytial Virus Infections in Patients with Lymphoma or Multiple Myeloma - A Seven-Year Retrospective Cohort Study

Abstract Background Respiratory viral infection (RVI) is a significant complication in patients with hematologic malignancies (HM). While risk factors and outcomes of severe infections have been studied in allogeneic hematopoietic cell transplant (HCT) recipients, data is limited for patients with lymphoma and multiple myeloma (MM). We investigated the risk factors and outcomes associated with severe respiratory syncytial virus (RSV) or influenza virus (IFV) infections from a large cohort of patients with lymphoma or MM.Figure 1:Respiratory viral infections per quarter stratified by viral pathogen.The dashed line represents the beginning of the COVID-19 era in the USA (March 2020).Abbreviations: IFV=influenza; Q=quarter; RSV= respiratory syncytial virus. Methods We performed a retrospective study in adult patients with lymphoma or MM who were diagnosed with RSV or IFV RVIs between 2016 and 2022 and followed up to 1 year. Primary outcomes were progression to lower respiratory tract infection (LRI) and all-cause 30- and 90-day mortality.Figure 2:Respiratory viral infections per quarter stratified by site of infection.The dashed line represents the beginning of the COVID-19 era in the USA (March 2020).The LRI group includes patients who presented with LRI or progressed from URI to LRI.Abbreviations: LRI=lower respiratory tract infection; Q=quarter; URI= upper respiratory tract infection Results We analyzed 440 patients with 490 consecutive viral episodes: 297 (61%) in patients with MM, and 193 (39%) with lymphoma. RVIs were secondary to RSV and IFV in 258 (52%) and 234 (48%) episodes, respectively. A decline in RVIs since the onset of the COVID-19 pandemic was noted, with an uptrend in the last quarter of 2022 (Figures 1, 2). Upon presentation, 303 (62%) patients were diagnosed with upper respiratory tract infection (URI) and 187 (38%) with LRI; while 19 patients (6%) with URI progressed to LRI. During follow-up, 57% were hospitalized, 8% were admitted to the ICU, 20 (4%) died within 30 days, and 32 (7%) within 90 days (Table 1). On multivariable analysis, RSV infection (vs. IFV), current/former smoking, recent steroid exposure, and lymphopenia or renal injury, were associated with LRI. Survival analysis revealed an association between MM (vs. lymphoma), current/former smoking, lymphopenia, and nosocomial infection and increased 30-day mortality risk, whereas LRI (vs. URI), current/former smoking, and lymphopenia were associated with 90-day mortality (Table 2).Table 1:Baseline characteristics and clinical outcomes following respiratory viral infections by site of infection.Abbreviations: BiPAP= bilevel positive airway pressure; CAR-T= chimeric antigen receptor T-cell therapy; COVID-19=Coronavirus Disease 2019; HCT= hematopoietic stem cell transplantation; HFNC= high-flow nasal cannula; HM= hematologic malignancy; ICU=intensive care unit; IQR= interquartile range; IVIG= Intravenous immunoglobulin; LRI= lower respiratory tract infection; RSV= respiratory syncytial virus; RVI= respiratory virus infection; SD=standard deviation; URI= upper respiratory tract infection. Conclusion We identified risk factors in lymphoma and MM patients with RVIs associated with substantial morbidity and mortality. Clinical parameters such as smoking status, recent steroid exposure, lymphopenia, and renal injury could potentially identify high-risk patients, thereby enabling better management strategies.Table 2:Independent predictors of LRI, 30-day and 90-day mortality by multivariable logistic regression.Abbreviations: aOR=Adjusted-Odds Ratio; LRI= lower respiratory tract infection; RSV= respiratory syncytial virus; RVI=respiratory tract infection; URI= upper respiratory tract infection; 95% CI= 95% Confidence Interval. Disclosures Fareed Khawaja, MBBS, Eurofins Viracor: Grant/Research Support|Symbio: Grant/Research Support Roy F. Chemaly, MD/MPH, AiCuris: Advisor/Consultant|AiCuris: Grant/Research Support|Ansun Pharmaceuticals: Advisor/Consultant|Ansun Pharmaceuticals: Grant/Research Support|Astellas: Advisor/Consultant|Eurofins-Viracor: Grant/Research Support|InflaRX: Advisor/Consultant|Janssen: Advisor/Consultant|Karius: Advisor/Consultant|Karius: Grant/Research Support|Merck/MSD: Advisor/Consultant|Merck/MSD: Grant/Research Support|Moderna: Advisor/Consultant|Oxford Immunotec: Advisor/Consultant|Oxford Immunotec: Grant/Research Support|Roche/Genentech: Advisor/Consultant|Roche/Genentech: Grant/Research Support|Shinogi: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Grant/Research Support|Tether: Advisor/Consultant

Association of systemic immune-inflammation index (SII) with risk of psoriasis: a cross-sectional analysis of National Health and Nutrition Examination Survey 2011–2014

BackgroundThe systemic immune-inflammation index (SII) is an emerging marker of inflammation, and the onset of psoriasis is associated with inflammation. The aim of our study was to investigate the potential impact of SII on the incidence rate of adult psoriasis.MethodsWe conducted a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) 2011–2014 data sets. Multiple logistic regression analyses with appropriate covariates adjustment were the major methods in this study. Subgroup analyses were conducted by age, gender, race, smoking status, alcohol consumption, history of heart attack, stroke, coronary heart disease and diabetes. Interactions among these variables were also detected. We further utilized smooth curve fitting to explore potential nonlinear associations between SII and psoriasis across different subgroups. The receiver operating characteristic curve analysis was used to assess the diagnostic value of SII for psoriasis in the general population and diabetic individuals. Multiple imputation was adopted as sensitivity analysis to address potential bias due to missing data.Results9314 participants (≥ 20 years) were included. A significant positive association was observed between SII and psoriasis (OR = 1.56; P = 0.0069). Subgroup analysis revealed significant positive association in males (OR = 1.52; P = 0.0288), females (OR = 1.61; P = 0.0322), Non-Hispanic Whites (OR = 1.55; P = 0.0190), people aged 40–59 years (OR = 1.98; P = 0.0386), diabetics (OR = 3.40; P = 0.0088), and overweight participants (OR = 1.80; P = 0.0034). SII had a higher predictive value for psoriasis in diabetic patients (AUC = 0.62; 95% CI [0.55, 0.70]). In stroke patients, SII was negatively correlated with the occurrence of psoriasis, and interaction test suggested the effect of SII on psoriasis was significantly modified by stroke (P = 0.0003). Nonlinear relationships between SII and psoriasis were observed in participants aged 20 to 39, former smokers, current drinkers, individuals with or without heart attack, those without coronary heart disease, and overweight participants.ConclusionsSII was positively associated with psoriasis. Testing for SII levels may help to identify the onset of psoriasis early.