Unadjusted OR Research Articles

Tobacco use and its association with HPV infection in normal uterine cervix: A study from a Sustainable Development Goals perspective.

INTRODUCTIONTo achieve the Sustainable Development Goals (SDGs) target 2030, the United Nations (UN) endorsed tobacco use reduction, which is essential in decreasing unnecessary deaths caused by tobacco-induced disease. This study investigates the association between tobacco use and Human Papillomavirus (HPV) infection in clinically normal uterine cervix populations from the SDGs perspective.METHODSThis study is a 7-year cross-sectional study of a clinically normal uterine cervix population, based on negative Visual Inspection of Acetic Acid (VIA). Subjects were recruited consecutively from the medical records of several public and private health providers in Jakarta. The Statistical Product and Service Solutions (SPSS) for Windows version 20.0 were used to analyze the data.RESULTSA total of 1397 negative VIA subjects were collected, consisting of 4.9% (69/1397) tobacco users, and 95.1% (1328/1397) non-users. HPV-DNA positive were 4.3% (3/69) in the tobacco user group and 3.7% (49/1328) in the non-user group. Statistical analysis showed unadjusted OR was 1.19 (95% CI: 0.36–3.91, p=0.778) and adjusted OR was 1.18 (95% CI: 0.36–3.89, p=0.786). High-risk HPV (hrHPV) infections of tobacco and non-tobacco users’ groups were found in 2/3 and 27/49 (55.1%), respectively.CONCLUSIONSThis study showed an insignificant statistical association between tobacco use and HPV infection in normal uterine cervix. However, the proportion of hrHPV infection was higher in tobacco users than non-users. From the SDGs perspective, cervical cancer is closely related to tobacco use and poverty. Further study is needed to support this result and evaluate other co-factor role-related cervical cancer history to achieve SDGs in 2030.

Efficacy and Safety of a Modified Vaccinia Ankara-NP+M1 Vaccine Combined with QIV in People Aged 65 and Older: A Randomised Controlled Clinical Trial (INVICTUS).

Background: Pre-existing T cell responses to influenza have been correlated with improved clinical outcomes in natural history and human challenge studies. We aimed to determine the efficacy, safety and immunogenicity of a T-cell directed vaccine in older people. Methods: This was a multicentre, participant- and safety assessor-blinded, randomised, placebo-controlled trial of the co-administration of Modified Vaccinia Ankara encoding nucleoprotein and matrix protein 1 (MVA-NP+M1) and annual influenza vaccine in participants ≥ 65. The primary outcome was the number of days with moderate or severe influenza-like symptoms (ILS) during the influenza season. Results: 846 of a planned 2030 participants were recruited in the UK prior to, and throughout, the 2017/18 flu season. There was no evidence of a difference in the reported rates of days of moderate or severe ILS during influenza-like illness episodes (unadjusted OR = 0.95, 95% CI: 0.54–1.69; adjusted OR = 0.91, 95% CI: 0.51–1.65). The trial was stopped after one season due to a change in the recommended annual flu vaccine, for which safety of the new combination had not been established. More participants in the MVA-NP+M1 group had transient moderate or severe pain, redness, and systemic responses in the first seven days. Conclusion: The MVA-NP+M1 vaccine is well tolerated in those aged 65 years and over. Larger trials would be needed to determine potential efficacy.

Do people with mental health problems have lower adherence to precautionary measures in COVID-19 pandemic? A cross-sectional observational study in Hong Kong

ObjectivesMental health problems are prevalent during the COVID-19 pandemic, but their effect on adherence to precautionary measures is not well understood. Given that psychological morbidities are associated with lower treatment...

Relationship between maternal vitamin D status in the first trimester of pregnancy and maternal and neonatal outcomes: a retrospective single center study

BackgroundThis study aimed to investigate the relationship between maternal serum vitamin D status in the first trimester of pregnancy and maternal as well as neonatal outcomes, considered the prevalence of vitamin D deficiency (serum 25(OH)D < 50 nmol/L) around the world, especially in the pregnant women.MethodsFrom January 2015 to December 2016, in this cross-sectional retrospective study, we enrolled women receiving regular prenatal examinations and giving birth in the International Peace Maternity and Child Health Hospital. Cases confirmed as multiple pregnancy, incomplete medical records, and vitamin D level recorded after 13 weeks of gestation were excluded. A total of 23,394 mother-infant pairs were included ultimately. Obstetric and neonatal information were extracted from the database. Maternal serum vitamin D concentration was measured by chemiluminescence microparticle immunoassay. Logistic regression analysis (unadjusted and adjusted models) was used to analyze the association between vitamin D and maternal and neonatal outcomes.ResultsThe average 25(OH) D concentration was 43.20 ± 0.10 nmol/L; 67.09% of patients were vitamin D deficient(25(OH) D < 50.00 nmol/L), 29.84% were vitamin D insufficient (50 nmol/L ≤ 25(OH)D < 75 nmol/L), 3.07% were sufficient (25(OH)D ≥ 75 nmol/L). The maternal 25(OH)D levels varied with age, pre-pregnancy BMI, season when blood sample was collected, number of previous-pregnancy. Notably, newborns delivered by women with deficient vitamin D status had a higher incidence rate of admission to NICU (Deficiency: 12.20% vs Insufficiency: 10.90% vs Sufficiency: 11.70%, Pbonferroni = .002) and a longer stay (deficiency: 6.2 ± 4.1 days vs insufficiency: 5.9 ± 3.1 days vs sufficiency: 5.1 ± 2.1 days, Pbonferroni = .010). Moreover, maternal vitamin D deficiency was a dependent risk factor for admission to NICU (unadjusted OR = 1.35, 95% CI,1.05–1.74 Pbonferroni = .022; adjusted OR = 1.31, 95% CI,1.010–1.687 Pbonferroni = .042).ConclusionsMaternal vitamin D deficiency (25(OH) D < 50 nmol/L) was prevalent in eastern coastal China. The incidence rate of GDM as well as preeclampsia was higher in vitamin D insufficient group while vitamin D deficiency group was liable to intrauterine infection when compared with the other two groups. Most importantly, low vitamin D status in the first trimester of pregnancy was a dependent risk factor for admission to NICU. More well-designed perspective researches are necessary to clarify the role of vitamin D in the early stage of pregnancy.

B-PO03-106 ASSOCIATION BETWEEN ADENOSINE USE AND ATRIAL FIBRILLATION RECURRENCE AFTER PULMONARY VEIN ISOLATION USING HIGH POWER SHORT DURATION ABLATION IN PATIENTS WITH ATRIAL FIBRILLATION

There is conflicting literature with regards to the effectiveness of adenosine in assessing PVI and long-term outcomes. Effectiveness of adenosine in the setting of HPSD is unknown. To study the association between adenosine use to assess pulmonary vein isolation (PVI) and long-term outcomes in patients who underwent atrial fibrillation (AF) ablation using high power short duration (HPSD) radiofrequency ablation technique. In this retrospective cohort analysis, case records of 215 consecutive patients with paroxysmal AF who underwent ablation at Wake Forest University, Baptist hospital between January 2018 - May 2020 were assessed. Five operators performed all the ablations using HPSD technique (50 watts RF lesions applied 5-8 secs in the posterior wall and 10 secs in the anterior wall). All study patients uniformly received PVI. Further, 81% (174/215 patients) received adenosine to assess PV reconnection and 19% (41/215 patients) did not receive adenosine to assess PV reconnection. Adenosine administration was per the discretion of the operator. Of the 215 study patients, 140/215 patients (65%) were men. Mean age was 66 years. At 1year follow-up, 14/41 (34%) had recurrence of AF in the no-adenosine group, whereas 53/174 (30%) had recurrence in the adenosine group (P = 0.65). Adenosine use to assess PV reconnection had similar odds of AF recurrence at 1-year follow-up [(unadjusted OR: 0.85, 95% CI: 0.41 - 1.74, P = 0.65), (fully adjusted OR: 0.82, 95% CI: 0.40 - 1.73, P = 0.61)]. Adenosine use to assess PV reconnection did not decrease AF recurrence at 1-year follow-up in patients undergoing PVI using HPSD technique. Larger sample randomized investigations are needed to confirm our findings.

The impact of race and ethnicity on outcomes in 19,584 adults hospitalized with COVID-19.

At the population level, Black and Hispanic adults in the United States have increased risk of dying from COVID-19, yet whether race and ethnicity impact on risk of mortality among those hospitalized for COVID-19 is unclear. Retrospective cohort study using data on adults hospitalized with COVID-19 from the electronic health record from 52 health systems across the United States contributing data to Cerner Real World DataTM. In-hospital mortality was evaluated by race first in unadjusted analysis then sequentially adjusting for demographics and clinical characteristics using logistic regression. Through August 2020, 19,584 patients with median age 52 years were hospitalized with COVID-19, including n = 4,215 (21.5%) Black and n = 5,761 (29.4%) Hispanic patients. Relative to white patients, crude mortality was slightly higher in Black adults [22.7% vs 20.8%, unadjusted OR 1.12 (95% CI 1.02-1.22)]. Mortality remained higher among Black adults after adjusting for demographic factors including age, sex, date, region, and insurance status (OR 1.13, 95% CI 1.01-1.27), but not after including comorbidities and body mass index (OR 1.07, 95% CI 0.93-1.23). Compared with non-Hispanic patients, Hispanic patients had lower mortality both in unadjusted and adjusted models [mortality 12.7 vs 25.0%, unadjusted OR 0.44(95% CI 0.40-0.48), fully adjusted OR 0.71 (95% CI 0.59-0.86)]. In this large, multicenter, EHR-based analysis, Black adults hospitalized with COVID-19 had higher observed mortality than white patients due to a higher burden of comorbidities in Black adults. In contrast, Hispanic ethnicity was associated with lower mortality, even in fully adjusted models.

Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer's Disease: a Systematic Review and Meta-Analysis.

Atrial fibrillation (AF) is a risk factor for cognitive impairment and dementia in patients with stroke history. However, the association between AF and cognitive impairment in broader populations is less clear. To systematically review and quantitatively synthesize the existing evidence regarding the association of AF with cognitive impairment of any severity and etiology and dementia. Medline, Scopus, and Cochrane Central were searched in order to identify studies investigating the association between AF and cognitive impairment (or dementia) cross-sectionally and longitudinally. Studies encompassing and analyzing exclusively patients with stroke history were excluded. A random-effects model meta-analysis was conducted. Potential sources of between-study heterogeneity were investigated via subgroup and meta-regression analyses. Sensitivity analyses including only studies reporting data on stroke-free patients, vascular dementia, and Alzheimer's disease were performed. In total, 43 studies were included. In the pooled analysis, AF was significantly associated with dementia (adjusted OR, 1.6; 95% CI, 1.3 to 2.1; I2, 31%) and the combined endpoint of cognitive impairment or dementia (pooled adjusted OR, 1.5; 95% CI, 1.4 to 1.8; I2, 34%). The results were significant, even when studies including only stroke-free patients were pooled together (unadjusted OR, 2.2; 95% CI, 1.4 to 3.5; I2, 96%), but the heterogeneity rates were high. AF was significantly associated with increased risk of both vascular (adjusted OR, 1.7; 95% CI, 1.2 to 2.3; I2, 43%) and Alzheimer's dementia (adjusted HR, 1.4; 95% CI, 1.2 to 1.6; I2, 42%). AF increases the risk of cognitive impairment, all-cause dementia, vascular dementia, and Alzheimer's disease. Future studies should employ interventions that may delay or even prevent cognitive decline in AF patients.

Disparity in the risk of exposure to respirable crystalline silica dust among non-manual and manual employees in the construction industry

Construction workers are at increased health risk due to exposure to respirable crystalline silica (RCS) dust. We examined differences in health risk among non-manual and manual employees in the construction industry. The participants were drawn randomly from the construction industry by targeting UK construction workers’ websites. Online survey of construction industry employees using a questionnaire consisted of 17 items to obtain information on demographic data, employment history and health risk exposure. Chi-squared tests were used to explore differences in health risk between manual and non-manual employees, and logistic regression to determine the risk of adverse events in manual workers. Of the 47 employees invited, 45 completed the questionnaire (95% response rate). Seventeen were non-manual (professional, project managers and managers) and 28 were manual employees (tradesmen and construction workers). There was a significantly higher percentage of non-manual employees below 45 years than older group (70.6% vs 39.3%; χ2 = 4.2, p = 0.039) and they worked less than 20 years than those working longer (82.4% vs 32.1%; χ2 = 10.7, p = 0.001). Compared to non-manual workers, manual workers were more likely to work >20 years: OR = 2.2 (95% CI = 1.3–3.6); be exposed to RCS dust and smoke: unadjusted OR = 1.8 (1.1–3.1), age and length of time working in construction industry adjusted OR = 2.2(1.2–4.2); and have breathing problems: unadjusted OR = 3.9 (1.5–10.4), age, smoking and length of time working in construction industry adjusted OR = 3.7 (1.1–12.5). The risk of breathing problems was increased among individuals working more than 20 years: OR = 4.8 (1.2–18.6), exposed to dust and smoking: unadjusted OR = 3.8 (1.0–14.1), age and length of time working in construction industry adjusted OR = 5.4 (1.2–24.4), whilst those with adequate information on health hazards were associated with lower risk of breathing problems. There is an increased risk of exposure to RCS dust and pulmonary symptoms among manual employees in the construction industry. Further efforts are required to provide greater protection for this group of workers to reduce their health risk.

Wound healing with "spray-on" autologous skin grafting (ReCell) compared with standard care in patients with large diabetes-related foot wounds: an open-label randomised controlled trial.

There is an urgent need for interventions that improve healing time, prevent amputations and recurrent ulceration in patients with diabetes‐related foot wounds. In this randomised, open‐label trial, participants were randomised to receive an application of non‐cultured autologous skin cells (“spray‐on” skin; ReCell) or standard care interventions for large (>6 cm2), adequately vascularised wounds. The primary outcome was complete healing at 6 months, determined by assessors blinded to the intervention. Forty‐nine eligible foot wounds in 45 participants were randomised. An evaluable primary outcome was available for all wounds. The median (interquartile range) wound area at baseline was 11.4 (8.8‐17.6) cm2. A total of 32 (65.3%) index wounds were completely healed at 6 months, including 16 of 24 (66.7%) in the spray‐on skin group and 16 of 25 (64.0%) in the standard care group (unadjusted OR [95% CI]: 1.13 (0.35‐3.65), P = .845). Lower body mass index (P = .002) and non‐plantar wounds (P = .009) were the only patient‐ or wound‐related factors associated with complete healing at 6 months. Spray‐on skin resulted in high rates of complete healing at 6 months in patients with large diabetes‐related foot wounds, but was not significantly better than standard care (Australian New Zealand Clinical Trials Registry: ACTRN12618000511235).

Trends in Cerebral Embolic Protection Device Use and Association With Stroke Following Transcatheter Aortic Valve Implantation

Stroke remains a serious complication of transcatheter aortic valve implantation (TAVI). Prior studies examining the association between cerebral embolic protection device (CEPD) use and stroke following TAVI have produced conflicting results. We used the Nationwide Readmissions Databases to identify all percutaneous (non-transapical) TAVIs performed in the US from July, 2017 to December, 2018. Overlap propensity score weighted logistic regression models were used to determine the association between CEPD use and outcomes. The primary outcome was in-hospital stroke or transient ischemic attack (TIA). Among 50,000 percutaneous TAVIs (weighted national estimate: 88,886 [SE: 2,819]), CEPD was used in 2,433 (weighted national estimate: 3,497 [SE: 857]). Nationally, the utilization rate of CEPD was 3.9% (SE: 0.9%) of all TAVIs during the overall study period, which increased from 0.8% (SE: 0.4%) in 2017Q3 to 7.6% (SE: 1.6%) in 2018Q4 (p<0.001). The proportion of hospitals using CEPD increased from 2.3% in 2017Q3 to 14.7% in 2018Q4 (p<0.001). There were no significant differences in rates of in-hospital stroke/TIA in TAVIs with versus without CEPD (2.6% vs 2.2%; unadjusted OR [95% CI] 1.18 [0.98-1.52]; overlap propensity score weighted OR [95% CI] 1.19 [0.81-1.75]). CEPD use was not associated with statistically significant lower rates of in-hospital stroke, ischemic stroke, hemorrhagic stroke, TIA, all-cause mortality, or discharge to skilled nursing facility. In conclusion, the rates of CEPD utilization and proportion of TAVI hospitals using CEPD increased during the study period. The use of CEPD during TAVI was not associated with statistically significant lower rates of in-hospital stroke, TIA, or mortality.

Comparative safety of percutaneous ventricular assist device and intra-aortic balloon pump in acute myocardial infarction-induced cardiogenic shock

BackgroundThe relative safety of percutaneous left ventricular assist device (pVAD) and intra-aortic balloon pump (IABP) in patients with cardiogenic shock after acute myocardial infarction remain unknown.MethodsMultiple databases were searched to...

PRS7 Characteristics, Cost and Health Care Resource Use in a Population of Medicare Fee-for-Service (FFS) Patients with Chronic Obstructive Pulmonary Disease (COPD) Who Also Experience Pneumonia

Patients with COPD are at increased risk for lung infections, such as pneumonia. However, few studies have characterized the impact of pneumonias on health care resource utilization (HRU) and cost in Medicare Fee-for-Service (FFS) patients. The objective of this study was to characterize and estimate outcomes among patients with pneumonia, compared to those without pneumonia. A retrospective analysis of COPD patients between 1/1/2016 and 12/31/2017 using FFS claims was conducted. To evaluate HCRU and costs, propensity scoring and exact matching were used to create a one-to-one matched cohort of incident pneumonia patients to those without pneumonia. Patient demographics, comorbidities (Charleston Comorbidity Index [CCI]), and treatments were evaluated before and after matching. HCRU and associated healthcare costs were assessed during the 12-months post-index. Regression models were utilized to compare adjusted outcomes between groups after matching. In the baseline cohort of 2.46M patients, incident pneumonia patients (15.5%) were older (mean age: 73.7 vs. 71.9 years), with more comorbidities (CCI: 4.5 vs. 3.1). 35.7% of pneumonia patients experienced ≥1 baseline exacerbation vs. 13.2% without pneumonia (unadjusted OR: 3.65; p<0.05). After matching, demographic and clinical differences between groups were balanced with N=330,435 in each cohort. In the matched cohort, post-index HCRU after pneumonia event were significantly higher (all p<0.05) for hospitalizations (65.8% vs. 35.9%), ER visits (58.3% vs. 53.1%), and outpatient office visits (94.1% vs. 92.2%) versus the control cohort. Matched unadjusted post-index mean all-cause costs were 58.9% higher in the pneumonia cohort ($53,268; 95% CI: $52,812-$53,734, p<0.0001) compared to those without pneumonia ($33,523; 95% CI: $33.402-$33,644, p<0.0001). After adjustment total costs remained 51.9% higher for the pneumonia cohort. Patients with COPD who experience pneumonia also experience more exacerbations and have significantly higher total HRU and costs when compared to non-pneumonia patients, primarily driven by the difference in hospitalizations.

Treatment success and its predictors as well as the complications of catheter ablation for atrial fibrillation in a high-volume centre

PurposeCatheter ablation for atrial fibrillation (AF) is a standard procedure for maintaining sinus rhythm. The aim of this study was to evaluate treatment success and its predictors and to provide quality control data on complications and redo operations in a centre with an initially a low but currently high annual volume.MethodsData on patients (n = 1,253) treated with catheter ablation for AF in Tays Heart Hospital between January 2010 and May 2018 was evaluated (n = 1178 ablation-naïve patients and n = 1514 AF ablations). Comprehensive data on patient characteristics, treatment results, redo operations and complications were collected. Treatment success (maintenance of sinus rhythm at 1 year) was evaluated among patients residing within the hospital district (45% of the entire study population).ResultsTreatment success was observed in approximately 62.9% of the ablation-naïve patients. Preoperative predictors of treatment success were paroxysmal AF type, previous use of antiarrhythmic drugs, left atrium diameter and age. The experience at the centre did not associate with the 1-year outcome. A relapse during the first 3-month blanking period was associated with a nine-fold risk of failure at 1 year (unadjusted OR 9.1, 95% CI 5.5–15.1, p < 0.001). The major complication rate was 4.5% (68/1514) with no deaths. Ten percent of the patients needed a redo procedure within the first year.ConclusionsPatient-related factors are the most significant predictors of treatment success. A relapse during a 3-month blanking period is associated with a very high risk of failure at 1 year.

Maternal Midpregnancy Leptin and Adiponectin Levels as Predictors of Autism Spectrum Disorders: A Prenatal Cohort Study.

Autism spectrum disorders (ASDs) are a group of conditions characterized by impaired social function and repetitive behaviors. Their etiology is largely unknown. This work aims to examine the associations of maternal second-trimester and cord blood leptin and adiponectin levels with ASDs in offspring. We used data from 1164 mother-child pairs enrolled in Project Viva, a prospective prebirth cohort. We used logistic regression analysis to examine the associations of leptin and adiponectin levels in maternal second-trimester blood and cord blood obtained at birth with ASDs. Additionally, we examined the association of maternal prepregnancy body mass index (BMI) as an exposure. Main outcome measures included doctor-diagnosed ASDs reported by mothers using questionnaires in midchildhood and early adolescence. The cumulative incidence of ASDs was 3.4%. Maternal prepregnancy BMI (per 5 points) was positively associated with ASDs in a logistic regression model adjusted for maternal race/ethnicity, education, smoking status and child sex (adjusted odds ratio [OR] 1.38; 95% CI, 1.06-1.79). Higher second-trimester adiponectin was associated with lower odds of ASD in offspring (unadjusted OR 0.49; 95% CI, 0.30-0.78; and OR 0.54; 95% CI, 0.32-0.91 after adjusting for maternal race/ethnicity, education, child sex, OR 0.55; 95% CI, 0.33-0.93 after adjusting for BMI, gestational weight gain, gestational diabetes, and smoking status). Maternal leptin and cord blood leptin and adiponectin levels were not associated with ASDs. Prepregnancy BMI and adiponectin during pregnancy may be useful as a tool to monitor the risk of autism. Increasing adiponectin levels prenatally may play a role in the prevention of ASDs.

Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection.

Hospitalizations for serious infections in patients with opioid use disorder (OUD) experiencing homelessness are common. Patients receiving 4 interventions (infectious disease consultation, addiction consultation, case management, and medications for OUD [MOUD]) had higher odds of clinical cure (unadjusted odds ratio [OR], 3.15; P = .03; adjusted OR, 3.03; P = .049) and successful retention in addiction care at 30 days (unadjusted OR, 5.46; P = .01; adjusted OR, 6.36; P = .003).

45 Risk factors for lower urinary tract injury with laparoscopic sacrocolpopexy

The objective of this study was to identify patient-specific risk factors for lower urinary tract (LUT) injury with laparoscopic sacrocolpopexy (LSCP). This is an age-matched case-control study including patients who underwent LSCP from 2014-2017 in a high volume Urogynecology practice. Patients were excluded if they had abnormal urinary tract anatomy. Risk factors such as race, body mass index (BMI), preoperative pelvic organ prolapse quantification (POP-Q) stage, prior abdominal and/or vaginal surgery, and concurrent procedures were analyzed. Groups were compared using Student’s t-test for independent samples and chi-square tests. Conditional logistic regression was used to estimate odds ratios, and all regression models were conditioned on the matching variable. The model for adjusted odds ratios included all potential risk factors. The prevalence of LUT injury was 2.4% (17 bladder injuries and 1 ureteral injury out of 763 LSCP procedures). These 18 cases were age-matched to 72 controls. History of prior hysterectomy (unadjusted OR 162.41; CI 3.21, 8227; P= 0.011; adjusted OR 19.94, CI 2.48, 160.38; P= 0.005) and lysis of adhesions (unadjusted OR 5.15; CI 0.50, 52.76; P= 0.168; adjusted OR 4.94, CI 1.05, 23.19; P= 0.043) were associated with an increased risk of LUT injury. Concurrent posterior colporrhaphy appeared to have a protective association with LUT injury (unadjusted OR 0.78, CI 0.02, 27.67; P= 0.892; adjusted OR 0.32; CI 0.11, 0.88; P= 0.028). Race, BMI, POP-Q stage, prior abdominal and/or vaginal surgery, as well as concurrent bilateral salpingo-oophorectomy, mid-urethral sling placement, and anterior colporrhaphy were not associated with an increased risk of LUT injury. The prevalence of LUT injury with LSCP is rare, occurring in 2.4% of patients. History of prior hysterectomy significantly increased LUT injury risk. Concurrent lysis of adhesions increased the risk of LUT injury, while posterior colporrhaphy showed a protective effect. Although these two procedures may impact LUT injury risk, the associations are less clear due to the rarity of cases and baseline differences between groups. Based on our findings, the clinician can individualize surgical counseling based on patient-specific risk factors. This may also aid in setting appropriate postoperative patient expectations, including discussion as necessary regarding potential for prolonged catheterization or additional procedures and/or postoperative imaging in the case of LUT injury.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Abstract 042: Do Disparities In Cardiovascular Comorbidities Account For Excess Covid-19 Morbidity And Mortality In African Americans?

Introduction: COVID-19 incidence, severity, and death in African Americans (AA) has been reported to markedly exceed those of White Americans (WA), but the epidemiologic basis for this is unclear. Hypothesis: We hypothesize that AA have an excess of comorbid conditions compared to WA accounting for the disparity in COVID-19 infection and death. Methods: We examined 67,094 COVID-19 cases with laboratory-confirmed COVID-19 and compared them to 135,188 controls (2:1 match by age, sex, and zip code) representing a state-wide sample of healthcare recipients from the ‘OneFlorida’ research consortium through August 3, 2020. We assessed the prevalence of preexisting comorbid conditions (e.g. cardiovascular disease, cancer), behavioral risk factors, and health outcomes in the electronic health records of COVID-19 cases compared to controls. Results: Cases included 25,443 (37.9%) WA, 11,709 (17.5%) AA, and 16,119 (24%) Hispanic Americans (HA). Among cases, there was a significant increase in the prevalence of several cardiovascular comorbidities in AA vs. WA, such as hypertension, diabetes, heart failure, and stroke, but not for common cancers, liver disease, and COPD (Table 1). Likewise, smoking and BMI were higher in AA. Similar disparities were also appreciated in matched controls. Compared to WA, AA and HA had higher odds of becoming infected with COVID-19 (Unadjusted OR, 1.08; CI [1.05-1.11] and OR, 1.17; [1.15-1.2]) respectively. The prevalence of severe COVID-19 outcomes (intubation and death) was higher in AA (3.6 and 2.7%) than WA (2.5% and 2.3%) or HA (1.3 and 1.4%), respectively. Conclusions: Excess comorbidities for cardiometabolic diseases are present in this population-based sample of COVID-19 cases and controls. Careful mediation analyses will determine whether these differences in cardiovascular comorbidities alone account for disparities in COVID-19 in AA patients. Such data would be important to identify high-risk subgroups benefitting from enhanced preventive and early therapeutic interventions.

Acute kidney injury in hospitalized patients with COVID-19: A Portuguese cohort

IntroductionThe incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients ranges from 0.5% to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19. MethodsWe conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions. ResultsIn this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs. 5.9%, p<0.001, unadjusted OR 6.03 (2.22–16.37), p<0.001). In this multivariate analysis, older age (adjusted OR 1.07 (95% CI 1.02–1.11), p=0.004), lower Hb level (adjusted OR 0.78 (95% CI 0.60–0.98), p=0.035), duration of AKI (adjusted OR 7.34 for persistent AKI (95% CI 2.37–22.72), p=0.001) and severity of AKI (adjusted OR 2.65 per increase in KDIGO stage (95% CI 1.32–5.33), p=0.006) were independent predictors of mortality. ConclusionAKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.

Opium use reporting error in case-control studies: neighborhood controls versus hospital visitor controls.

Background: There are relatively scant data to determine whether hospital visitors could serve as a proper source of controls in case-control studies of illicit drug use. The aim of this study was to evaluate using neighborhood versus hospital visitor controls in reporting opium use. Methods: We used data from 2 independent case-control studies of cancer in Iran. In the first study, controls were selected from neighborhoods of the patients. For the second one, controls were selected from among hospital visitors. In the latter study, hospital visitors were companions of the patients or others visiting the hospital for reasons other than disease treatment. We used stata (version 12; Stata Corp( for all analyses and with a significance level of 0.05. Results: Data from 616 of neighborhood controls and 414 of hospital visitor controls were analyzed. Opium point prevalence among men was significantly higher in hospital visitors than neighborhood controls (43.3% vs 32.2%; P = 0.047), while the prevalence of cigarette smoking was very similar in both control groups (46.3% vs 47.2%; P =.847). Using a logistic regression analysis, in an unadjusted analysis, neighborhood controls were less likely to report opium use in both genders, with (unadjusted OR = 0.77; 95% CI: 0.59,1). After adjusting for potential confounders, the differences of opium use between the 2 control groups became more pronounced (Adjusted OR = 0.26; 95% CI: 0.10, 0.69). Conclusion: Because of the similarity of reporting cigarette smoking among neighborhood controls but substantially lower reporting of opium use among them, we concluded that neighborhood controls underreport opium use—a sensitive question— and that using neighborhood control biases the findings in case-control studies. Hospital visitor controls may be more appropriate than neighborhood controls for case-control studies of illicit drugs.

Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients.

PurposeWe sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients.Materials and methodsWe retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis.Results9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5–3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6–2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6–2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1–1.6; p<0.001).ConclusionAbnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.