Underlying Comorbid Conditions Research Articles

P-840. Is Staphylococcus lugdunensis just another coagulase-negative Staphylococcus? A Comparative Study of community-acquired Staphylococcus lugdunensis and methicillin-susceptible Staphylococcus aureus Bacteremia

Abstract Background Staphylococcus lugdunensis (SL), a coagulase-negative staphylococcus (CoNS), usually a skin commensal, has demonstrated similar virulence to Staphylococcus aureus. Current studies have compared SL bacteremia (SLB) to S. aureus bacteremia, primarily hospital-onset methicillin-resistant Staphylococcus aureus bacteremia. Our study is the first to compare the clinical characteristics and outcomes between community-acquired SL bacteremia (SLB) and MSSA bacteremia (SAB).Table 1:Patient Demographics Methods This retrospective cohort study evaluated hospitalized adults with SLB and SAB at an urban tertiary care center from January 1, 2017 to December 31, 2022. CA-BSI was defined as at least one positive blood culture with SL or methicillin-susceptible Staphylococcus aureus (MSSA) within 72 hours of admission. Patients previously hospitalized within 30 days, on chemotherapy, or transferred from another facility were excluded. The primary outcome was in-hospital mortality rate with a secondary outcome of hospital length of stay (LOS). The Whitney Mann U test and chi-square test were used for the analysis. Figure 2 Results 33 SLB patients and 66 SLB patients were included. The demographics of both groups are seen in Table 1. The SLB group was older and had a higher Charlson Comorbidity Index score compared to the SAB group. The incidence of SLB increased during the study period while the incidence of SAB remained the same (Figure 1). Two-thirds of the patients in both groups met sepsis criteria on presentation. 33% of SLB and 18% of SAB had a Pitt bacteremia score of ≥4 points. Endocarditis, skin and soft tissue infections, osteoarticular, line-related, and pneumonia are the primary sources of infections in SLB and SAB. There was no statistical difference in rates of ICU admission, need for ventilator support, need for renal replacement therapy, and length of stay between the two groups. In-hospital mortality was 15% for both groups. Conclusion SL is a CoNS recognized as an emerging pathogen. The incidence of CA-SLB is increasing, particularly in older individuals with underlying comorbid conditions. The in-hospital mortality rate associated with SLB is as high as CA-SAB. Clinicians must recognize the high pathogenicity of SLB and implement comprehensive strategies to prevent morbidity and mortality. Disclosures All Authors: No reported disclosures

Shared genetic architecture of non‐viral cirrhosis with several pleiotropic traits: A nested case‐control study in the UK Biobank

AbstractBackground and AimsCirrhosis is a leading cause of liver‐related mortality and a multifactorial disease. To date, the complex genetic architecture of non‐viral cirrhosis has not been fully explored. Cross‐trait genetic correlations can elucidate the common genetic aetiology of genetically correlated phenotypes. This study aims to identify polygenic and pleiotropic traits associated with cirrhosis using the linkage disequilibrium score regression analysis.MethodsWe conducted genome‐wide association analysis of 9 622 842 imputed SNPs on 3368 non‐viral cirrhosis cases and 258 258 controls, and cross‐trait analysis between non‐viral cirrhosis and various polygenic and pleiotropic traits using the UK Biobank cohort study. We further performed sensitivity analyses by removing genomic regions of alcohol intake, smoking behaviours and obesity. We observed multiple traits showing robust genetic correlations (rg) with non‐viral cirrhosis.ResultsWe found strong genetic correlations between the genetic architectures of non‐viral cirrhosis and clinical/physiologic factors, including BMI (rg = 0.82), alanine aminotransferase (0.71), diabetes (0.70), number of cigarettes currently smoked daily (0.67), amount of alcohol drunk on a typical drinking day (0.60), insomnia (0.59), gout (0.57), depression (0.50), apolipoprotein‐A (−0.33) and HDL cholesterol (−0.49). Exclusion of genomic regions associated with alcohol intake, smoking behaviours and obesity demonstrated consistent directions and persistent associations in genetic patterns. The inheritability of cirrhosis on the observed scale showed 0.56%.ConclusionsThis study provides a comprehensive assessment of the shared genetic architecture of non‐viral cirrhosis predisposition and numerous polygenic and pleiotropic traits, most notably BMI, alanine aminotransferase and diabetes. These findings provide new information on underlying comorbid conditions that can increase the non‐viral cirrhosis risk.

The Geriatric Nutrition Risk Index Is Not a Prognostic Predictor for Postoperative Morbidity in Extremely Elderly Patients Undergoing Surgery for Proximal Femur Fractures.

Background/Objectives: The geriatric nutrition risk index (GnRI) has been regarded as a useful predictor of morbidity and mortality in elderly patients. This study aimed to determine the use of the GnRI as a prognostic predictor in extremely elderly patients undergoing proximal femur fracture surgery and the usefulness of evaluation tools related to a patient's underlying disease and functional capacity in predicting the prognosis of extremely elderly patients. Methods: We analyzed 548 patients who had undergone surgery for proximal femur fracture caused by trauma, with an age of ≥80 years, without other accompanying trauma. Results: Body mass index (BMI) (OR, 1.077; 95% CI, 1.010-1.149; p = 0.023), serum albumin levels (0.389; 0.223-0.678; p = 0.001), and Charlson comorbidity index (CCI) (1.170; 1.014-1.349; p = 0.031) were determined to be predictors of morbidity in a multivariable regression analysis. The area under the curve (AUC) in the receiver operating characteristic curve of BMI was 0.565 (95% CI, 0.493-0.637; p = 0.065), and the optimal cut-off value could not be determined. The AUC of serum albumin was 0.647 (0.576-0.717; p < 0.001), and the optimal cut-off value was 3.65 g/dL (sensitivity, 72.2%; specificity, 52.7%). The AUC of the CCI was 0.648 (0.580-0.715; p < 0.001), and the optimal cut-off value was 6.5 (sensitivity, 63.3%; specificity, 61.4%). Conclusions: The GnRI was not a predictive factor for patient prognosis after proximal femur fractures in extreme elderly patients. Rather, serum albumin level and CCI, which reflect the patient's underlying comorbid conditions, were more useful in predicting in-hospital morbidity after proximal femur surgery in extremely elderly patients.

Clinical Characteristics of Tick-Borne Encephalitis in Adult Patients: A 10-year Retrospective Study in Stockholm, Sweden.

The incidence of tick-borne encephalitis (TBE) has increased during the last decades in Europe. Our aim was to assess the clinical characteristics and outcome of patients with TBE in Region Stockholm, as a high-risk area in Sweden. The notification database at the regional Department of Communicable Disease Control and Prevention was used to identify TBE cases during 2006-2015. Clinical data were retrieved from the included patients' medical records. The associations of specific variables to predefined outcomes of disease severity were evaluated with multivariate logistic regression models. Of 1004 identified TBE cases, 703 adult patients were included. Sixty-one percent were men, and the median age was 50 years (range, 18-94 years). The majority of patients were nonvaccinated. Comorbidity was present in 34%, and 4% were receiving immunomodulatory therapy. Seventy-five percent were hospitalized, and 11% had severe disease. More than 70% of the 79 patients followed up for >6 months had persisting symptoms. The case fatality rate was 1.4%, 15% in the group with immunomodulatory treatment. In the multivariate analysis, severe disease was associated with underlying comorbid conditions, age ≥50 years, and previous complete TBE vaccination. This is the largest cohort of patients with TBE in Scandinavia. Our findings of a more severe course of disease in older patients, those receiving immunomodulatory therapy, those with comorbid conditions, and those with vaccination breakthrough infections must be interpreted in the context of hospitalized patients. Optimized prevention is needed for patients receiving immunomodulatory therapy, given the considerable case fatality rate. Follow-up visits and rehabilitation should be better standardized.

Clinical and Microbiological Study of Intra-Abdominal Infections in a Tertiary Care Hospital

Intra-abdominal infections (IAIs) are one of the important contributors to sepsis in intensive care units. The emergence of antibiotic resistance and the diversification of etiological agents make it challenging to determine the optimal empirical therapy. This study attempts to know the etiological agents, their antibiotic susceptibility patterns, and the risk factors associated with IAIs in different settings. This prospective cross-sectional study was conducted in a tertiary care facility from January 2023 to June 2023. Adult and paediatric patients having primary IAI or developed infections during their hospital stay were included in this study. Specimen like peritoneal swabs or fluid from intra-abdominal drains placed for more than 24 hours were excluded. Matrix-assisted Laser Desorption/Ionization Time-Of-Flight was used to identify the etiological agents. Vitek®2 system was used to perform the antimicrobial susceptibility. Associated risk factors were documented. A total of 86 cases were analysed. The majority of the patients had complicated IAIs (95.3%), and 65.12 % acquired the infection in the community (CA-IAI). The vast number of cases presented with intra-abdominal abscesses (46.5%). Diabetes and hepatic disorders were the frequent underlying comorbid conditions associated with CA-IAIs. Prolonged hospital stay and the presence of concomitant conditions like malignancy and chronic renal failure significantly influenced the occurrence of hospital-acquired infections (HA-IAIs). E. coli was the frequently isolated Gram-negative pathogen both in the community and hospital settings. Whereas among Gram-positives, Enterococcus predominated and was commonly isolated from HA-IAIs. Enterobacterales were highly susceptible to meropenem and piperacillin-tazobactam. E. coli and Klebsiella were the frequent extended-spectrum beta-lactamase producers and showed the least susceptibility towards cephalosporins and fluoroquinolones. Multidrug-resistant organisms (MDROs) (p=.013), including carbapenem-resistant strains (p=.048), were significantly isolated from hospital-acquired IAIs. The high prevalence of IAIs with MDROs in hospital settings emphasizes the importance of developing hospital-based antibiotic policy, infection control measures, and judicious use of antibiotics.

Gastrointestinal histoplasmosis with small intestinal perforation: 20-year experience.

Postmortem studies show gastrointestinal tract involvement in as many as 70% of patients affected by disseminated histoplasmosis. Although gastrointestinal involvement is common in disseminated disease, the presentation of small intestinal perforation is exceedingly rare with few reported cases in the literature. Herein we present our institutional case series. The aim of the study is to describe small intestinal perforation in gastrointestinal histoplasmosis with attention to management and outcomes. This is a retrospective single-institution review of patients ≥ 18years of age treated for small intestinal perforation due to gastrointestinal histoplasmosis. A prospectively maintained institutional database was searched from 2002 to 2022.Data obtained included demographics, comorbidities, treatment course, and outcomes. Five patients with a mean age of 54years (range 25-72) were identified. Pertinent underlying comorbid conditions included Crohn's disease, psoriatic arthritis, rheumatoid arthritis, and solid organ transplantation. All patients were on chronic immunosuppressive medication(s) with the most common being tumor necrosis factors alpha inhibitors and corticosteroids. Four had a clinical diagnosis of perforation based on physical examination and imaging. All patients underwent segmental resection(s) of the small intestineandreceived medical treatment with intravenous amphotericin B and eventual transition to an oral antifungal. No patients experienced complications related to surgery. The limitations of the study include nonrandomized retrospective review, single-institution experience, and small patient sample size. Although rare, histoplasmosis should be considered in the differential of patients on chronic immunosuppressive therapy who present with gastrointestinal symptoms concerning perforation, especially from endemic areas. Small intestinal perforation due to gastrointestinal histoplasmosis can be successfully treated with resection and antifungal therapy.

A Case report on subdural hematoma in a 60yr old male patient with ESRD

A subdural hematoma occurs when a clot forms between the brain and its outer covering. Chronic dialysis becomes necessary as a treatment to externally filter the blood, when kidneys are no capable of fulfilling this role. This validates that the patients undergoing hemodialysis face a higher risk of developing subdural hematoma. The KDIGO foundation guidelines defines the chronic kidney disease using the markers such as the proteinuria and the glomerular filtration rate(GFR). Hemodialysis patient and other type of bleeding tendency are more prone to the spontaneous traumatic subdural hematoma and the intracerebral hematoma. This increased risk is attributed to the elevated mortality rate observed in the dialysis patient affected by the subdural hematoma. Consequently, it becomes imperative to implement the preventive measures aimed at reducing the occurrence of subdural hematoma in the individuals with the end stage renal disease, especially those undergoing the hemodialysis treatment. The high occurrence rate of the subdural hematoma and its recent surge is related to the increased use of anticoagulant in the long-term hemodialysis patient. Hence proper care for the patient is necessary to prevent devastating the disorder. This case report is demonstrating that there is a striking enrichment for the underlying comorbid conditions in the patient who has developed subdural hematoma and has the high risk of the immediate mortality.

Acute Colonic Diverticulitis.

Acute colonic diverticulitis is a gastrointestinal condition that is frequently encountered by primary care and emergency department practitioners, hospitalists, surgeons, and gastroenterologists. Clinical presentation ranges from mild abdominal pain to peritonitis with sepsis. It is often diagnosed on the basis of clinical features alone, but imaging is necessary in more severe presentations to rule out such complications as abscess and perforation. Treatment depends on the severity of the presentation, the presence of complications, and underlying comorbid conditions. Medical and surgical treatment algorithms are evolving. This article provides an evidence-based, clinically relevant overview of the epidemiology, diagnosis, and treatment of acute diverticulitis.

Microbiological Cure at Treatment Completion Is Associated With Longer Survival in Patients With Mycobacterium avium Complex Pulmonary Disease

Morbidity and mortality from nontuberculous mycobacterial pulmonary disease (NTM-PD) are increasing. Mycobacterium avium complex (MAC) is the most common cause of NTM-PD. Microbiological outcomes are widely used as the primary end point of antimicrobial treatment, but their long-term impact on prognosis is uncertain. Do patients who achieve microbiological cure at the end of treatment have longer survival than those who do not? We retrospectively analyzed adult patients who met the diagnostic criteria for NTM-PD, were infected with MAC species, and were treated with a macrolide-based regimen for≥ 12months per guidelines between January 2008 and May 2021 at a tertiary referral center. Mycobacterial culture was performed during antimicrobial treatment to assess the microbiological outcome. Patients with three or more consecutive negative cultures collected≥ 4weeks apart and no positive cultures until treatment completion were considered to have achieved microbiological cure. To assess the impact of microbiological cure on all-cause mortality, we performed multivariable Cox proportional hazards regression analysis adjusted for age, sex, BMI, presence of cavitary lesions, erythrocyte sedimentation rate, and underlying comorbid conditions. Among 382 patients enrolled, 236 (61.8%) achieved microbiological cure at completion of treatment. These patients were younger, had lower erythrocyte sedimentation rates, were less likely to use four or more drugs, and had shorter treatment duration than those who failed to achieve microbiological cure. During a median follow-up of 3.2 (first quartile to third quartile, 1.4-5.4) years after treatment completion, 53 patients died. Microbiological cure was significantly associated with reduced mortality after adjustment for major clinical factors (adjusted hazard ratio, 0.52; 95%CI, 0.28-0.94). The association between microbiological cure and mortality was maintained in a sensitivity analysis that included all patients treated< 12months. Microbiological cure at completion of treatment is associated with longer survival in patients with MAC-PD.

Tobacco, alcohol use and underlying comorbidities in symptomatic COVID-19 cases versus asymptomatic COVID-19 cases: a case control study in Mumbai city

Background: Coronavirus disease-2019 belonging to Corona virus family, was first reported in Wuhan, China in November 2019 which is an ongoing Pandemic. The apparent vulnerable group more susceptible to the symptomatic infection are the elderly population, tobacco and alcohol users and people having underlying comorbid conditions. Methods: An unmatched case-control study was conducted in March 2021 through purposive sampling amongst the Covid-19 infected population. The socio-demographic details, use of tobacco, alcohol and underlying comorbid conditions were studied to show the association with symptomatic Covid-19 infection, in the population more than 18 years of age in Mumbai City. Results: Out of the total 528 Covid-19 infected individuals, 38.8% were symptomatic and 61.2% were asymptomatic. The elderly population and the underlying comorbid conditions were not found to be associated with symptomatic Covid-19 infection. Alcohol consumption (OR 0.87 (95% CI -0.39, 1.92)), and both alcohol consumption and smoking (OR 0.94[95% CI 0.45, 1.97) association with symptomatic Covid-19 infection were found to be insignificant at 95% CI in the present study whereas significant negative association was observed in smoking (OR 0.21 (95% CI 0.08, 0.53)) with symptomatic covid-19 infection. Conclusions: Covid-19, addiction and the non-communicable diseases together is a major public health concern in India. Since no significant association was found, study on other unknown factors like the genetics, race, ongoing treatment for underlying comorbid disease and other should be conducted to understand the actual risk factors of the novel disease.

Potential Anti-Amnesic Activity of a Novel Multimodal Derivative of Salicylamide, JJGW08, in Mice.

Memory impairments constitute a significant problem worldwide, and the COVID-19 pandemic dramatically increased the prevalence of cognitive deficits. Patients with cognitive deficits, specifically memory disturbances, have underlying comorbid conditions such as schizophrenia, anxiety, or depression. Moreover, the available treatment options have unsatisfactory effectiveness. Therefore, there is a need to search for novel procognitive and anti-amnesic drugs with additional pharmacological activity. One of the important therapeutic targets involved in the modulation of learning and memory processes are serotonin receptors, including 5-HT1A, 5-HT6, and 5-HT7, which also play a role in the pathophysiology of depression. Therefore, this study aimed to assess the anti-amnesic and antidepressant-like potential of JJGW08, a novel arylpiperazine alkyl derivative of salicylamide with strong antagonistic properties at 5-HT1A and D2 receptors and weak at 5-HT2A and 5-HT7 receptors in rodents. First, we investigated the compound's affinity for 5-HT6 receptors using the radioligand assays. Next, we assessed the influence of the compound on long-term emotional and recognition memory. Further, we evaluated whether the compound could protect against MK-801-induced cognitive impairments. Finally, we determined the potential antidepressant-like activity of the tested compound. We found that JJGW08 possessed no affinity for 5-HT6 receptors. Furthermore, JJGW08 protected mice against MK-801-induced recognition and emotional memory deficits but showed no antidepressant-like effects in rodents. Therefore, our preliminary study may suggest that blocking serotonin receptors, especially 5-HT1A and 5-HT7, might be beneficial in treating cognitive impairments, but it requires further investigation.

Dynamic analysis and optimal control of COVID-19 with comorbidity: A modeling study of Indonesia

Comorbidity is defined as the coexistence of two or more diseases in a person at the same time. The mathematical analysis of the COVID-19 model with comorbidities presented includes model validation of cumulative cases infected with COVID-19 from 1 November 2020 to 19 May 2021 in Indonesia, followed by positivity and boundedness solutions, equilibrium point, basic reproduction number (R0), and stability of the equilibrium point. A sensitivity analysis was carried out to determine how the parameters affect the spread. Disease-free equilibrium points are asymptotically stable locally and globally if R0 &amp;lt; 1 and endemic equilibrium points exist, locally and globally asymptotically stable if R0 &amp;gt; 1. In addition, this disease is endemic in Indonesia, with R0 = 1.47. Furthermore, two optimal controls, namely public education and increased medical care, are included in the model to determine the best strategy to reduce the spread of the disease. Overall, the two control measures were equally effective in suppressing the spread of the disease as the number of COVID-19 infections was significantly reduced. Thus, it was concluded that more attention should be paid to patients with COVID-19 with underlying comorbid conditions because the probability of being infected with COVID-19 is higher and mortality in this population is much higher. Finally, the combined control strategy is an optimal strategy that provides an effective guarantee to protect the public from the COVID-19 infection based on numerical simulations and cost evaluations.

Uropathogens and their antimicrobial-resistant pattern among suspected urinary tract infections patients in eastern Nepal: A hospital inpatients-based study.

Urinary tract infections are the primary factors that cause mortality and morbidity in patients with underlying comorbid conditions and are responsible for most hospital admissions worldwide. The study aims to identify the common bacterial uropathogens and determine their antimicrobial susceptibility pattern, including multidrug-resistant/extensively drug-resistant bacteria. The descriptive cross-sectional study was conducted among inpatients provisionally suspected of urinary tract infections in the medical ward of Koshi Hospital, Biratnagar, Nepal. Samples were inoculated in a cystine lysine electrolyte-deficient medium, and pure growth of significant bacteria was further subjected Gram staining, biochemical identification, and antimicrobial susceptibility testing as per laboratory standard procedure and Clinical Laboratory Standards Institute guidelines, respectively. Descriptive and inferential statistical analysis was performed to analyze the outcomes and a p-value < 0.05 was considered statistically significant. A total of 305 patients urine specimens were examined, of which 251 (82.29%) samples resulted in significant bacterial growth in the culture. Escherichia coli (62.94%) was the most predominantly isolated organism, followed by Klebsiella pneumoniae (12.35%), Staphylococcus aureus (9.16%), and Pseudomonas aeruginosa (8.76%). Among antimicrobials, colistin had shown absolute susceptibility (100%) toward gram-negative uropathogens followed by carbapenem and aminoglycosides in a majority of uropathogens. Escherichia coli was found to be the leading drug-resistant bacteria (70%) among uropathogens. The presence of multidrug-resistant/extensively drug-resistant bacteria uropathogens was found to be significantly associated with diabetes mellitus and those with combined antimicrobial therapies. Diabetic patients were twice (OR~2) more likely to colonize and develop uropathogens as compared to non-diabetics. Escherichia coli was the most common uropathogens followed by Klebsiella pneumoniae in urinary tract infection patients. The polymyxin group (colistin) of antimicrobials was found to be effective in all multidrug-resistant and extensively drug-resistant uropathogens. The study recommends the need of optimized antimicrobial stewardship program to develop effective strategies in the management of urinary tract infections in diverse healthcare settings.

Incidence of Central Line-associated Bloodstream Infection in the Intensive Care Unit: A Prospective Observational Study

Aims: The aim of this study was to determine the incidence of central line-associated bloodstream infections (CLABSIs) in the medical and surgical intensive care units (ICUs) of a tertiary care hospital. Materials and Methods: One hundred and twenty patients admitted to medical and surgical ICU with an indwelling, nontunneled central venous catheter (CVC) inserted at admission in the department of emergency medicine or at medical and surgical ICU for more than 48 h were monitored. The patients were followed up daily for the development of new-onset sepsis after 48 h of insertion of CVC, by analyzing the culture of two sets of blood samples, over a span of 24 h. The data were evaluated statistically using Microsoft Excel version 11 and SPSS version 17 (IBM, USA). Results: Among 120 patients hospitalized for an aggregate of 972 days, 7 patients had acquired CLABSI with an incidence rate of 7.2/1000 central line days. The organisms isolated were Staphylococcus aureus, Acinetobacter spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae. Conclusion: The incidence rate of CLABSI in this study was in line with other studies on the CLABSI rate in India. The study found a significant association of CLABSI with duration of CVC catheterization, underlying comorbid conditions and diseases of patients, and indication of CVC insertion. However, there was no significant association of CLABSI with age of patients, their gender, and site of insertion.

Strategies Tackling Viral Replication and Inflammatory Pathways as Early Pharmacological Treatment for SARS-CoV-2 Infection: Any Potential Role for Ketoprofen Lysine Salt?

COVID-19 is an infective disease resulting in widespread respiratory and non-respiratory symptoms prompted by SARS-CoV-2 infection. Interaction between SARS-CoV-2 and host cell receptors prompts activation of pro-inflammatory pathways which are involved in epithelial and endothelial damage mechanisms even after viral clearance. Since inflammation has been recognized as a critical step in COVID-19, anti-inflammatory therapies, including both steroids and non-steroids as well as cytokine inhibitors, have been proposed. Early treatment of COVID-19 has the potential to affect the clinical course of the disease regardless of underlying comorbid conditions. Non-steroidal anti-inflammatory drugs (NSAIDs), which are widely used for symptomatic relief of upper airway infections, became the mainstay of early phase treatment of COVID-19. In this review, we discuss the current evidence for using NSAIDs in early phases of SARS-CoV-2 infection with focus on ketoprofen lysine salt based on its pharmacodynamic and pharmacokinetic features.

RWD57 Emergency and Inpatient COVID-19 Service Utilization and Its Stratification Based on Comorbid Conditions

ObjectiveInsights on COVID-19 Inpatient and Emergency Utilization and To Stratify them Based on Comorbid Conditions in the US.BackgroundEver since the very first case of COVID-19 was detected, many studies have been carried out to identify the various aspects of this multifaceted challenging disease. The disease has infected humans of all ages, gender, race and ethnicity. It was observed that the disease manifested differently in individuals with different comorbid conditions. This study was intended to identify emergency and inpatient healthcare service utilization in COVID-19 patients based on underlying Comorbid conditions.MethodIn this study, the total number of patients diagnosed with COVID-19 from March 2020 to March 2021 were identified using Optum’s de-identified administrative claims database and the percentage utilization was calculated. Further stratification of utilization of emergency and inpatient services will be done based on comorbid conditions.ResultA total of 750,612 patients diagnosed with COVID-19 from March 2020 to March 2021 were included in the analysis. Out of these 187,389 and 120,709 patients utilized the emergency and inpatient services amounting to 24.96% and 16.08% respectively. We would further see which comorbid conditions lead to maximum utilization of these services.ConclusionThe study observed that around one fourth of the population infected required emergency services and there was also a substantial increase in inpatient service utilization. Further analysis is to be done to see how the underlying comorbid conditions influenced the percentage utilization of these services. ObjectiveInsights on COVID-19 Inpatient and Emergency Utilization and To Stratify them Based on Comorbid Conditions in the US. Insights on COVID-19 Inpatient and Emergency Utilization and To Stratify them Based on Comorbid Conditions in the US. BackgroundEver since the very first case of COVID-19 was detected, many studies have been carried out to identify the various aspects of this multifaceted challenging disease. The disease has infected humans of all ages, gender, race and ethnicity. It was observed that the disease manifested differently in individuals with different comorbid conditions. This study was intended to identify emergency and inpatient healthcare service utilization in COVID-19 patients based on underlying Comorbid conditions. Ever since the very first case of COVID-19 was detected, many studies have been carried out to identify the various aspects of this multifaceted challenging disease. The disease has infected humans of all ages, gender, race and ethnicity. It was observed that the disease manifested differently in individuals with different comorbid conditions. This study was intended to identify emergency and inpatient healthcare service utilization in COVID-19 patients based on underlying Comorbid conditions. MethodIn this study, the total number of patients diagnosed with COVID-19 from March 2020 to March 2021 were identified using Optum’s de-identified administrative claims database and the percentage utilization was calculated. Further stratification of utilization of emergency and inpatient services will be done based on comorbid conditions. In this study, the total number of patients diagnosed with COVID-19 from March 2020 to March 2021 were identified using Optum’s de-identified administrative claims database and the percentage utilization was calculated. Further stratification of utilization of emergency and inpatient services will be done based on comorbid conditions. ResultA total of 750,612 patients diagnosed with COVID-19 from March 2020 to March 2021 were included in the analysis. Out of these 187,389 and 120,709 patients utilized the emergency and inpatient services amounting to 24.96% and 16.08% respectively. We would further see which comorbid conditions lead to maximum utilization of these services. A total of 750,612 patients diagnosed with COVID-19 from March 2020 to March 2021 were included in the analysis. Out of these 187,389 and 120,709 patients utilized the emergency and inpatient services amounting to 24.96% and 16.08% respectively. We would further see which comorbid conditions lead to maximum utilization of these services. ConclusionThe study observed that around one fourth of the population infected required emergency services and there was also a substantial increase in inpatient service utilization. Further analysis is to be done to see how the underlying comorbid conditions influenced the percentage utilization of these services. The study observed that around one fourth of the population infected required emergency services and there was also a substantial increase in inpatient service utilization. Further analysis is to be done to see how the underlying comorbid conditions influenced the percentage utilization of these services.

Factors Associated With the Decay of Anti-SARS-CoV-2 S1 IgG Antibodies Among Recipients of an Adenoviral Vector-Based AZD1222 and a Whole-Virion Inactivated BBV152 Vaccine.

BackgroundThe magnitude of protection conferred following recovery from COVID-19 or by vaccine administration, and the duration of protective immunity developed, remains ambiguous.MethodsWe investigated the factors associated with anti-SARS-CoV-2 S1 IgG decay in 519 individuals who recovered from COVID-19 illness or received COVID-19 vaccination with two commercial vaccines, viz., an adenoviral vector-based (AZD1222) and a whole-virion-based inactivated (BBV152) vaccine in Chennai, India from March to December 2021. Blood samples collected during regular follow-up post-infection/-vaccination were examined for anti-SARS-CoV-2 S1 IgG by a commercial automated chemiluminescent immunoassay (CLIA).ResultsAge and underlying comorbidities were the two variables that were independently associated with the development of a breakthrough infection. Individuals who were >60 years of age with underlying comorbid conditions (viz., hypertension, diabetes mellitus and cardiovascular disease) had a ~15 times and ~10 times greater odds for developing a breakthrough infection and hospitalization, respectively. The time elapsed since the first booster dose was associated with attrition in anti-SARS-CoV-2 IgG, where each month passed was associated with an ebb in the anti-SARS-CoV-2 IgG antibody levels by a coefficient of −6 units.ConclusionsOur findings advocate that the elderly with underlying comorbidities be administered with appropriate number of booster doses with AZD1222 and BBV152 against COVID-19.

Coinfections in hospitalized COVID-19 patients are associated with high mortality: need for improved diagnostic tools

Background: Hospitalized patients with COVID-19 often receive antimicrobial therapies due to concerns for bacterial and fungal coinfections. We analyzed patients admitted with COVID-19 to our VA facility to understand antimicrobial use, frequency of coinfections, and outcomes in our population. Methods: This retrospective study included veterans who were 18 years or older and hospitalized with COVID-19 from March 10, 2020, to March 9, 2021 at the Louis Stokes VA Medical Center in Cleveland, Ohio. We identified antimicrobials administered and coinfections with bacterial or fungal pathogens. Patients were deemed to have coinfection if there was supporting microbiological data and a consistent clinical course upon review of clinical records. Urinary tract infections were excluded because of difficulty determining infection. Odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day mortality were derived using multivariate logistic regression models that included age, Charlson comorbidity index (CCI), corticosteroid use, and time of infection. Results: In our cohort of 312 patients, the median age was 70 years and 97% of the patients were male. The mean CCI was 3.7 (SD, 3.0), and 111 patients (35.6%) had a score ≥5. Oxygen was administered to 250 patients (80.1%), and 20 (6.4%) required mechanical ventilation. Antimicrobials were administered to 164 patients (52.6%) (Fig. 1). Of 20 patients (6.4%) with coinfection, 11 (3.5%) had a bloodstream infection (BSI) and 9 (2.9%) had bacterial pneumonia (Fig. 2). The overall 30-day mortality rate was 12.5% (39 of 312). Among patients with coinfection, the 30-day mortality rate was 45% (9 of 20). Diagnoses of BSI (OR, 6.35; 95% CI, 1.41–26.30) and bacterial pneumonia (OR, 9.34; 95% CI, 2.01–46.34) were associated with increased mortality. Of the data available, 12 (63%) of 19 patients with coinfection had elevated procalcitonin levels (ie, &gt;0.50). At the time of COVID-19 diagnosis, the median absolute lymphocyte count in patients who died was 0.7 K/mm3 (95% CI, 0.6–1.12) in comparison to 1 K/mm3 (95% CI, 0.7–1.4) in patients who survived at 30 days. Conclusions: Our analysis of hospitalized COVID-19 patients with advanced age and underlying comorbid conditions demonstrated that coinfections were infrequent but that they were independently associated with increased mortality. This finding highlights the need for better tools to diagnose the presence or absence of bacterial and fungal coinfection in COVID-19 patients. Our findings also emphasize the need for judicious use of antimicrobials while discerning which patients are at risk of critical illness and mortality.Funding: NoneDisclosures: None

Association of COVID-19 severity with body mass index and underlying comorbid conditions-a hospital-based cross-sectional study

Background: To reduce the severity of the disease among COVID-19 patients with co-morbidities is the need of the hour. Obesity may contribute to adverse outcomes in coronavirus disease 2019 (COVID-19). This study aimed to find the association between the COVID-19 biomarker values and the underlying comorbid conditions and assess the severity of the disease according to the patients' body mass index (BMI).Methods: A single centre cross-sectional study was conducted in a tertiary hospital among 184 COVID-19 patients admitted for one month (June-July 2021).Results: The results show a statistically significant association between the COVID-19 severity and co-morbidity status of the patients, with diabetes mellitus being the most prevalent co-morbidity among the patients, followed by diabetes with hypertension. A statistically significant association was also seen between age and co-morbidity and biomarkers and co-morbidity.Conclusions: Obesity and other comorbid conditions like diabetes mellitus and hypertension should be given utmost importance during treatment among COVID-19 patients. Biomarker screening should be routinely done in patients with co-morbidities and obesity. Awareness among the COVID-19 patients regarding the comorbid conditions and BMI is the need of the hour.

Assessment of APACHE II Score to Predict ICU Outcomes of Patients with AKI: A Single-center Experience from Haryana, North India.

BackgroundThe acute physiology and chronic health evaluation (APACHE) II severity score has shown a good calibration and discriminatory value across a range of disease processes and remains the most widely used source of prognostic information on the risk for death in patients admitted to intensive care units (ICUs).ObjectivesTo study APACHE II scores in patients of acute kidney injury (AKI) admitted in the ICU and to find its association with outcome.Materials and methodsOne hundred patients with AKI aged 18 years or above were admitted in the ICU, department of general medicine, of a tertiary care institute in Haryana, North India, from October 2019 to September 2020, were studied. Patients who had known causes of chronic kidney disease (CKD), on maintenance hemodialysis, and those who underwent renal replacement therapy (RRT) or nephrectomy were excluded. All required investigations were performed, and data were collected. The patients were followed till discharge or in-hospital mortality.ResultsThe mean age of the patients was 55.92 ± 18.18 years. Male–female ratio was 1.5:1. Thirty-five percent of the admitted patients had an in-hospital mortality. Sepsis (47%) was the most common cause of AKI, and 83% of the patients had underlying comorbid conditions. The mean APACHE II score of the expired patients on admission, i.e., 24.80 ± 13.65, was found to be significantly higher compared to the mean APACHE II score (17.25 ± 10.12) of the discharged patients (p-value <0.001). APACHE II score was found to have 57.14% sensitivity, 86.15% specificity, 69% PPV, 78.9% NPV, and 76% diagnostic accuracy to predict mortality among the AKI patients.ConclusionAPACHE II scoring system has a good discrimination and calibration when applied to ICU-admitted AKI patients and is a good predictor of prognosis in them.How to cite this articlePatel P, Gupta S, Patel H, Bashar MDA. Assessment of APACHE II Score to Predict ICU Outcomes of Patients with AKI: A Single-center Experience from Haryana, North India. Indian J Crit Care Med 2022;26(3):276–281.