TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19最新文献

{"title":"Prone Positioning to Improve Oxygenation in COVID-19 Patients Outside Critical Care (PRONE-COVID Study)","authors":"F. Chen, A. Jha, M. Fisk, S. Mann, R. Shah, J. Fuld","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3843","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3843","url":null,"abstract":"Introduction: Prone positioning has potential efficacy in improving oxygenation in patients with coronavirus disease (COVID-19). The UK Intensive Care Society has published recommendations for prone positioning in awake patients with COVID-19 but it remains unknown whether it is beneficial in those patients prior to requiring respiratory support, and whether there is applicability for patients with non-COVID-19 pneumonia. Published studies are limited by their retrospective nature, inclusion of minimal time-points for physiological assessment and lack of information on tolerability. This prospective study aimed to assess the tolerability and physiological effects of prone positioning in non-ventilated patients with or without COVID-19 pneumonia. Methods: This interventional case-control study (ClinicalTrials.gov Identifier: NCT04589936) is currently being conducted at a tertiary hospital, with the aim of recruiting 56 patients with pneumonia. Inclusion criteria include those able to provide informed consent and rotate independently through a cycle of supine, lateral (for a duration of 15 minutes) and prone position (for as long as tolerable). The tolerability of each position was qualitatively assessed using a questionnaire and visual analogue scores (VAS). Continuous assessment of oxygenation, respiratory rate, end tidal carbon dioxide and pulse rate will be performed throughout the cycle of position changes. Thirtytwo of these patients will be proned for a longer duration, using a non-invasive positional sensor which will correlate body positions with the tolerability and physiological effects. Statistical analysis of ordinal VAS data was performed using a non-parametric Freidman test and demographic data presented as median (range). Results: The progress of participant recruitment is summarized in figure 1. To date, 73 patients with pneumonia were identified, 22 of whom were approached, of which eleven patients (eight COVID-19 and three non-COVID-19 pneumonia) underwent proning (6 female, 5 male;age, 67 [25-88] years;body mass index, 27.3 [22.8-32.0] kg/m2). There were no significant differences between different positions in the VAS for breathlessness (p=0.41), although the VAS for discomfort worsened between the supine (median score 2) and prone (score 5) position with a trend towards significance (p=0.100). Conclusion: Whilst awake prone positioning is recommended in national guidance, our prospective study to date highlights the challenge in recruiting patients who are suitable and are successfully able to self-prone. Our qualitative data suggests some patients experience discomfort in the prone position. Further detailed characterisation of physiological variables with ongoing recruitment will help inform the feasibility of performing prone positioning in hospitalised patients with pneumonia.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73648310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombosis in the Patients with Coronavirus Disease 2019 (COVID-19)","authors":"W. Huang, T. Shu","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3841","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3841","url":null,"abstract":"RATIONALE: The risk factors for thrombosis associated with coronavirus disease 2019 (COVID-19) are unclear. Therefore, we conducted a meta-analysis to analyze the risk factors for thrombosis in patients with COVID-19. METHODS: We searched PubMed, Embase, Web of Science, and other databases for clinical studies published from the date of database inception to October 30, 2020. RESULTS: We included 4 clinical trials with 250 participants in this meta-analysis. The proportion of thrombosis in COVID-19 patients was 57.6%. We found that the age of COVID-19 patients with thrombosis group was older than that in the non-thrombosis group (P = 0.001, I2 = 0%). The levels of infection indicators, C-reactive protein (P = 0.02, I2 = 3%) and white blood cell count (P = 0.0006, I2 = 0%) in COVID-19 patients with thrombosis group were higher than that in nonthrombosis group. The D-Dimer level in the thrombosis group was significantly higher than that in the nonthrombosis group (P < 0.00001, I2 = 4%). The levels of alanine aminotransferase (P = 0.001, I2 = 0%), aspartate aminotransferase (P = 0.002, I2 = 0%), and blood urea nitrogen (P = 0.002;I2 = 0%) in thrombosis group were significantly higher than those in non-thrombosis group. There were no significant differences in gender, comorbidities (hypertension, diabetes, coronary heart disease, etc.), and death between the thrombosis group and the non-thrombosis group. CONCLUSION: The prevalence of thrombosis in elderly patients with COVID-19 is higher. Inflammation, liver, and kidney dysfunction may be associated with thrombosis in patients with COVID-19. This study indicated that thrombosis in patients with COVID-19 is not significantly related to comorbidities.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90575475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breathing Nitric Oxide at High Dose in Severe-Critical COVID-19 During Pregnancy: A Case Series","authors":"B. S. Fakhr, S. Wiegand, R. Pinciroli, S. Gianni, C. Morais, Takamitsu Ikeda, Yusuke Miyazaki, Eizo Marutani, R. Fenza, G. Larson, V. Parcha, Lauren E. Gibson, Marvin G. Chang, J. Ackman, P. Arora, R. Carroll, R. Kacmarek, F. Ichinose, W. Barth, A. Kaimal, E. Hohmann, W. Zapol, L. Berra","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3844","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3844","url":null,"abstract":"Introduction: Pregnant patients with a severe form of COVID-19 are at increased risk of maternal and fetal complications. Nitric Oxide (NO) gas is a selective pulmonary vasodilator currently approved to treat newborns with pulmonary hypertension. Inhaled NO has been safely used in patients with severe pneumonia and for cases of pregnant patients with pulmonary hypertension. The antimicrobial effect of NO has been confirmed against bacteria and viruses. In vitro study demonstrated a dose-dependent effect of NO against SARS-CoV-1 and 2. We hypothesize that breathing NO at 160-200 ppm twice daily for 30 minutes in spontaneously breathing pregnant patients might provide a safe and effective treatment for COVID-19. Methods: We retrospectively reviewed the data of 6 pregnant patients hospitalized for COVID-19 treated with inhaled NO. Nitric Oxide was delivered at 160- 200 ppm for 30 minutes twice daily until resolution of respiratory symptoms or negative RT-PCR for SARS-CoV- 2. Demographic and clinical data were collected to assess cardiopulmonary function and safety during the treatment. For safety, we focused on the values of blood methemoglobin (MetHb) and inhaled Nitrogen Dioxide (NO2). Data regarding newborn delivery and health, and 28 days outcomes of mothers and babies were collected. Results: Six pregnant patients were admitted with a severe (2 patients) or critical (4 patients) form of COVID-19 and received inhaled NO therapy between April and June 2020. Two pregnant patients were in the second trimester, while 4 were in the third trimester. A total of 39 treatments were administered. No adverse events were reported relating to NO administration. MetHb peaked at 2.5% (1.95%-3%, safety limit =5%) and inhaled NO2 remained below the safety limit of 2ppm. The patients remained hemodynamically stable;cardiac ultrasound performed in three patients did not detect any rebound pulmonary hypertension after NO interruption. Oxygen saturation improved in hypoxemic patients after the initiation of NO (Figure-1). All patients experienced a reduction in respiratory rate (by a median 4.5breaths/min after NO initiation). Three patients delivered a total of 4 babies (negative for SARS-CoV-2) while the other 3 remained pregnant after hospitalization (gestational age 22-26-33weeks) with normal follow-ups. Five mothers out of 6 tested negative for COVID-19 28 days after hospitalization. Conclusion: Nitric oxide gas at 160-200 ppm was safely administered to pregnant patients with severe-critical COVID-19, improved oxygenation and reduced respiratory rate in all 6 patients. The clinical effectiveness shown suggests inhaled high dose NO as a therapeutic novel therapy for COVID-19 in pregnancy.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81800100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Sequelae of COVID-19 Infection in Patients Without Comorbidities","authors":"M. Adame, K. Nada, J. Seashore","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3821","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3821","url":null,"abstract":"Introduction: Since the appearance of SARS-CoV-2, more than 40 million patients worldwide have recovered from the infection. Co-morbidities have been linked with severity of disease and outcomes in patients infected with COVID-19. As the pandemic progresses, patients deemed “Long Haulers” are being recognized as more individuals recover. Currently, there is limited data on the late sequalae of the disease especially in the population of patients with no comorbidities. Objective: Evaluate the long-term sequalae of COVID-19 infection in healthy individuals. Methods: We identified 101 patients who presented to the University of Texas Medical Branch (UTMB) COVID-19 recovery clinic between July, 16, 2020 to October,8, 2020, and excluded all subjects with underlying comorbidities. Demographics and data regarding hospitalization history, persistent symptoms, patient health questionnaire score (PHQ-9), Generalized anxiety disorder score (GAD-7) and six-minute walk distance were collected. Results (Table 1): A total of 25 patients (24.7%) with no comorbidities were identified during the study period. Patients were predominantly female (80%), and older than 40 years (90%). More than half of subjects identified as white (52%), and 10 patients (40%) were hospitalized for COVID related symptoms. The mean duration from positive test to clinic visit was 66 days. Persistent fatigue, dyspnea on exertion and cough were reported by 96%, 84% and 68% of patients, respectively. Depression (PHQ-9 ≥ 5) and anxiety (GAD-7 ≥ 5) were present in 15 patients (60%), while 84% reported persistent gastrointestinal symptoms including abdominal pain, nausea, vomiting and diarrhea, and 76% reported persistent headache. The mean six-minute walk distance was 1084 feet. Conclusion: While comorbidities may be an indicator of COVID-19 disease severity, those without comorbidities are not spared from the prolonged recovery from illness.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79196493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Immunocompromising Conditions on Severity of Presentations and Outcomes in Hospitalized Coronavirus Disease 2019 (COVID-19) Patients","authors":"A. Lenyo, C. Vazquez Guillamet, R. Vazquez Guillamet","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3824","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3824","url":null,"abstract":"Introduction An initial hypothesis regarding outcomes of COVID-19 infection linked worse outcomes to a dysregulated hyperinflammatory response. As a result, immunosuppressive medications have been proposed for treatment of severe cases of COVID-19. We sought to evaluate the impact of immune compromise in patients admitted for COVID-19-related pneumonia. Methods We constructed a retrospective observational study including patients admitted with COVID-19 pneumonia at Barnes Jewish/Christian (BJC) Hospitals between March 15 to May 13. Washington University School of Medicine IRB waived the need for informed consent. Inclusion criteria were duration of admission of more than 24 hours and positive nasopharyngeal RT-PCR for SARS-CoV-2. Data collection and follow-up were completed on August 27. Collected data included demographics, comorbidities (Elixhauser comorbidity score, nursing home residence, cardiovascular, renal, and pulmonary conditions, diabetes, obesity, substance abuse) and markers of severity of presentation (presence of shock, need for mechanical ventilation). Immunocompromising conditions were grouped in: hematological malignancy or bone marrow transplantation, solid organ transplantation, solid cancer on chemotherapy, TNF-α inhibitor use, and chronic glucocorticoid use. Primary outcome was all-cause mortality, and secondary outcomes were need for ICU stay, length of ICU stay, need for mechanical ventilation (MV), and MV-free days. ICU stay was defined as beginning when more than 6 L of oxygen were needed and ending with discharge from the ICU. Results 627 patients met the inclusion criteria and 80 (14.6%) were immunocompromised at admission. Immunocompromised patients were more likely to be non- African American and with lower BMI. Immunocompromised patients were as likely to develop shock (21.3% vs 28.7%, p=0.164), require ICU admission (33.8% vs 38.8%, p=0.389), mechanical ventilation (22.5% vs 28.5%, p=0.275), and die when compared to non-immunocompromised patients (20% vs 26.1%, p=0.238). Age (OR: 1.08;95% CI:1.06-1.10, p < 0.001), admission from nursing homes (OR: 2.1;95% CI: 1.3-3.3, p=0.002), non-white race (OR: 1.5;95% CI: 1.1-2, p=0.022) and need for > 6 L of oxygen (OR: 4.7;95% CI: 2.4- 9.1, p < 0.001) and mechanical ventilation (OR: 2.3;95% CI: 1.2-4.5, p=0.02) were significant predictors for mortality in multivariable logistic regression analyses. Immunocompromised status did not impact admission to the ICU and all-cause mortality. Conclusion Immunocompromised status does not seem to impact mortality and need for ICU admission for COVID-19 patients in our multi-center cohort. Future larger studies and analyses including treatment data will further characterize the trajectory of immunocompromised patients admitted for COVID-19 related pneumonia.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80862043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Asthma or Chronic Obstructive Pulmonary Disease on Hospitalization Outcomes of COVID-19 Patients: A Retrospective Cohort Study","authors":"J. Im, S. Arjun, K. Farraj, J. Desai, K. Yeroushalmi, S. Gomez Paz, A. Castillo, P. Mustacchia, J. Iqbal","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3813","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3813","url":null,"abstract":"Introduction: First identified in Wuhan, China in December 2019, COVID-19 infection, caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), is responsible for the ongoing global pandemic that has claimed more than 1.5 million lives. The United States has become one of the epicenters for the outbreak. The effects of asthma or chronic obstructive pulmonary disease (COPD) are unknown with regards to the outcomes of patients with COVID-19 infection. This study aims to evaluate the effect of asthma or COPD on patients admitted with COVID-19 viral infection at a safety-net hospital in Long Island, New York. Method: In this retrospective single-center study, we identified 636 patients (age ≥18), admitted to our institution for COVID-19 infection from March 2020 to May 2020. Diagnosis of asthma or COPD was documented through patient history upon admission. The primary outcome was in-hospital all-cause mortality. In addition, secondary outcomes included cardiac arrest, acute respiratory distress syndrome (ARDS), intubation/mechanical ventilation, shock, and hospital and intensive care unit length of stay. Chi-square tests and independent T-sample tests were used to analyze categorical and continuous variables, respectively. Multivariate logistic regression analyses were performed to measure the odds of inpatient mortality and other secondary outcomes. All statistical analyses were performed using SPSS. Results: Of the 636 patients, 67 (10.5%) reported a history of asthma or COPD, 567 (89.2%) denied and 2 (0.3%) were unable to provide history. Patients with asthma or COPD had a statistically elevated risk of mortality than those without (44.8% vs. 30.7%, p=0.008) and a higher rate of cardiac arrest (35.8% vs. 21.5%, p=0.021). Patients with asthma or COPD had an increased rate of comorbidities compared to those without (Table 1). There was no statistical difference in between groups for other secondary outcomes including intubation, shock, ARDS, and arrhythmias. Mean age in those with asthma or COPD was 66.3 versus 59.1 (standard deviation 14.1 and 15.9 respectively, p=0.243). There was also no statistical difference between the two groups in the hospital or intensive care unit (ICU) length of stay (Table 1). Conclusion: Our study supports that COVID-19 patients with asthma or chronic obstructive pulmonary disease (COPD) demonstrated an elevated risk of all-cause in-hospital mortality and cardiac arrest but did not correlate with an increase in intubation, ARDS, arrhythmias, shock, and hospital/ICU length of stay.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79959899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Predictive of Outcome in COVID-19 Pneumonia with Acute Respiratory Failure","authors":"M. Gupta, S. Nguyen, G. Manek, D. Datta","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3854","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3854","url":null,"abstract":"Rationale: Coronaviruses usually cause mild upper respiratory tract infections in humans, however, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) can replicate in the lower respiratory tract. The pathophysiology of SARS-CoV-2 is similar to its predecessor SARS-CoV inciting an aggressive and disproportionate host immune response leading to multi organ failure and death. Multiple factors have been studied for their association with outcome in COVID-19. Variable data exists in current literature regarding the impact of demographic factors, admission hemoglobin, creatinine, d-dimer, ferritin and BNP on patient's survival. The objective of this study was to identify whether these parameters affect mortality in COVID-19 with acute respiratory failure. Methods: Seventy-one patients admitted to our hospital with COVID-19 and acute respiratory failure were studied. Medical records were reviewed to obtain age, gender, body mass index (BMI), admission hemoglobin (Hb), white blood cell (WBC) count, d-dimer, C-reactive protein (CRP), ferritin, creatinine, brain natriuretic peptide (BNP), and outcome (survived or expired). Correlation analysis and t-test was performed to determine the impact of above parameters on outcome. Results: Of the 71 patients, 73% were male and 27% were females. Mean age was 47.7 + 16.7 years. Mean BMI was 32.27 + 2.73 kg/m2. Nineteen percent (19%) patients required invasive mechanical ventilation (MV);twenty-two percent (22%) of patients expired. Studied admission parameters in survivors and non-survivors are shown in the table below. Pearson's correlation analysis showed a significant correlation between mortality and variables such as age, BMI and WBC count. No correlation was observed with gender, admission Hb, creatinine, CRP, ferritin, d-dimer or BNP levels. Conclusions: Information on COVID-19 continues to evolve. Future studies aimed at determining clinical parameters at the time of hospital admission that can predict mortality can be helpful in optimizing treatment and monitoring of these patients. Our study did not show any correlation between mortality and various inflammatory markers including CRP, ferritin, d-dimer which could have been due to the limited number of patients in this study.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77566241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Pneumococcal Vaccination with Outcomes Related to Coronavirus Disease 2019 (COVID-19)","authors":"M. Pascoe, L. Daboul, A. Nowacki, J. Sullivan, P. R. Wang, D. Liu, S. Harwood, A. Wei, E. Kirchner, C. Calabrese, G. Weaver, S. Walvekar, G. Whelan, S. Seck, L. Aboussouan","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3830","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3830","url":null,"abstract":"Background: As secondary bacterial infections have been associated with increased mortality in respiratory virus pandemics, we sought to determine if prior pneumococcal vaccination improves clinical outcomes in COVID-19 patients. Methods: We analyzed an observational registry of patients tested for COVID-19 at the Cleveland Clinic because of symptoms or other qualifying criteria from 3/8/2020-5/8/2020. Overlap propensity-score weighted logistic/linear regressions investigated associations between pneumococcal vaccination status and COVID-19- related clinical outcomes. Results: 18,197 patients (median age 50.2 yrs [IQR 30.4], 40% male, 67% white) were included. 2785 (15.3%) tested SARS-CoV-2-positive and 738(26.5%) were hospitalized. Prior pneumococcal vaccination in SARS-CoV-2 positive patients did not reduce ICU admission, oxygen usage, radiographic infiltrates, or need for mechanical ventilation. Pneumococcal vaccine recipients were less likely to test positive for SARSCoV- 2 (OR 0.77, 95% CI [0.68,0.87]). Pneumococcal vaccine recipients aged 15-65 years testing positive for SARS-CoV-2 had increased risk of hospitalization (OR 1.54 [1.001, 2.38] and death (OR 12.51 [1.92,81.36]) compared to non-recipients, and those >65 years were more likely to develop pneumonia (OR 8.45, 95% CI [1.77,40.42]). Conclusions: Pneumococcal vaccination status serves as a marker of underlying co-morbidities with greater risk of hospitalization and death from COVID-19 for those age 15-65 and of pneumonia for those >65, with no impact on other important adverse outcomes. The reduced prevalence of SARS-CoV-2 among pneumococcal vaccine recipients could reflect off-target vaccine effects or patterns of health behavior that persist despite propensity score adjustments. Our study supports evaluation of vaccination status, and vaccination of those at risk.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90045055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Hyper-Polarized 129Xe Pulmonary MRI for Study of the Lung Damage in COVID-19 Survivors, Preliminary Results","authors":"T.K. Ranota, H. Serrai, G. Parraga, D. Mccormack, A. Ouriadov","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3835","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3835","url":null,"abstract":"RATIONALE: Severe COVID-19 viral infection results in parenchymal pneumonia involving the terminal bronchi and alveolar cells;viral re-production results in damaged and destroyed cells, causing whole lung inflammation resulting in failed gas exchange and respiratory failure that leads to end-stage organ failure. Hyperpolarized 129Xe gas MRI is non-invasive, radioactive-free tool can examine COVID-19 damage to the lungs with spatial-resolution similar to the CT-resolution. We hypothesize, that the high-resolution 129Xe MRI can be used for the assessment of the lung structure and function in COVID-19 survivors (CS). In this pilot study conducting with a small number of CS, we measured the Ventilation-Defect-Percent (VDP) a sensitive indicator of lung function, using highresolution (voxel-size=3x3x3mm3) 129Xe MRI. This should improve our understanding on the effects of COVID-19 on the lungs. METHODS: Three CS with written informed consent provided, underwent spirometry and 1H/129Xe MRI scanning (NCT04584671), performed on a 3.0T scanner. Traditional or low-resolution coronal xenon images (3x3x15mm3), were acquired in a <16 sec breath-hold after inspiration of 1.0L of gas (129Xe/4He-30/70) from functional-residual-capacity using acquisition parameters reported elsewhere.2 Pre- and post-salbutamol data set acquired for each subject. Isotropic-voxel high-resolution-images with 3x3x3mm3 were reconstructed by using the key-hole approach.3 Hyperpolarized 129Xe gas (polarization=35%) was obtained from a turn-key 129Xe polarizer system. Proton MRI was performed as described.1 Image SNR and VDP values were calculated as elsewhere.4 RESULTS: Figure 1 reports CS information and imaging results. The calculated VDPs for the highresolution data were lower than the low-resolution data. The pre- and post-salbutamol values were similar except for CS-1, where the post-salbutamol value was larger. The SNR values are reported on Figure1.DISCUSSION: The good quality of the high-res 129Xe images permitted a precise VDP calculation, which are comparable to those reported elsewhere.5 The North-American xenon consortium expects 129Xe MRI to be FDA approved any moment now, which allow for better diagnoses, treatment planning and treatment assessment of CS. This increases the potential of the 129Xe MRI clinical translation for better treatment of patients with different diseases. CONCLUSION: The preliminary results using 129Xe MR imaging demonstrated accurate lung damage assessment. The results from this pilot study will inform future guidelines on therapies and treatment planning, resulting in improved outcomes for COVID-19 patients.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89803689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory and Non-Respiratory Symptom Duration and Its Association with Severity of Radiographic Edema in Patients with COVID-19","authors":"D. Kotok, J. Rivera Robles, C. Girard, A. Kim, S. Shettigar, A. Lavina, S. Gillenwater, A. Hadeh","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3852","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3852","url":null,"abstract":"Background: Symptoms of COVID-19 are often indistinguishable from other upper and/or viral lower respiratory tract infections, with some studies suggesting higher risk for severe disease and worse outcomes in certain symptom groups compared to others. We sought to evaluate the association of specific symptom/symptom groups and their duration with severity of radiographic edema - a clinical feature that has been independently associated with poor outcomes in patients with COVID-19. Methods: We collected CXRs, demographic and clinical data from patients with a naso- and/or oropharyngeal swab positive for SARS-CoV-2 PCR visiting the ED for COVID-19-related symptoms between March and September 2020 in a large, multi-hospital healthcare system. Two independent reviewers quantified radiographic edema using the Radiographic Assessment of Lung Edema (RALE) scoring system. We collected symptom duration based on the following groups: overall (total), dyspnea, cough, constitutional (fever, chills, malaise, myalgia), nausea and/or vomiting, and diarrhea. We assessed for correlation between radiographic edema and symptom duration as continuous variables using Pearson's R and based on symptom duration quartiles using one-way analysis of variance (ANOVA). Results: 433 symptomatic patients with available CXRs were identified (median age 54, 52% female). Inter-rate agreement for RALE score was excellent (interclass correlation coefficient = 0.89, 95% CI 0.87 - 0.92, p < 0.0001). Radiographic edema associations were as following (% of patients with symptom[s], Pearson's R and respective p-value;ANOVA p-value): total duration (r = 0.19, p < 0.001;p < 0.001), constitutional (84%, r = 0.23, p < 0.00;p < 0.001), dyspnea (55%, r = 0.14, p = 0.03;p = 0.1), cough (72%, r = 0.25, p < 0.001;p < 0.001), diarrhea (22%, r = 0.02, p = 0.83;p = 0.71) and nausea and/or vomiting (17%, r = 0.04, p = 0.71;p = 0.63). Conclusions: In a multi-center study of patients presenting to the ED with symptomatic COVID-19, severity of radiographic edema was associated with overall duration of symptoms, constitutional symptoms and cough but not with duration of dyspnea, diarrhea or nausea and/or vomiting.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79278318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}