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

{"title":"The Relationship of Smoking with ACE2 and COVID-19","authors":"W. Li, Y. Zhou","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3857","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3857","url":null,"abstract":"RATIONALE: Respiratory epithelium expressing angiotensin-converting enzyme 2 (ACE2) is the entry for novel coronavirus, pathogen of the outbreaking pneumonia (COVID-19). Although a few recent studies have found different ACE2 expression in lung tissue of smokers. The effect of smoking on ACE2 expression and COVID-19 is still not clear. So, we did this research to determine the effect of smoking on ACE2 expression pattern and its relationship with COVID-19. Methods: The clinical data of COVID-19 patients with smoking and non-smoking were analysed, and ACE2 expression of respiratory and digestive mucosa epitheliums from smoker and non-smoker patients or healthy subjects were detected by Immunohistochemistry (IHC) staining.Results: only 24 (8.1%) Of 295 laboratory-confirmed COVID-19 patients, were current smokers with moderate smoking or above, which accouted for 54.2% of severe cases with higher motality than non-smokers (8.3% vs 0.4%, p=0.018). Data analysis showed that the proportion of smokers in COVID-19 was lower than that in general population of China (Z=11.65, P<0.001). IHC staining showed downregulated ACE2 expression in respiratory and digestive epitheliums of smokers. Conclusions: The proportion of smokers in COVID-19 patients was lower, which may be explained by ACE2 downregulation in respiratory mucosa epitheliums. However, smoking COVID-19 patients accounted for higher proportion in severe cases and higher motality than non-smoking COVID-19 patients, which need to be noticed.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85935657","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 Chronic Obstructive Pulmonary Disease and/or Emphysema on Outcomes of Hospitalized Patients with COVID-19 Pneumonia","authors":"R. Marron, M. Zheng, G. Fernandez Romero, H. Zhao, R. Patel, I. Leopold, Abin Varghese Thomas, T. Standiford, M. Kumaran, N. Patlakh, J. Stewart, G. Criner","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3814","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3814","url":null,"abstract":"","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76751560","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":"Variation in High-Flow Nasal Cannula and Non-Invasive Ventilation Practice Patterns During the COVID-19 Pandemic: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS)","authors":"M.A. Garcia, S. Johnson, E. Sisson, C. Sheldrick, V.K. Kumar, K. Boman, S. Bolesta, V. Bansal, M. Bogojobic, J. Domecq, A. Lal, O. Gajic, R. Kashyap, A. Walkey","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3825","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3825","url":null,"abstract":"RATIONALE: Critical care guidelines have supported use of non-invasive respiratory support modalities in patients with acute respiratory failure from COVID-19 since the beginning of the pandemic. However, concerns surrounding viral particle aerosolization, nosocomial spread, and patient self-induced lung injury have likely influenced choice of respiratory support strategies. To date, high flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) practice patterns have not been characterized for patients with COVID-19. METHODS: We enrolled hospitalized patients aged 18 years or older with laboratory confirmed COVID-19 infection who received supplemental oxygen, using the Society of Critical Care Medicine Discovery VIRUS Registry. The primary outcome was hospital-level variation in use of HFNC and NIPPV, summarized using the intraclass correlation coefficient and median odds ratio. Hierarchical random effects models were used to estimate patient and hospital factors associated with HFNC and NIPPV use. Risk-adjusted estimation of the association between hospital HFNC/NIPPV use and patient risk of receiving invasive mechanical ventilation (IMV) was assessed as a secondary outcome. RESULTS: Among 8,532 patients with COVID-19 receiving oxygen support across 73 hospitals, the majority were treated in the US (92.3%) and were older (median age 63 years, IQR 52-74), white (49.1%), men (56.8%) with median SOFA score of 4 (IQR 1-6) and admission PaO2:FiO2 below 300 (49.4%). Of these, 5,298 (62.1%) received low flow oxygen (nasal cannula or face mask), while 1,768 (20.7%) received HFNC, 773 (9.1%) received NIPPV and 693 (8.1%) received both HFNC/NIPPV. Patient SOFA score (OR 0.92, 95% CI 0.90, 0.95), treatment for COVID-19 after July versus March-June (OR 1.3, 95% CI 1.0, 1.6) and ICU versus floor admission (OR 10.3, 95% CI 8.2, 12.8) were associated with HFNC/NIPPV use. After adjusting for patient and hospital characteristics, the hospital of admission contributed to 27% of the variation in use of HFNC and/or NIPPV. Odds of receiving either modality at a randomly selected high vs. low HFNC/NIPPV utilization hospital was 2.9. Hospital rates of HFNC/NIPPV use were not associated with patient receipt of IMV (OR 0.87, 95% CI 0.7, 1.1). CONCLUSION: Throughout the course of the COVID-19 pandemic, use of HFNC and NIPPV varied widely across hospitals, though use of non-invasive respiratory support modalities was not associated with patient risk for invasive mechanical ventilation. Further evaluation of HFNC and NIPPV exposure, progression to IMV and subsequent mortality within these subgroups may provide additional insights regarding optimal oxygenation and ventilation strategies of patients with COVID-19.","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":"85684108","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":"Computed Tomography Scan Abnormalities in Patients with Post-Acute COVID Syndrome","authors":"J. Bailey, R. Mylvaganam, S. R. Russell, K. Arkin, J. Karoń, C. Davidson, J. Sznajder, G.S. Budinger, M. Sala, NU Comprehensive COVID Center Investigators","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3836","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3836","url":null,"abstract":"Rationale: Patients recovering from COVID-19 infection can have persistent respiratory symptoms. These symptoms are part of a syndrome of prolonged recovery from of COVID-19 which has been termed 'Post-Acute Covid Syndrome (PACS).' Many patients with PACS have been found to have persistent radiographic changes. It is not known whether these radiographic changes represent developing fibrosis, a developing inflammatory process such as organizing pneumonia, or both. In this study we sought to characterize the radiographic changes seen in patients with persistent pulmonary symptoms. Methods: The medical records of patients who presented to the pulmonary clinic at the Comprehensive COVID Center were reviewed. Computed tomography (CT) scans were reviewed if obtained greater than 4 weeks after COVID diagnosis. If multiple CT scans were performed, the most recent scan was included. Radiographic abnormalities were categorized as inflammatory (ground-glass opacities or consolidation), fibrotic (traction bronchiectasis, reticulation, or honeycombing), both, or neither. Results: 33 patients were evaluated. During the acute phase of COVID infection 8 (24%) were admitted to the intensive care unit, 7 (21%) required mechanical ventilation, and 12 (36%) were admitted to the floor. 20 (61%) patients had CT that fit inclusion criteria. Of the 20 CT scans reviewed, 13 (65%) were abnormal. 10 (50%) scans demonstrated evidence of fibrosis, 11 (55%) scans demonstrated inflammatory changes, and 8 (40%) scans demonstrated both fibrosis and inflammatory changes. The average time from COVID diagnosis to recovery CT was 131 days. The average time from COVID diagnosis to scans with signs of fibrosis was 151 days, whereas the average time from COVID diagnosis to scans with inflammatory changes was 127 days. Conclusion: The etiology of persistent dyspnea in PACS is an area of active investigation, and radiographic patterns of injury may suggest underlying pathologic processes. Our study demonstrates abnormal radiographic findings, including evidence of both fibrotic and inflammatory parenchymal changes, in the majority of patients seen with PACS followed greater than 4 months after initial diagnosis. It is unknown if the ground glass opacities or consolidative changes are representative of post infectious organizing injury or fibrosis that is below the level of detection of CT resolution. Further prospective observational studies are warranted to determine if these changes are progressive, or if interventions such as steroids can expedite respiratory symptom recovery in the setting of a post-acute COVID clinic.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84192670","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":"COVID-19 Course in Recovered Patients Evaluation by Clinical, Radiological and Pulmonary Function Parameters","authors":"F. Darawshy, A. Abu Rmeileh, R. Kuint, P. Cohen- Goychmann, U. Laxer, N. Berkman","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3818","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3818","url":null,"abstract":"Introduction: As of December 2020, the Coronavirus- 2019 (COVID -19) pandemic has affected over 70 million people and caused over 1.6 million deaths worldwide. However, the long term effects of COVID-19 are still unclear, and very limited data in this regard is available. Both persistent pulmonary and extra-pulmonary manifestations and their relationship to initial disease severity are unclear. Methods: This is a prospective cohort single centre study, performed at Hadassah Medical centre, Jerusalem, Israel. Patients admitted due to COVID-19 were invited to a clinic visit for follow up 4-12 weeks after acute infection. Clinical, radiological and pulmonary function parameters were evaluated according to the initial disease severity: mild, moderate and severe. Results: 98 patients included in the analysis. Mean age was 47.5±14.5 years, 48% were male.34.7% had an abnormal chest x-ray at presentation (CXR). After a follow-up period of 4-12 weeks, the majority of patients (90.8%) still has residual symptoms, with dyspnea and fatigue being the most common symptoms in 54.1% and 57.1%, respectively. Other common symptoms included cough (21.4%), arthralgia (27.6%), memory disturbance or concentration difficulties (31.6%). No significant difference was observed in the frequency of residual symptoms between patients with initial mild, moderate or severe disease. Mean forced vital capacity was 91% of predicted. There was no significant difference between groups of patients in forced expiratory volume at 1 second (FEV1), FVC, or the ratio FEV1/FVC. At the follow-up visit, 18 (18.3%) and 14 (14.2%) patients had abnormal CXR and computerized tomography respectively. Conclusion: The large majority of patients who have COVID-19 infection suffer from prolonged residual symptoms. In contrast, significant abnormalities on spirometry or imaging studies are uncommon. In our cohort, we found no significant difference in the frequency of post-COVID symptoms in patients with the initial mild, moderate or severe initial disease.","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":"83736227","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":"Thirty-Day Mortality Among Patients with SARS-CoV-2 Infection Undergoing Active Antitumoral Therapy","authors":"K. Wong, K. Lazo, Y. Mogilevskaya, M. Tan, M. Feinstein","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3812","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3812","url":null,"abstract":"Background: Coronavirus Disease 2019 (COVID-19),the disease related to the novel respiratory pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the first major pandemic of the 21stCentury. Early studies have examined COVID-19 outcomes among cancer patients but factors affecting mortality in this population remain unclear. The purpose of this study is to determine whether immunotherapy affects mortality rates in cancer patients undergoing active antitumoral therapy when compared to cytotoxic chemotherapy alone. Methods: This is a retrospective study of cancer patients who tested positive for SARS-CoV-2 virus between March 2020 and May 2020 at a tertiary care cancer center in New York City. Patients who tested positive for the virus were identified from an institutional registry. Subjects were identified by their active antitumoral treatment status, then further delineated by whether they recently received chemotherapy, immunotherapy, or both. Cancer type was identified by ICD-10 codes. Immunotherapy was defined as therapy that modulates immunity to treat cancer. Analyses (cross-tabulation) were performed to compare the thirty-day mortality rates between patients receiving cytotoxic chemotherapy and those receiving immunotherapy (either as monotherapy or combined with other chemotherapy). Thirty-day mortality was defined as death within 30 days of SARS-CoV-2 detection. Results: Among the 1770 cancer patients identified who tested positive for SARS-Cov-2, 48% (n=848) were men and the average age was 61 years old. 38.0% of these patients (n=671) received active antitumoral therapy within 6 months prior to viral detection. Within this cohort, 598 patients received chemotherapy only and 73 patients received either immunotherapy alone or in combination with chemotherapy. The thirty-day mortality was 8.0% (n=48) in the subgroup receiving chemotherapy and 19.2% (n=14) in the subgroup who received immunotherapy as part of their treatment regimen. The odds of thirty-day mortality in the group who received immunotherapy as part of their treatment regimen was 2.7 times greater than that of chemotherapy alone (OR 2.7, 95% CI [1.4,5.2]). Conclusion: This study suggests that short-term mortality among patients receiving immunotherapy as part of cancer treatment may be higher than among those who receive chemotherapy alone. These results have the potential for significant clinical impact in the treatment of patients with active cancer, as they may suggest an added risk of immunotherapy in those positive for SARS-CoV-2. Further directions of study will assess for possible confounders, the effect of immunotherapy on mortality among different types of cancer, and other factors affecting mortality in this population.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79261953","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 COVID19 Experience: Preliminary Results in 1651 Patients at Two Multi-Ethnic Community Hospitals in NYC","authors":"K. Cervellione, J. Shakil, F. Bagheri, J. Robitsek, V. Zafonte, D. Wisa, M. Walczyszyn, K. Gafoor, A. Solinas, R. Mendelson","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3833","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3833","url":null,"abstract":"New York City was one of the first epicenters of the COVID19 pandemic in the United States, and continues to be the hardest hit in terms of the number of total hospitalizations and deaths. As the pandemic has spread, it has become evident that the virus disproportionately affects minority populations and may result in more adverse outcomes. The multi-ethnic communities of Queens, NY, some of which include large proportions of low socio-economic and immigrant families, provide a unique opportunity to observe the COVID19 experience at the height of the pandemic. This information allows clinicians and researchers to learn more about the presentation and course of disease in a diverse sample. An estimated 2800 patients admitted for COVID19 were seen between March 10 and May 31 2020 (not including asymptomatic positive patients). A sample of 1651 were included in these preliminary analyses (806 from hospital A and 845 from hospital B).Most patients were male(62%) with mean age 67(16.1). Ethnicities were 33% Hispanic, 24% Black, 18% Asian, 17% White, and 8% other/unknown. At presentation, half had HR>100 and/or RR>20;25% had fever>100.5F. Symptoms included dyspnea(69%), cough(60%), fever(58%), weakness/fatigue(42%), myalgia(24%), AMS/confusion(21%), and GI complaints(20%). Comorbidities were HTN(65%), DM(43%), HLD(43%), CAD(19%), CKD(15%), CVA(10%) and COPD/asthma(10%). Complications included sepsis(44%), AKI/ARF(36%), intubation(24%), and arrhythmias(7%). Disposition included 29% home, 18% to skilled nursing facility, and 36% expired.In our cohort of mainly minority patients from low to middle class urban neighborhoods, presence of comorbidies was higher than in other reported cohorts in the region. Though presenting symptoms were similar to other New York City hospitals, clinical course was poorer, with over 1/3 of patients expiring. Further analyses will concentrate on predictors of poor outcome within and between racial/ethnic groups in the complete cohort of eligible patients.","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":"73571592","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":"COVID-19 Prognosis in Patients with Underlying CKD and Kidney Related Complications","authors":"M. Goel, A. Aggarwal, W. Zaidi, V. Tegeltija","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3842","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3842","url":null,"abstract":"Introduction: In December 2019, a novel RNA virus causing COVID-19, a respiratory illness that can lead to diffuse alveolar damage and respiratory failure, was reported. The virus facilitates host cell entry through angiotensin-converting enzyme-2 (ACE2) receptor which is present in many organs including kidneys. Kidney injury, including acute kidney injury (AKI), proteinuria and hematuria, has been a reported in COVID-19 patients. The extent of renal involvement has not been extensively correlated with prognosis and outcomes in COVID-19 patients. Methods: Retrospective chart review including patients aged 18 years and older, admitted to a community hospital from March 15, 2020 to April 15, 2020, testing positive for COVID-19. Patient characteristics on admission were collected which included presence of AKI, hematuria, proteinuria and underlying CKD stage, if any. Outcomes included intubation rate, ICU admission, length of stay and inpatient-mortality. Continuous variables were compared using independent t-test. Chi-square test was used to test relationships between categorical variables. Results: A total of 212 charts were studied. After removing missing data, 186 patients were included. 22.6% (n=42) had moderate-severe underlying CKD (stage 3 or more). 38.7% (n=72) of total patients had AKI on presentation. Urinalysis was not done in 51 patients, so of the rest 135 patients, 55.6% (n=75) had hematuria and 52.6% (n=71) had proteinuria on admission. Inpatient mortality was found to be significantly higher in patients with underlying moderate-severe CKD compared to those who did not (52.4% vs 31.3%, p=0.012). Patients with hematuria on admission had significantly higher rates of intubation (37.3% vs 20%, p=0.028) and ICU admissions (44% vs 26.7%, p=0.037) compared to those who did not have hematuria on admission. Length of stay was also significantly higher in patients who had hematuria on admission compared to those who did not (10±8 vs 7±6 days, p=0.042). AKI and proteinuria on admission resulted in no significant difference in intubation, ICU admission, length of stay, or inpatient mortality. No significant difference in length of stay, intubation, and ICU admission was found in patients with underlying mod-severe CKD compared to those who didn't. Conclusion: Early renal involvement and underlying CKD worsen the prognosis of COVID-19 pneumonia and result in higher mortality outcomes. Such patients, especially those with findings of hematuria on admission, need closer monitoring. Furthermore, many COVID-19 patients receive steroids and anticoagulants as part of treatment regimen which will need to be further evaluated as these therapies may contribute to further damage of the kidneys.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75147707","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":"Admission Serum Lactate as a Predictor of Mortality in COVID-19 Pneumonia with Acute Respiratory Failure","authors":"S. Nguyen, M. Gupta, G. Manek, D. Datta","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3855","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3855","url":null,"abstract":"Rationale: Novel coronavirus-19 (COVID-19) has been observed to cause multi-organ failure and death. Lactic acid has been shown to predict worse outcomes in patients with multi-organ failure in various disease processes. During episodes of acute hypoxia there is increased conversion of pyruvate to lactic acid. In COVID-19 patients, the dysregulated inflammatory response, also known as the cytokine storm, has been known to cause acute respiratory distress syndrome (ARDS) causing refractory hypoxemia and worsening lactic acidosis. Various inflammatory markers have been studied to predict outcomes in COVID-19 patients. The objective of this study was to identify whether lactic acid at admission correlated with mortality in patients with acute respiratory failure due to COVID-19. Methods: Seventy-one patients admitted to our hospital with acute respiratory failure due to COVID-19 were studied. Medical records were reviewed to obtain demographics including age, gender, body mass index (BMI), outcome (survivor or non-survivor) and admission lactic acid levels. Pearson's correlation analysis was performed to evaluate the correlation between admission lactic acid levels and mortality. Independent t-test was performed to determine the impact of this parameter on mortality. p < 0.05 was deemed statistically significant. Results: Of the seventy-one (71) patients, admission lactic acid levels were obtained in sixty-four (64) patients. Mean age was 47.7 + 16.7 years, 73% were male, and mean BMI was 32.27 + 2.73 kg/m2. Twelve patients (18.75%) did not survive. The mean admission lactic acid for non-survivors was 2.05 + 1.032 mmol/L and for survivors was 1.16 + 0.85 mmol/L (p = 0.002, independent t-test) [Figure 1]. Pearson's correlation analysis showed a significant correlation between admission lactic acid levels and mortality (r = -0.372, p = 0.002). Conclusions: A lactic acid at admission has a significant correlation with mortality in COVID-19 patients with acute respiratory failure. Further studies are required to assess this correlation and of rise in lactic acid to risk of mortality in patients. In addition, more studies are also needed to determine if there is a specific value of lactic acid that would predict mortality in patients.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91462216","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 Chronic Immunosuppression on the Severity and Outcomes of COVID-19 ICU Patients","authors":"H. Yaqoob, D. Greenberg, R. Manglani, D. Vernik, D. Chandy","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3822","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3822","url":null,"abstract":"Rationale: There is currently limited and conflicting data regarding the effect of immunosuppression on severity and outcomes of Coronavirus Disease 2019 (COVID-19). Mortality rates of solid organ transplant recipients hospitalized with COVID-19 range as widely as 5-67%. Some of these reports therefore seem to suggest that immunosuppressed patients have a similar mortality when compared to non-immunosuppressed patients. Also, there is limited data on the incidence of bacterial and fungal superinfections in these critically ill COVID-19 patients who are immunosuppressed. Our study aims to understand the impact of immunosuppression on the clinical course and outcomes of COVID-19 patients admitted to our intensive care units (ICUs). Methods: This study is a retrospective analysis of all adult patients with COVID-related acute respiratory distress syndrome (ARDS) admitted to the ICUs of a quaternary care hospital between 03/01/2020 and 05/31/2020. Patients on chronic immunosuppressive medications were identified. Demographic and clinical characteristics, inflammatory markers at the time of ICU admission and clinical outcomes of these patients were compared and analyzed with patients who were not immunosuppressed. Means, medians and categorical variables were compared using t-test, Mann-Whitney U-test and Fisher's exact test, respectively. P-value of <0.05 was taken to be statistically significant. Results:Of the 210 patients admitted to our ICUs with COVID-related Acute Respiratory Distress Syndrome, 23 (11%) were taking immunosuppressant medications before they were admitted to our unit. 11 patients had a history of organ transplantation (Liver: 4, Kidney: 4, Heart: 2 and Stem cell transplantation: 1). There was no statistically significant difference between the two groups in terms of demographics, comorbidities, severity as indicated by inflammatory markers and outcomes such as death, acute kidney injury (AKI) requiring dialysis, and bacterial or fungal superinfection. Conclusion: Our study seems to imply that there is no significant difference in the severity and outcomes of the immunosuppressed patients who were admitted to our ICUs. Our study did show an increased incidence of mortality (52.17% vs. 44.02%) and an increased rate of positive sterile fluid cultures (34.78% vs. 25.13%) in these immunosuppressed patients but the difference was not statistically significant. It is possible that an increased sample size may have revealed statistically significant differences. Therefore, larger studies are needed to determine if immunosuppression impacts the outcome of critically ill COVID-19 patients.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75998721","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}