Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1010
M. Stutz, S. Pearson, R. Nayak, E. Littman, P. Lecompte Osorio, S. Mukhopadhyay, C. Metcalf, H. Lin, W. Leiter, H. Tryon, J. Romero, A. Pohlman, K. Wolfe, Jean-Luc Chaubard, J. Hall, E. Pamer, B. K. Patel, J. Kress
{"title":"Metabolomic Analysis of Fecal Microbiota Among Critically Ill Patients","authors":"M. Stutz, S. Pearson, R. Nayak, E. Littman, P. Lecompte Osorio, S. Mukhopadhyay, C. Metcalf, H. Lin, W. Leiter, H. Tryon, J. Romero, A. Pohlman, K. Wolfe, Jean-Luc Chaubard, J. Hall, E. Pamer, B. K. Patel, J. Kress","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1010","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1010","url":null,"abstract":"","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114927207","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1012
S. Bhavani, A. Holder, R. Kamaleswaran, P. Verhoef, M. Churpek, M. Wang, C. Coopersmith
Rationale: COVID-19 is associated with significant morbidity and presents unique challenges, including an increased risk of venous thromboembolism (VTE). In a single-center study early in the pandemic, we identified four distinct COVID-19 subphenotypes using longitudinal body temperature (i.e., temperature trajectory subphenotypes). Importantly, these subphenotypes had significant differences in hematological labs such as platelets and d-dimer, suggesting a relationship between temperature and coagulopathy. In this study, we aim to validate the temperature trajectory subphenotypes in a multi-center cohort of COVID-19 patients and evaluate whether temperature trajectory can identify patients at higher risk for VTEs. Methods: We included all patients hospitalized with laboratory-confirmed diagnosis of COVID-19 across four hospitals in the greater Atlanta area. For the trajectory analyses, we included patients' temperature measurements from the first 72 hours of hospitalization. We compared the temperature measurements from the study patients to each of the four trajectories from the published model to calculate the “trajectory distance” (i.e., the distance the patient is away from each trajectory). The patients were classified into the trajectory subphenotype from which they were the smallest distance away. We used ICD-10 codes at discharge to identify patients who had documented diagnoses of acute VTEs and evaluated the association between VTEs and trajectory subphenotype. Then, we used logistic regression to evaluate whether trajectory distance could predict VTE when controlling for demographics and ddimer levels. Results: The 2,107 hospitalized patients who met study criteria had a median age of 59 years (IQR 47-71 years), were 51% female, 65% Black, 21% White, and 10% Hispanic. The incidence of VTE was 12% and the inpatient mortality rate was 11.6%. By temperature trajectory subphenotype: 12% were Group 1, 31% Group 2, 48% Group 3, and 8.1% Group 4 (“hypothermic”). Temperature trajectory had significant association with mortality (p<0.001), with Groups 1 and 4 having the highest mortality rates (17 and 18%, respectively). Temperature trajectory subphenotype was significantly associated with VTE (p=0.004), with “hypothermic” patients having twice the incidence of other subphenotypes. On logistic regression, trajectory distance was significantly associated with VTEs even controlling for d-dimer (Figure). Conclusions: We validated our temperature trajectory subphenotypes in a multi-center cohort of hospitalized patients with COVID-19. We found that temperature trajectory could have utility in identifying patients at higher risk for VTEs who may require more aggressive anticoagulation. (Table Presented).
{"title":"Body Temperature Trajectory Associated with Venous Thromboembolism in COVID-19 Patients","authors":"S. Bhavani, A. Holder, R. Kamaleswaran, P. Verhoef, M. Churpek, M. Wang, C. Coopersmith","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1012","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1012","url":null,"abstract":"Rationale: COVID-19 is associated with significant morbidity and presents unique challenges, including an increased risk of venous thromboembolism (VTE). In a single-center study early in the pandemic, we identified four distinct COVID-19 subphenotypes using longitudinal body temperature (i.e., temperature trajectory subphenotypes). Importantly, these subphenotypes had significant differences in hematological labs such as platelets and d-dimer, suggesting a relationship between temperature and coagulopathy. In this study, we aim to validate the temperature trajectory subphenotypes in a multi-center cohort of COVID-19 patients and evaluate whether temperature trajectory can identify patients at higher risk for VTEs. Methods: We included all patients hospitalized with laboratory-confirmed diagnosis of COVID-19 across four hospitals in the greater Atlanta area. For the trajectory analyses, we included patients' temperature measurements from the first 72 hours of hospitalization. We compared the temperature measurements from the study patients to each of the four trajectories from the published model to calculate the “trajectory distance” (i.e., the distance the patient is away from each trajectory). The patients were classified into the trajectory subphenotype from which they were the smallest distance away. We used ICD-10 codes at discharge to identify patients who had documented diagnoses of acute VTEs and evaluated the association between VTEs and trajectory subphenotype. Then, we used logistic regression to evaluate whether trajectory distance could predict VTE when controlling for demographics and ddimer levels. Results: The 2,107 hospitalized patients who met study criteria had a median age of 59 years (IQR 47-71 years), were 51% female, 65% Black, 21% White, and 10% Hispanic. The incidence of VTE was 12% and the inpatient mortality rate was 11.6%. By temperature trajectory subphenotype: 12% were Group 1, 31% Group 2, 48% Group 3, and 8.1% Group 4 (“hypothermic”). Temperature trajectory had significant association with mortality (p<0.001), with Groups 1 and 4 having the highest mortality rates (17 and 18%, respectively). Temperature trajectory subphenotype was significantly associated with VTE (p=0.004), with “hypothermic” patients having twice the incidence of other subphenotypes. On logistic regression, trajectory distance was significantly associated with VTEs even controlling for d-dimer (Figure). Conclusions: We validated our temperature trajectory subphenotypes in a multi-center cohort of hospitalized patients with COVID-19. We found that temperature trajectory could have utility in identifying patients at higher risk for VTEs who may require more aggressive anticoagulation. (Table Presented).","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127087725","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1017
T. Miano, N. Meyer, S. Hennessy, T. Dunn, A. Weisman, C. Ittner, R. Agyekum, J. Reilly, B. J. Anderson, T. Jones, O. Oniyide, H. Giannini, C. Cosgriff, M. Shashaty
{"title":"Combined Vancomycin and Piperacillin-Tazobactam Treatment Is Not Associated with Acute Kidney Injury (AK) When Assessed Using Plasma Cystatin C","authors":"T. Miano, N. Meyer, S. Hennessy, T. Dunn, A. Weisman, C. Ittner, R. Agyekum, J. Reilly, B. J. Anderson, T. Jones, O. Oniyide, H. Giannini, C. Cosgriff, M. Shashaty","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1017","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1017","url":null,"abstract":"","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"126 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121031331","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1013
D. White, E. McCreary, P. Pathak, T. Sonmez, U. Unver, M. Schmidhofer, R. Bariola, N. Jonaissant, D. Yealy, R. Sackrowitz, L. Li, J. Daley, G. Persad, R. Truog
RATIONALE: The burdens of the COVID-19 pandemic have fallen disproportionately on disadvantaged groups, including the poor and Black, Latinx, and Indigenous communities. We sought to develop and implement a weighted lottery to more equitably allocate scarce COVID-19 medications in a large U.S. health system. METHODS: We convened a multi-institution consortium of experts in bioethics, economics, health disparities, medicine, pharmacy, and health law to develop the weighted lottery. The UPMC Patient and Family Advisory Council and the Commonwealth of Pennsylvania's Ethical Allocation Committee reviewed and endorsed the framework. We implemented the weighted lottery during periods when there was inadequate remdesivir to treat all patients in need. We used administrative data to ascertain the number and characteristics of patients who, on days of drug shortage: 1) were eligible for remdesivir;2) were offered remdesivir;and 3) accepted remdesivir. RESULTS: We implemented the weighted lottery across 23 hospitals in the UPMC health system during periods of drug shortage in May-July 2020. We proactively identified eligible patients using an EHR-and telephone-based screening system. To determine the general population chances in the lottery, each week we divided the number of available treatment courses by the predicted number of patients who would be eligible that week, based on the number of eligible patients in the prior week. The table contains the weighting factors in the remdesivir lottery. An allocation team met daily to apply the weighting system that determined each eligible patient's chance, then used a random number generator to run the lottery. Overall, 93 patients met the clinical eligibility criteria outlined in the FDA's emergency use authorization;44% were from disadvantaged neighborhoods, 20% were essential workers, and 9% had an underlying end-stage medical condition. During the periods of drug shortage, the general population chances to receive treatment ranged from 28%-88%. 59% of eligible patients (55 of 93) were allocated remdesivir, 13% of whom (7 of 55) refused the treatment. Overall 61% of drug was allocated to patients who were from disadvantaged neighborhoods and/or were essential workers, who made up 56% of the population. >CONCLUSIONS: We developed and implemented a weighted lottery to promote equity in the allocation of scarce COVID-19 therapeutics. The lottery resulted in heightened access to treatment among groups that have been disproportionately impacted by the pandemic, though larger weightings may be needed to substantially mitigate disparities. (Table Presented).
{"title":"Developing and Implementing a Weighted Lottery to Equitably Allocate Scarce COVID-19 Medications","authors":"D. White, E. McCreary, P. Pathak, T. Sonmez, U. Unver, M. Schmidhofer, R. Bariola, N. Jonaissant, D. Yealy, R. Sackrowitz, L. Li, J. Daley, G. Persad, R. Truog","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1013","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1013","url":null,"abstract":"RATIONALE: The burdens of the COVID-19 pandemic have fallen disproportionately on disadvantaged groups, including the poor and Black, Latinx, and Indigenous communities. We sought to develop and implement a weighted lottery to more equitably allocate scarce COVID-19 medications in a large U.S. health system. METHODS: We convened a multi-institution consortium of experts in bioethics, economics, health disparities, medicine, pharmacy, and health law to develop the weighted lottery. The UPMC Patient and Family Advisory Council and the Commonwealth of Pennsylvania's Ethical Allocation Committee reviewed and endorsed the framework. We implemented the weighted lottery during periods when there was inadequate remdesivir to treat all patients in need. We used administrative data to ascertain the number and characteristics of patients who, on days of drug shortage: 1) were eligible for remdesivir;2) were offered remdesivir;and 3) accepted remdesivir. RESULTS: We implemented the weighted lottery across 23 hospitals in the UPMC health system during periods of drug shortage in May-July 2020. We proactively identified eligible patients using an EHR-and telephone-based screening system. To determine the general population chances in the lottery, each week we divided the number of available treatment courses by the predicted number of patients who would be eligible that week, based on the number of eligible patients in the prior week. The table contains the weighting factors in the remdesivir lottery. An allocation team met daily to apply the weighting system that determined each eligible patient's chance, then used a random number generator to run the lottery. Overall, 93 patients met the clinical eligibility criteria outlined in the FDA's emergency use authorization;44% were from disadvantaged neighborhoods, 20% were essential workers, and 9% had an underlying end-stage medical condition. During the periods of drug shortage, the general population chances to receive treatment ranged from 28%-88%. 59% of eligible patients (55 of 93) were allocated remdesivir, 13% of whom (7 of 55) refused the treatment. Overall 61% of drug was allocated to patients who were from disadvantaged neighborhoods and/or were essential workers, who made up 56% of the population. >CONCLUSIONS: We developed and implemented a weighted lottery to promote equity in the allocation of scarce COVID-19 therapeutics. The lottery resulted in heightened access to treatment among groups that have been disproportionately impacted by the pandemic, though larger weightings may be needed to substantially mitigate disparities. (Table Presented).","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125214699","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1011
P. Tejera, M. Du, X. Dong, Dong Liu, L. Su, D. Christiani
{"title":"Mendelian Randomization Analyses Reveals a Casual Effect of Gut Microbiome in the Development of ARDS","authors":"P. Tejera, M. Du, X. Dong, Dong Liu, L. Su, D. Christiani","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1011","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1011","url":null,"abstract":"","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123788882","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1014
T. Fukuda, N. Ohashi-Fukuda, R. Inokuchi, H. Sekiguchi, I. Kukita
{"title":"Sex- and Age-Based Disparities in Receipt of Rescue Breathing Among Out-of-Hospital Cardiac Arrest in Japan: A Nationwide Population-Based Study","authors":"T. Fukuda, N. Ohashi-Fukuda, R. Inokuchi, H. Sekiguchi, I. Kukita","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1014","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1014","url":null,"abstract":"","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116369162","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1015
A. Castro, Y. Ou, S. Yende, F.B. Mayr
{"title":"Racial Disparities in the Management of Sepsis","authors":"A. Castro, Y. Ou, S. Yende, F.B. Mayr","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1015","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1015","url":null,"abstract":"","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126949614","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1016
K. Lu, N. Klauer, Z. Lonjers, E. Zhao, P. Lecompte-Osorio, S. Pearson, M. Stutz, A. Pohlman, J.B. Hall, J. Kress, B. Patel, K. Wolfe
{"title":"Assessment of Change in Vasopressor Requirements During Sedation Hold in Mechanically Ventilated Patients","authors":"K. Lu, N. Klauer, Z. Lonjers, E. Zhao, P. Lecompte-Osorio, S. Pearson, M. Stutz, A. Pohlman, J.B. Hall, J. Kress, B. Patel, K. Wolfe","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1016","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1016","url":null,"abstract":"","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126202364","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}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1018
K. Gorsky, K. Wong, M. Wąsowicz, A. Steel, M. Parotta, H. Zhang, E. Wilcox, B. McDonald, C. Overgaard, R. Vivek, N. D. Ferguson, A. Jerath
{"title":"Use of Inhaled Volatile Anesthetics for Longer-Term Critical Care Sedation (VALTS): A Pilot Randomized Controlled Trial","authors":"K. Gorsky, K. Wong, M. Wąsowicz, A. Steel, M. Parotta, H. Zhang, E. Wilcox, B. McDonald, C. Overgaard, R. Vivek, N. D. Ferguson, A. Jerath","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1018","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1018","url":null,"abstract":"","PeriodicalId":339098,"journal":{"name":"A3. A003 MICROBIOME, DISPARITIES, COVID-19, AND MORE: CRITICAL CARE HOT TOPICS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129288336","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}
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