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the COVID-19 pandemic, Medicaid enrollment offset employer-based insurance of in-hospital mortality. Patients who required vasopressors or NMBA were associated losses precipitated by the recession. e Th aim of this study was to evaluate whether with in-hospital mortality. Despite national trends reporting increased mortality in Medicaid expansion may have impacted COVID-19 mortality. patients with obesity, diabetes, cardiovascular disease, and of African American race, Methods. We conducted an ecologic study that included all US counties in the 50 this was not observed in our health system safety net hospitals. states and District of Columbia. County-specific Medicaid expansion status was based Disclosures. All Authors: No reported disclosures on whether expansion was adopted within the state. COVID-19 cases and deaths for each county were obtained from the Centers of Disease Control (CDC). Unadjusted 446. Prognostic Value of Absolute Lymphocyte Count for Disease Severity and and multivariable negative binomial regression with robust standard errors to account Clinical Outcomes in Adult COVID-19 Inpatients for clustering of counties within each state were used to evaluate the association of 1 1 1 Jianli Niu, MD, PhD ; Candice Sareli, MD ; Maria Deane, n/a ; COVID-19 case fatality rate and Medicaid expansion status. Adjusted models included 1 1 Aharon E. Sareli, MD ; Memorial Healthcare System, Hollywood, FL the addition of four sets of county-level covariates thought to influence the associ - ation of Medicaid status and COVID-19 fatality rate: demographics, comorbidities, Session: P-21. COVID-19 Research economic indicators, and physician density. These analyses were then performed in Background. Lymphopenia has been reported as a relatively frequent finding in subgroups of counties defined by urbanicity (metro, suburban or rural) and quartiles patients with coronavirus disease 2019 (COVID-19). This study aimed to assess the of poverty rates. Incidence Rate Ratios (IRR) and 95% confidence intervals (CI) are use of absolute lymphocyte count (ALC) as a prognostic biomarker for disease severity reported. and clinical outcomes. Results. A total of 1,814 Medicaid expansion and 1,328 non-expansion counties Methods. A cohort of adult patients with COVID-19 admitted to Memorial were included in the analysis. Crude case fatality rates were 2.1% (non-expansion) and Healthcare System, Hollywood, Florida from March 7, 2020 to January 18, 2021 was 1.8% (expansion). Medicaid expansion was not associated with a significantly lower retrospectively analyzed. An absolute lymphocyte count (ALC) < 1.1 × 10 /L was used COVID-19 case fatality rate in either the unadjusted (IRR: 0.86; 95% CI: 0.74, 1.01) as cutoff point to define lymphopenia. Correlations of ALC upon admission with age or fully adjusted (IRR: 1.02; 95% CI: 0.90, 1.16) models. In adjusted models, Medicaid and serum levels of C-reactive protein, interleukin-6, lactate dehydrogenase, and cre- expansion status was also not associated with differences in COVID-19 case fatality atinine were analyzed. Univariate and multivariate regression models were developed rate when counties were stratified by either urbanicity or percent of individuals living to assess the association of lymphopenia with the risk of ICU admission and clinical below the poverty line. outcomes. Results. 4,485 hospitalized patients were included in the final analyses. Median age was 61 (interquartile range, 47-73) years and 2,311 (51.5%) were men. Lymphopenia was more frequent in patients admitted to the ICU compared to those that were not admitted to the ICU, with an odds ratio of 2.14 (95% conﬁdence interval [CI], 1.78-2.56, p < .0001) (Figure 1). The actual value of the ALC was negatively cor - related with age and serum levels of C-reactive protein, interleukin-6, lactate dehydro- genase, and creatinine (all p < 0.005). Patients with lymphopenia (n=2,409) compared to those without lymphopenia (n=2,076) had multivariable-adjusted odds ratios of 1.85 (95% CI, 1.53-2.24) for ICU admission, 2.08 (95% CI, 1.67-2.58) for intubation, 1.98 (95% CI, 1.31-3.00) for development of acute kidney failure, and 2.23 (95% CI, 1.79-2.79) for in-hospital mortality (Table 1). Analyses were adjusted for age, gender, race, hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, malignancy, obesity, and smoking. Conclusion. In this county-level analysis, Medicaid expansion status was not associated with a significant difference in county-level COVID-19-related case fatality rates among people of all ages. Future individual-level studies are needed to better characterize the effect of Medicaid on COVID-19 mortality. Disclosures. All Authors: No reported disclosures 445. COVID-19 Pharmacotherapy Was Not Associated with Mortality in a Community Teaching System 1 1 1 Eric Urnoski, PharmD, BCPS, BCCCP ; Thomas Butler, MD, MS, FACS ; Crozer- Chester Medical Center, Havertown, Pennsylvania Session: P-21. COVID-19 Research Background. During the COVID-19 pandemic, a task force was assembled to col- lect data on patient characteristics and treatment exposures to assess what factors may contribute to patient outcomes, and to help develop institutional treatment guidelines. Methods. A retrospective study was performed on COVID-19 inpatient admis- sions within a four-hospital community health system over a six-month period from April-October 2020. Positive COVID-19 immunology results and/in conjunction with an inpatient admission was criteria for inclusion. Covariates for age, gender, race were added apriori. Covariates of interest included baseline comorbidities, admission level- Conclusion. Lymphopenia in adult COVID -19 hospitalized patients was associ- of-care, vital signs, mortality outcomes, need for intubation, and specific pharmaco - ated with increased risk of disease severity (as evidenced by need for ICU admission) logical treatment exposures. Logistic regression was performed on our final model and and poor clinical outcomes. Absolute lymphocyte count may help with prognostication reported as OR +/- 95% CI. in individuals hospitalized with COVID-19. Results. A total of 349 patients met inclusion criteria. Pharmacotherapies were Disclosures. All Authors: No reported disclosures not associated with a difference in mortality in a four-hospital system. Corticosteroids (p = 0.99); Remdesivir (p = 0.79); hyrdroxychloroquine (p = 0.32); tocilizumab (p = 0.91); were not associated with mortality. ACE-inhibitor or angiotensin II receptor blockers OR 0.29 (0.09-0.93) (p = 0.03); convalescent plasma OR 7.85 (1.47-42.1) 447. An Ordinal Scale Assessing SARS-CoV-2 Infected Patient Outcomes Using (p = 0.02); neuromuscular blocking agents (NMBA) OR 5.51 (1.28-23.8) (p = 0.02); Electronic Health Records 1 2 3 vasopressors OR 17.6 (5.62-54.9) (p = 0.00) were associated with in-hospital mortality. Maryam Khodaverdi, MSc ; Bradley S. Price, Ph.D. ; Susan L. Santangelo, Sc.D. ; 4 2 Covariates that were associated with a difference in mortality were: age > 60 years OR Alfred (Jerrod) Anzalone, MS ; Wesley Kimble, MPA ; 5 6 2.73 (1.04-7.14) (p = 0.04); structural lung disease OR 3.02 (1.28-7.10) (p = 0.01). J. Zachary Porterfield , MD, PhD ; Michael T. Vest, DO ; 7 2 8 Covariates not associated with mortality included African American race (p = 0.30); Sally L. Hodder, M.D. ; Brian Hendricks, PhD ; Clifford james Rosen, MD ; 9 10 1 critical care admission (p = 0.19); obesity (p = 0.06); cardiovascular disease (p = 0.89); H TImothy Bunnell, PhD ; HAMIDREZA MORADI, Ph.D. ; WVCTSI, diabetes (p = 0.28). Morgantown, West Virginia; West Virginia University, Morgantown, West Virginia; 3 4 Conclusion. e u Th se of corticosteroids, remdesivir, tocilizumab, and hydroxy - Tufts University School of Medicine, Portland, Maine; University of Nebraska chloroquine, and admission to a critical care bed was not associated with a difference Medical Center, Omaha, NE; University of Kentucky College of Medicine, Lexington, S324 • OFID 2021:8 (Suppl 1) • Abstracts 6 7 Kentucky; Christiana Care Healthcare System, Hockessin, Delaware; West Virginia subsequently expired, two were discharged home, one returned to ACHP aer in ft - University School of Medicine, Morgantown, West Virginia; Maine Medical Center patient hospitalization, and one remains hospitalized. One additional patient that was Research Institute, scarborough, Maine; Nemours Children’s Health System & successfully discharged home from ACHP was later readmitted and expired in a subse- University of Delaware, Wilmington, Delaware; University of Mississippi Medical quent hospitalization. The patients that expired had significant immunocompromising Center, JACKSON, Mississippi conditions that may have contributed to their outcomes. Conclusion. ACHP can provide care equivalent to hospitalization for select Session: P-21. COVID-19 Research COVID-19 patients. Immunocompromised hosts with COVID-19 may represent Background. A major challenge to identifying effective treatments for COVID- a subset of patients in which in-house hospitalization must be carefully con- 19 has been the conflicting results oer ff ed by small, oen un ft derpowered clinical trials. sidered, even with mild oxygen requirements. Health systems should consider e W Th orld Health Organization (WHO) Ordinal Scale (OS) has been used to measure ACHP as a substitution for hospitalization for COVID-19 patients with mild clinical improvement among clinical trial participants and has the benefit of measur - symptoms. ing effect across the spectrum of clinical illness. We modified the WHO OS to enable Disclosures. All Authors: No reported disclosures assessment of COVID-19 patient outcomes using electronic health record (EHR) data. Methods. Employing the National COVID Cohort Collaborative (N3C) database 449. Performance of the Brighton Case Definition for Multisystem Inflammatory of EHR data from 50 sites in the United States, we assessed patient outcomes, April Syndrome in Children (MIS-C) Among a Large Single Center Cohort 1,2020 to March 31, 2021, among those with a SARS-CoV-2 diagnosis, using the follow- 1 2 1 Jessica Nguyen, MD ; Isabella Osuna, BS ; Eyal Muscal, MD ; Kristen Sexson, MD ing modification of the WHO OS: 1=Outpatient, 3=Hospitalized, 5=Required Oxygen 1 1 3 PhD MPH ; Marietta DeGuzman, MD ; Flor M. Munoz, MD ; Tiphanie Vogel, MD (any), 7=Mechanical Ventilation, 9=Organ Support (pressors; ECMO), 11=Death. OS 1 1 2 3 PhD ; Baylor COM, Houston, Texas; Rice University, Houston, Texas; Baylor is defined over 4 weeks beginning at first diagnosis and recalculated each week using College of Medicine, Houston, Texas the patient’s maximum OS value in the corresponding 7-day period. Modified OS dis - tributions were compared across time using a Pearson Chi-Squared test. Session: P-21. COVID-19 Research Results. e s Th tudy sample included 1,446,831 patients, 54.7% women, 14.7% Background. Multisystem Inflammatory Syndrome in Children (MIS-C) is a Black, 14.6% Hispanic/Latinx. Pearson Chi-Sq P< 0.0001 was obtained comparing nd rare, life-threatening, hyperinflammatory condition presumed to follow SARS-CoV-2 the distribution of 2 Quarter 2020 OS with the distribution of later time points for infection. Whether MIS-C can also follow SARS-CoV-2 vaccination is not clear, mak- Week 4. ing MIS-C an adverse event of special interest following immunization. Monitoring for post-vaccine MIS-C is complicated by the clinical overlap of MIS-C with nu- Table 1. OS at week 1 and 4 by quarter merous other inflammatory conditions including Kawasaki Disease, toxic shock syn - drome, and viral myocarditis. A case definition for MIS-C was recently created with the Brighton Collaboration (BC). We aimed to determine the performance of the BC MIS-C case definition among a large, single-center MIS-C cohort. Methods. Retrospective review was performed for the first 100 MIS-C cases at our institution (May 2020-February 2021). All cases met the Centers for Disease Control and Prevention (CDC) case definition. Data on age, presentation, laboratory results and cardiac studies were collected and used to determine cases that fulfilled the BC case definition for MIS-C (see figure). Case Definition: Definite Case The study sample included 1,446,831 patients, 54.7% women, 14.7% Black, Results. Of 100 children (age < 21 years) diagnosed with MIS-C using the CDC 14.6% Hispanic/Latinx. Pearson Chi-Sq P< 0.0001 was obtained comparing the case definition, 93 patients also fulfilled the BC definition. All 100 patients had elevated distribution of 2nd Quarter 2020 OS with the distribution of later time points laboratory markers of inflammation and positive SARS-CoV-2 antibodies. However, 1 for Week 4. patient was excluded for significant respiratory symptoms (pulmonary hemorrhage), Conclusion. All Week 4 OS distributions significantly improved from the initial 5 were excluded due to only 1 clinical feature, and an additional patient was excluded period (April-June 2020) compared with subsequent months, suggesting improved for having none of the measures of disease activity. Among the 93 patients fulfilling the management. Further work is needed to determine which elements of care are driving revised case definition, 88 (95%) met criteria for a definite case. Five of the 93 patients the improved outcomes. Time series analyses must be included when assessing impact (5%) were considered probable cases, 1 reported only 1 day of fever and 4 had only 1 of therapeutic modalities across the COVID pandemic time frame. measure of disease activity. Disclosures. Sally L. Hodder, M.D., Gilead (Advisor or Review Panel mem- Conclusion. e o Th riginal case definitions for MIS-C were created rapidly follow - ber)Merck (Grant/Research Support, Advisor or Review Panel member)Viiv ing the first emerging reports of this hyperinflammatory state. Knowledge of the varied Healthcare (Grant/Research Support, Advisor or Review Panel member) clinical presentations of this disorder has grown substantially. Modification of the case definition to include features truly representative of MIS-C will allow for more precise diagnosis in the face of conditions which mimic MIS-C, and for accurate and reliable 448. COVID-19 Acute Care at Home: A Substitution for Hospitalization in monitoring for adverse events following immunization. Patients with Mild Symptoms Disclosures. Flor M. Munoz, MD, Biocryst (Scientific Research Study 1 2 2 Joel A. Kammeyer, MD, MPH ; Brian Perkins, MD ; Sara Seegert, RN, MSN ; Investigator)Gilead (Scientific Research Study Investigator) Meissa (Other Financial 2 1 3 Dave E. Caris, RN, MPH ; Caitlyn M. Hollingshead, MD ; Evan D. Brochin, MD ; or Material Support, DSMB)Moderna (Scientific Research Study Investigator, Other 3 1 Benjamin H. Russell, n/a ; University of Toledo College of Medicine and Life Financial or Material Support, DSMB)Pfizer (Scientific Research Study Investigator, 2 3 Sciences, Toledo, Ohio; ProMedica-Toledo Hospital, Toledo, Ohio; University of Other Financial or Material Support, DSMB)Virometix (Other Financial or Material Toledo College of Medicine, Toledo, Ohio Support, DSMB) Session: P-21. COVID-19 Research Background. Constraints on resources require healthcare systems to implement 450. Type I Interferon Autoantibodies Are Detected in Those with Critical alternative and innovative means for delivering care. The COVID-19 pandemic ampli - COVID-19, Including a Young Female Patient 1 1 2 2 fied this issue throughout the world, leading to shortages of ventilators, hospital beds, Debra Yee, B.S. ; Marana Tso, B.S. ; Elana Shaw, B.S. ; Lindsey B. Rosen, Ph.D. ; 1 3 3 and healthcare personnel. We report the results of an Acute Care at Home Program Emily Samuels, B.S. ; Paul Bastard, Ph.D. ; Jean-Laurent Casanova, M.D., Ph.D. ; 4 5 6 (ACHP) response to COVID-19, providing in-home hospital-level care to patients Steven M. Holland, MD ; Helen C. Su, MD, PhD ; Stephanie A. Richard, PhD ; 7 8 9 with mild symptoms, preserving in-hospital beds for more serious illness. Katrin Mende, PhD ; Tahaniyat Lalani, MBBS ; David A. Lindholm, MD ; 9 1 Methods. Patients with COVID-19 were selected for ACHP aer un ft dergoing risk David A. Lindholm, MD ; Mark P. Simons, Ph.D., MSPH ; David Tribble, M.D., 1 10 1 11 stratification for severe disease, including oxygen evaluation, time course of illness, and DrPH ; Allison Malloy, MD ; Eric Laing, PhD ; Brian Agan, MD ; 1 12 1 evaluation of comorbidities. Patients admitted to ACH met inpatient criteria, required Simon Pollett, MBBS ; Timothy Burgess, MD, MPH ; Andrew L. Snow, Ph.D. ; oxygen supplementation of ≤4 liters, and received insurance approval. Services were Uniformed Services University of the Health Sciences, Bethesda, Maryland; provided consistent with best practice of inpatient care, including 24/7 provider avail- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes ability via TeleMedicine, bedside care provided by paramedics and nurses, respiratory of Health, Bethesda, Maryland; e R Th ockefeller University, New York, New York; therapy, radiology and laboratory services, pulse oximetry monitoring, and adminis- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy tration of medications. Protocols existed for patient transfer to hospital in the event of and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Immune clinical deterioration. Deficiency Genetics Section, Laboratory of Clinical Immunology and Microbiology, Results. Our initial cohort included 62 patients enrolled October 1, 2020 – May National Institute of Allergy and Infectious Diseases, National Institutes of Health, 6 71 31, 2021. Of these, 57 patients were discharged successfully from ACHP. Patients pre- Bethesda, Maryland; IDCRP, Rockville, Maryland; Infectious Disease Clinical sented with initial oxygen requirements of 0-4 liters. Average length-of-stay in ACHP Research Program, Department of Preventive Medicine and Biostatistics, Uniformed was 5.4 days. Five patients required hospitalization aer enr ft ollment in ACHP; one Services University of the Health Sciences and Brooke Army Medical Center, JBSA Abstracts • OFID 2021:8 (Suppl 1) • S325
Open Forum Infectious Diseases – Oxford University Press
Published: Dec 4, 2021
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