Predictive Modeling of Poor Outcome in Severe COVID-19: A Single-Center Observational Study Based on Clinical, Cytokine and Laboratory Profiles

Pneumonia is the main cause of hospital admission in COVID-19 patients. We aimed to perform an extensive characterization of clinical, laboratory, and cytokine profiles in order to identify poor outcomes in COVID-19 patients. Methods: A prospective and consecutive study involving 108 COVID-19 patients was conducted between March and April 2020 at Hospital Clínico Universitario de Valladolid (Spain). Plasma samples from each patient were collected after emergency room admission. Forty-five serum cytokines were measured in duplicate, and clinical data were analyzed using SPPS version 25.0. Results: A multivariate predictive model showed high hepatocyte growth factor (HGF) plasma levels as the only cytokine related to intubation or death risk at hospital admission (OR = 7.38, 95%CI—(1.28–42.4), p = 0.025). There were no comorbidities included in the model except for the ABO blood group, in which the O blood group was associated with a 14-fold lower risk of a poor outcome. Other clinical variables were also included in the predictive model. The predictive model was internally validated by the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.94, a sensitivity of 91.7% and a specificity of 95%. The use of a bootstrapping method confirmed these results. Conclusions: A simple, robust, and quick predictive model, based on the ABO blood group, four common laboratory values, and one specific cytokine (HGF), could be used in order to predict poor outcomes in COVID-19 patients.

757. Evaluating Use of the New ICD-10 Codes for Clostridioides difficile Infection in the Premier U.S. Hospital Discharge Database

Background The single ICD-10 code for Clostridioides difficile infection (CDI) A04.7 was replaced in Oct 2017 with two codes delineating “recurrent CDI” (rCDI, A04.71) and “nonrecurrent CDI” (nrCDI, A04.72). This study aims to evaluate and validate use of the new ICD-10 codes for CDI among inpatient encounters at hospitals contributing to the Premier Healthcare Database (PHD). Methods This retrospective study included inpatient encounters with a CDI-related ICD code between Oct 2016-May 2019 in the PHD. Trends in CDI-related ICD coding were examined pre- and post- the Oct 2017 code update. Post Oct 2017, CDI-related inpatient encounters were characterized by clinical, facility, and provider variables, and whether coding was concordant or discordant to the 2017 IDSA guidelines ‘within 60-days (2 months) from index CDI episode’ time window for capturing rCDI. Multivariable regression examined variables associated with concordant coding. Results There was widespread adoption of the new CDI codes across hospitals in the PHD in Oct 2017. Post-Oct 2017, a total of 21,446 CDI-related encounters met sample selection criteria. About 67% of rCDI encounters and 25% of nrCDI encounters were coded concordantly. In the overall sample, the rCDI vs. nrCDI-coded encounters (p< 0.05) had higher proportions with emergency room admission, admitted by a gastroenterologist or infectious disease specialist, and receiving fidaxomicin, bezlotoxumab or FMT. Trends in inpatient characteristics for rCDI vs. nrCDI-coded encounters did not differ by coding concordance status. In regression analyses, encounters coded concordantly were significantly more likely to be for rCDI (OR 5.67), a non-elective admission (OR 1.17-1.42), or prescribed fidaxomicin (OR 1.11), or FMT (OR 1.29). Encounter Frequency Frequency Table Resource and Cost Table Conclusion There was no delay in transition to the new CDI-related ICD codes across hospitals in the PHD. Important for disease management, drug treatment trends for encounters coded as rCDI vs. nrCDI were consistent with guideline-recommendations for CDI. Coding concordance status based on the IDSA 60-day time window for identifying rCDI did not affect direction of observed trends in descriptive analyses, suggesting that other validation methods maybe needed. Regression Table Disclosures Abhishek Deshpande, MD, PhD, Merck & Co., Inc (Consultant, Shareholder)The Clorox Company (Grant/Research Support) Yiyun Chen, PhD, Merck & Co., Inc (Employee) Eugenia Boye-Codjoe, MPH, Merck & Co., Inc (Employee) Engels N. Obi, PhD, Merck & Co. (Employee, Shareholder)

Is There a Role for Topical Swallowed Steroids upon Emergency Room Admission for Suspected Food Bolus Obstruction in Eosinophilic Esophagitis?

Since most pharmacological treatments in case of esophageal food impaction (EFI) are unsuccessful, an endoscopy is usually required to resolve EFI. We present the first results of a budesonide orodispersible tablet (BOT) as a medical treatment option before endoscopy. We evaluated all patients with a suspected EFI to receive BOT before emergent endoscopy at a tertiary hospital between March 2019 and June 2020. A total of eight patients received BOT before endoscopy. Mean age was 50.1 years and 87.5% were male. In 38% (3/8) of patients the EFI resolved without endoscopic intervention. No adverse events occurred. After endoscopy, a diagnosis of EoE was established in 75%. This case series demonstrate the potential of BOT as medical rescue therapy in case of EFI.

Dual opioid therapy in a cancer patient with myasthenia gravis who developed respiratory depression from codeine

This case report describes a patient who was referred to our unit after an emergency room admission for respiratory depression induced by codeine, and was successfully managed with tapentadol.

An 8-year retrospective review of gastrointestinal medical emergency conditions at a tertiary health facility in Nigeria

Background: Globally, gastrointestinal emergency conditions constitute a considerable proportion of the medical emergency cases seen in the emergency room.Objective: This study investigated the spectrum of gastrointestinal medical emergency conditions seen in the emergency room of Federal Teaching Hospital Ido-Ekiti, Nigeria.Materials and Methods: The emergency room admission register was used to obtain the following information: Age, Sex, Diagnosis, Year of admission and the Outcome. The period under review was 1st January 2009 to 31st December 2016. The data was analyzed using the SPSS version 21.0 software package.Results: A total number of 5,912 patients with medical emergency conditions were admitted into the emergency room during the period under review, out of which 813(13.7%) were gastrointestinal medical emergency conditions. The age range of the patients was 15 to 100years with a mean(±SD) of 47.32±18.938. Acute exacerbation of acid peptic disorders(29.3%) was the most common indication for emergency room admission followed by acute gastroenteritis(26.8%) and decompensated chronic liver disease(14.3%). Decompensated chronic liver disease and upper gastrointestinal bleeding were the conditions with the highest mortality being 31.8% and 29.5% respectively.Conclusion: Gastrointestinal medical conditions are common indications for emergency admission. Measures should be taken to avoid these preventable conditions in a bid to reduce their morbidity and mortality.