Khan, Syed Anjum

Abstract Background: Ventilator-associated pneumonia (VAP) is one of the leading causes of mortality in patients with critical care illness. Since obesity is highly prevalent, we wanted to study its impact on the outcomes of patients who develop VAP. Methods: Using the National Inpatient Sample (NIS) Database from 2017 to 2020, we conducted a retrospective study of adult patients with a principal diagnosis of VAP with a secondary diagnosis with or without obesity according to ICD-10 codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included tracheostomy, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a p-value less than 0.05 considered statistically significant. Results: The study included 3832 patients with VAP, 395 of whom had obesity. The mean age in both groups was around 58 years, and 68% of the group with obesity were females compared to 40% in the control group. Statistically significant comorbidities in the obesity group included a Charlson Comorbidity Index score of three and above, Diabetes Mellitus, Hypertension, and chronic kidney disease. Rates and odds of mortality were not significantly higher in the collective obesity group 39 (10%) vs. 336 (8.5%), p-value 0.62, aOR 1.41, p-value 0.39). The rates and odds of tracheostomy were higher in the obesity group but not statistically significant. Obese patients were also found to have a longer and more expensive hospitalization. Conclusions: Obesity was not found to be an independent risk factor for worse outcomes in patients who develop VAP in the intensive care unit.

Abstract Background Early diagnosis, prognostication, and treatment initiation are the cornerstones of sepsis management. There remains an immense interest in exploring the diagnostic and prognostic roles of neutrophil-lymphocyte ratio (NLR) in the sepsis population. Methods We performed a retrospective multi-center observational study including patients admitted to different Mayo Clinic sites with a diagnosis of sepsis between October 2018 and August 2022. Patients were excluded if they were aged < 18 years, lacked research authorization, or had missing Neutrophil or Lymphocyte count at admission. Data were collected from an existing sepsis database and Mayo Data Explorer (MDE). Categorical variables were summarized as percentages and continuous variables were summarized as medians. Chi-square test for significance, independent sample t-test, and multivariate Cox Proportional Hazard models were performed on IBM SPSS Statistics v28.0. Results Our study cohort consisted of 13968 patients, of which the majority were males (55.9%), Caucasian (91.6%), and non-Hispanic or Latino (94.3%). The median age of the cohort was 71 (60, 80) years, and the median BMI was 27.7 (23.4, 33.3) kg/m2. Among all sepsis patients, 6.0% had a positive blood culture and the most common organisms were E. coli (26.5%), Klebsiella sp. (15.6%), Streptococcus sp. (12.8%) and Staphylococcus aureus (9.9%). 13131 patients (94.1%) survived the hospital stay and 837 (5.9%) did not. There was no difference in mortality based on blood culture positivity status (6.0% vs 6.6%, p=0.41). However, the median NLR was higher among patients with a positive blood culture (16.4 vs. 12.1, p< 0.001) and among non-survivors (14.3 vs 12.2, p< 0.001). NLR did not significantly vary based on the type of organism growing in the blood culture. A multivariate model revealed NLR as an independent predictor of mortality (HR 1.003, 95% CI: 1.000-1.006, p=0.029) after adjusting for comorbidities, baseline clinical and laboratory variables. (Tables 1 & 2) Conclusion Our retrospective multicentric study showed that the Neutrophil-Lymphocyte ratio at admission was higher among bacteremic sepsis patients and non-survivors. Further prospective studies are needed to explore its diagnostic and prognostic utility. Disclosures All Authors: No reported disclosures

Eosinophilic granulomatosis with polyangiitis (EGPA) also referred to as Churg-Strauss syndrome is a rare vasculitis of the small to medium vessels. We present a rare case of acute coronary artery dissection brought on by EGPA, which generally has a poor prognosis. A 41-year-old male with history of bronchial asthma presented to the emergency room with a 2-week history of dyspnea, cough with clear phlegm, and fever. For the past eight months he had experienced episodes with similar symptoms relieved by steroids. CT chest showed bilateral upper lobe patchy opacities with extensive workup for infectious etiology being negative. He had peripheral eosinophilia with sinusitis. He had acute coronary syndrome and Coronary angiogram showed Right coronary artery dissection. After making a diagnosis of EGPA based on American college of Rheumatology criteria, he was successfully treated with high dose immunosuppression. Coronary artery dissection is a fatal and uncommon complication of EGPA which is usually diagnosed postmortem. Early recognition of this condition ante mortem and aggressive treatment can be lifesaving as demonstrated in our case.

Abstract Introduction There is evidence of increased risk of admission with influenza in patients with untreated obstructive sleep apnea (OSA). There is however limited evidence of the impact of OSA on patients admitted with influenza pneumonia. We aim to study this association on a nationwide scale. Methods Using the National Inpatient Sample (NIS) Database from 2017 to 2020, a retrospective study of adult patients with principal diagnosis of influenza viral pneumonia with secondary diagnosis with or without obstructive sleep apnea (OSA) according to ICD-10 codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included mechanical intubation, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a p value less than 0.05 considered statically significant. Results The study included 174,339 patients admitted with an influenza pneumonia, 13,094 of which had OSA. The Mean age for patients with and without OSA was 67 and 70 years, respectively. In the OSA group, 48% were females compared to 55% in the non-OSA group. Around 73% in both groups were Caucasian white. Statistically significant comorbidities noticed in the OSA group included chronic kidney disease (29% vs. 22%), Diabetes Mellitus (48% vs. 31%), COPD (47% vs. 31%) . In-hospital mortality rate was not higher in the OSA group with statistical significance (2.1% vs. 2.3%, p =0.48). The adjusted Odds ratio was 0.51 without statistical significance. In-hospital mechanical ventilation and tracheotomy rates were higher in the OSA group with statistical significance (5.3 % vs. 3.7%, p < 0.01) (0.31 % vs. 0.12%, p 0.013 ) however the adjusted odds ratio was not statistically significant in either (aOR 1.27, p value 0.14). (aOR 0.9, p value 0.98). The length of stay was higher in the OSA group (5.5 vs. 4.9 days, adjusted means +0.4 days, p value 0.04) Patients in the OSA group had a higher total charge (59,949$ vs. 44,091$, adjusted means +1,997$ p value 0.45) Conclusion Patients admitted with influenza viral pneumonia with associated OSA were not found to have worse clinical outcomes and a higher economic burden. Support (if any)

A 35-year-old male greenhouse worker presented with myalgia, fatigue, and fever. Initially, he was thought to have an unspecified viral infection and was treated with conservative therapy. However, the patient’s symptoms persisted, and he reported additional symptoms of mild abdominal pain and headaches. Laboratory evaluation was significant for elevated liver enzymes. Due to concern for acute hepatitis and persistent fever the patient was hospitalized. During his hospital course, no infectious etiology was found to explain his symptoms. After discharge from the hospital, additional testing showed positive serology for Q fever IgG phase II antibody (1:8192) and phase II antibody IgM (> 1:2048). He was treated with doxycycline and had a good clinical response. Upon follow-up, he had worsening Phase I IgG serologies. Transesophageal echo demonstrated vegetations consistent with endocarditis.