key: cord-1010650-yumv3nev
authors: Fatade, Yetunde A; Collins, Lauren F; Collins, Lauren F; Almuwaqqat, Zakaria; Chen, ZhenChao; Prasad, Mahadev; Quyyumi, Arshed; Ofotokun, Igho
title: 441. The Effects of Race and Comorbidity Burden on Inflammatory Biomarkers Among Persons Hospitalized with COVID-19
date: 2021-12-04
journal: Open Forum Infect Dis
DOI: 10.1093/ofid/ofab466.640
sha: 3a9271a8b3d7a262145a9de53ac2763f7ea17904
doc_id: 1010650
cord_uid: yumv3nev

BACKGROUND: African Americans (AA) and Latinos, compared with Whites, experience disproportionately higher rates of morbidity and mortality in COVID-19. Exuberant inflammatory responses may explain, in part, the differences in disease severity in COVID-19 observed among different demographic groups. METHODS: In a retrospective cohort study, we analyzed data from patients aged ≥18 years hospitalized for COVID-19 (confirmed by positive SARS-CoV-2 PCR) from 3/1/2020 – 12/31/2020 at Emory Healthcare hospitals. Patient demographics, clinical characteristics, and peak levels of high-sensitivity C-reactive protein (hs-CRP) during hospitalization were abstracted from electronic medical record. Comorbidity burden was defined as the number of six total comorbidities assessed per patient. Multivariable logistic regression (adjusted for age, sex, body mass index [BMI], smoking status) assessed the effects of race and comorbidity burden on peak hs-CRP level. RESULTS: 3,860 patients, median age 60 [18-108] years, 51% female, 57% AA, 28% White, 6% Latino and 9% other races were enrolled. Median comorbidity burden per patient was 2 (Q1-Q3, 1-3), with prevalent comorbidities distributed as follows: 68% had hypertension, 43% renal disease, 42% diabetes, 16% cardiovascular disease, 12% lung disease, and 5% cancer. Unadjusted peak hs-CRP (mg/L) levels were highest among Latino patients (144.9) followed by other races (137), AA (130.3), and Whites (122.2). In adjusted models (including race), the mean difference in peak hs-CRP (mg/L) compared with patients who had no comorbidities was 18.7 (p=0.108), 56.7 (p< 0.001), and 78.2 mg/L (p< 0.001) for 1, 2, and ≥3 comorbidities, respectively. In adjusted models (including comorbidity burden), the mean level of peak hs-CRP, compared with Whites, was 34.2 (p< 0.001), 38.4 (p=0.003), and 36.0 mg/L (p=0.06) higher in AA, Latinos, and other races, respectively. CONCLUSION: Among patients hospitalized with COVID-19, non-White race and comorbidity burden were associated with significantly higher levels of inflammation. These findings suggest that exuberant inflammatory responses may be driving, in part, the differences in COVID-19 disease severity observed across different demographic groups. DISCLOSURES: Lauren F. Collins, MD, MSc, Nothing to disclose

The University of Toledo College of Medicine, Toledo, Ohio Session: P-21. COVID-19 Research Background. A naïve Bayes classifier is a popular tool used in assigning variables an equal and independent contribution to a binary decision. With respect to COVID-19 severity, the naïve Bayes classifier can consider different variables, such as age, gender, race/ethnicity, comorbidities, and initial laboratory values to determine the probability a patient may need to be admitted or transferred to an intensive care unit (ICU). The aim of this study was to develop a screening tool to detect COVID-19 patients that may require escalation to ICU status.

Methods. Patients hospitalized with COVID-19 were gathered from the end of March 2020 to the end of May 2020 from four hospitals in our metropolitan area. We began searching for potential variables to include in the classification model using chi-square analysis or calculating the optimal cutpoint to separate ICU and non-ICU status. After identifying significant variables, we began using standard procedures to construct a classifier. The dataset was split 7:3 to create samples for training and testing. To appraise the model's performance, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC), and the Matthew's correlation coefficient (MCC) were calculated. Abbreviations: HR: Hazard ratio, CI: Confidence interval, CWIC: Charlson weighted index of comorbidity, qSOFA: Quick sepsis related organ failure assessment Conclusion. After controlling for risk factors for mortality including age, comorbidity and sepsis-related organ failure assessment, males continued to have a higher hazard of death. These demographic and clinical factors may help healthcare providers identify risk factors from COVID-19.

Disclosures. All Authors: No reported disclosures

Pre-vaccination Antibody Titers Against Seasonal Coronaviruses And Antibody Responses to the Pfizer-BioNTech BNT162b2 COVID-19 mRNA Vaccine in Healthcare Workers Eric Laing, PhD 1 ; Si' Ana Coggins

MD 8 ; 1 Uniformed Services University of the Health Sciences

General Dynamics Information Technology

Background. The Prospective Assessment of SARS-CoV-2 Seroconversion (PASS) study is following over 200 healthcare workers who have received the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. A major aim of the study is to determine whether baseline antibody titers against the seasonal human coronaviruses are associated with altered levels of vaccine-induced antibody responses to SARS-CoV-2.Methods. Serial serum samples obtained pre-vaccination and 1 month after the second dose were tested for IgG antibodies against the full pre-fusion spike protein and the receptor binding domain (RBD) of SARS-CoV-2, as well as the full pre-fusion spike proteins of OC43, HKU1, 229E, and NL63. Antibodies were measured using highly sensitive and specific multiplex assays based on Luminex-xMAP technology.Results. Preliminary analyses of the first 103 subjects in whom we have 1 month post-vaccination serum demonstrate development of high IgG geometric mean titers (GMT) to both the full spike protein (GMT: 13,685, 12,014-15,589, 95% CI) and the RBD (GMT: 19,448, 17,264-21,908, 95% CI) of SARS-CoV-2 after the 2 nd vaccine dose. Preliminary analysis demonstrates no association between baseline antibody titers against spike protein of OC43 and antibody titers against SARS-CoV-2 spike protein (Pearson's r-value= 0.13, P-value= 0.21) or RBD (Pearson's r-value= 0.09, P-value= 0.36) one month after vaccination. Future analyses will evaluate whether there is an association with baseline seasonal coronavirus antibody titers and either SARS-CoV-2 neutralization titers or anti-SARS-CoV-2 spike protein titers at 6 months after vaccination.Conclusion. These preliminary results suggest that baseline antibody responses to seasonal coronaviruses neither boost nor impede SARS-CoV-2 vaccine-induced antibody responses. Longitudinal sampling will enable assessment of vaccine durability and determination of whether baseline seasonal coronavirus antibody levels are associated with altered duration of detectable COVID-19 vaccine-induced antibody responses.Disclosures. Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work)) David Tribble, M.D., DrPH, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))