309. TB Quantiferon Testing Predicts Mortality in Patients with COVID-19

Abstract Background Finding reliable clinical predictors for severity of COVID-19 has been challenging. Interferon gamma (IFNG) plays an important role in viral replication. QuantiFERON-TB (QFT) test relies on IFNG release in response to antigens. A positive or negative test signifies adequate IFNG response, whereas an indeterminate result is obtained when such a response is lacking. In this study, we have attempted to see if an indeterminate QFT result can provide prognostic information on patients with COVID–19. Survival Probability in patients with Covid - 19 and an indeterminate TB Quantiferon test result Methods This is a retrospective study of patients who were admitted at our institute with COVID–19 and had a QFT done within one month of the positive SARS-CoV-2 nucleic acid amplification test result. Patient charts were analyzed for clinical course and outcomes, including in-hospital mortality (primary outcome), 90-day mortality, respiratory failure, requirement for intubation and other complications that would portend a more severe disease course. Results A total of 120 patient charts were analyzed, out of which 43 (35.8%) had an indeterminate QFT. All the indeterminate results were due to an inadequate mitogen response. The indeterminate QFT group had a 41.86% (18/43) in-hospital mortality vs. 9.09% (7/77) in the negative or positive QFT group (p-value of < 0.001). The 90-day mortality was similar between the two groups. Patients with indeterminate QFT also had a higher incidence of respiratory failure (97.7% vs. 75.3%; p-value = 0.020), requirement for mechanical ventilation (55.8% vs. 23.4%; p-value < 0.001), requirement of ECMO (25.58% vs. 0%; p-vale < 0.001), requirement of pressor (48.83% vs. 14.28%; p-value < 0.001) and requirement for renal replacement therapy (32.5% vs. 1.3%; p-value < 0.001), when compared to patients with a negative or positive QFT. Patients in indeterminate group had a higher hospital length of stay than the other group (p-value = 0.035). Conclusion Our study indicates that patients with COVID-19 who fail to mount an adequate IFNG mitogen response in QFT assay have worse clinical outcomes and a more complicated and protracted clinical course. Evaluating cell-mediated immune responses through commercially available IFNG release assays may yield a promising strategy to predict COVID-19 clinical outcomes. Disclosures All Authors: No reported disclosures

Methods. This was a retrospective review of pts requiring ECMO for COVID-19 from April 2020-2021 at a single center. Strict definitions of infections (including ventilator-associated PNA, VAP) were in accordance with CDC criteria.

Conclusion.
Super-infection (most commonly PNA) occurred in almost all COVID-19 pts requiring ECMO for >4 days, and was a significant risk factor for death. Recurrent infections among survivors were common, especially when caused by Enterbacterales or S. aureus. Super-infection and mortality rates of ARDS pts on ECMO for COVID-19 were worse than for ARDS pts on ECMO for influenza at our center.
Disclosures Background. Finding reliable clinical predictors for severity of COVID-19 has been challenging. Interferon gamma (IFNG) plays an important role in viral replication. QuantiFERON-TB (QFT) test relies on IFNG release in response to antigens. A positive or negative test signifies adequate IFNG response, whereas an indeterminate result is obtained when such a response is lacking. In this study, we have attempted to see if an indeterminate QFT result can provide prognostic information on patients with COVID-19.

Survival Probability in patients with Covid -19 and an indeterminate TB Quantiferon test result
Methods. This is a retrospective study of patients who were admitted at our institute with COVID-19 and had a QFT done within one month of the positive SARS-CoV-2 nucleic acid amplification test result. Patient charts were analyzed for clinical course and outcomes, including in-hospital mortality (primary outcome), 90-day mortality, respiratory failure, requirement for intubation and other complications that would portend a more severe disease course.
Results. A total of 120 patient charts were analyzed, out of which 43 (35.8%) had an indeterminate QFT. All the indeterminate results were due to an inadequate mitogen response. The indeterminate QFT group had a 41.86% (18/43) in-hospital mortality vs. 9.09% (7/77) in the negative or positive QFT group (p-value of < 0.001). The 90-day mortality was similar between the two groups. Patients with indeterminate QFT also had a higher incidence of respiratory failure (97.7% vs. 75.3%; p-value = 0.020), requirement for mechanical ventilation (55.8% vs. 23.4%; p-value < 0.001), requirement of ECMO (25.58% vs. 0%; p-vale < 0.001), requirement of pressor (48.83% vs. 14.28%; p-value < 0.001) and requirement for renal replacement therapy (32.5% vs. 1.3%; p-value < 0.001), when compared to patients with a negative or positive QFT. Patients in indeterminate group had a higher hospital length of stay than the other group (p-value = 0.035).
Conclusion. Our study indicates that patients with COVID-19 who fail to mount an adequate IFNG mitogen response in QFT assay have worse clinical outcomes and a more complicated and protracted clinical course. Evaluating cell-mediated immune responses through commercially available IFNG release assays may yield a promising strategy to predict COVID-19 clinical outcomes. Background. Fungal infections have been identified with or following SARS-CoV-2 infection, most commonly COVID associated pulmonary aspergillosis. Cryptococcus species are ubiquitous in the environment and the third most common invasive fungal infection following Solid Organ Transplant (SOT). We describe four cases of concurrent or subsequent cryptococcal infection within 90 days following COVID-19 infection.

Cryptococcal Infection Following COVID-19 infection in Solid Organ Transplant Recipients: A Case Series
Methods. We conducted a retrospective study of patients presenting with proven cryptococcosis either concurrently or within 90 days following COVID-19 diagnosis. Cases were identified March 2020 through May 2021. All were seen at the University of Alabama in Birmingham, a regional referral and comprehensive transplant center. Exemption for this review was approved by our IRB.
Results. Four cases were identified, all were SOT recipients. Case details are provided in Table 1. No patients required ICU level care at any point. COVID-19 treatment included 10 days of increased steroids for 3 patients, remdesivir for 2, and 1 received no treatment for COVID-19. In contrast to the typical time-course for cryptococcal infection post-SOT (median time approx. 500 days post-transplant), three patients were greater than 2 years post-transplant and were without rejection or recent changes in immunosuppression. Patient 1 was less than 6 months post liver-kidney transplant and was diagnosed at time of admission with concurrent COVID-19 and cryptococcal pneumonia. Infection was disseminated in the other 3 cases including positive blood cultures in 2 patients and cryptococcal meningitis (CM) in 2 patients. CM cases presented later following COVID-19 and had the longest delay between symptom onset (headache, neurologic symptoms) and CM diagnosis. One patient had CM 8 years prior, but had done extremely well off fluconazole for over 6 years prior to this recurrence. All patients are doing well at most recent follow-up evaluations.

Conclusion.
We describe the first case series with a temporal association between SARS-CoV-2 infection and cryptococcosis. All cases were immunocompromised due to SOT. Some symptoms were attributed to post-COVID syndrome leading to significant delays in diagnosis for those patietns, highlighting the importance of considering this association for at-risk patients.
Disclosures Background. Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease with a prevalence up to 30%. NAFLD is strongly associated with components of metabolic syndrome, already recognized as risk factors for worse outcomes in COVID-19. However, the impact of NAFLD on COVID-19 is not well characterized. The aim of this study was to investigate a possible association between NAFLD and COVID-19 severity and outcomes.
Methods. A prospective observational study included consecutively hospitalized adult patients with severe COVID-19 at the University Hospital for Infectious Diseases in Zagreb, Croatia between March and June 2021. On admission patients were screened for fatty liver by the ultrasound and subsequently diagnosed with NAFLD according to current guidelines. Demographic, clinical and laboratory data was collected and correlated to clinical outcomes.