Dysbiosis and structural disruption of the respiratory microbiota in COVID-19 patients with severe and fatal outcomes

AbstractThe COVID-19 outbreak has caused over three million deaths worldwide. Understanding the pathology of the disease and the factors that drive severe and fatal clinical outcomes is of special relevance. Studying the role of the respiratory microbiota in COVID-19 is especially important as the respiratory microbiota is known to interact with the host immune system, contributing to clinical outcomes in chronic and acute respiratory diseases. Here, we characterized the microbiota in the respiratory tract of patients with mild, severe, or fatal COVID-19, and compared it to healthy controls and patients with non-COVID-19-pneumonia. We comparatively studied the microbial composition, diversity, and microbiota structure between the study groups and correlated the results with clinical data. We found differences in the microbial composition for COVID-19 patients, healthy controls, and non-COVID-19 pneumonia controls. In particular, we detected a high number of potentially opportunistic pathogens associated with severe and fatal levels of the disease. Also, we found higher levels of dysbiosis in the respiratory microbiota of patients with COVID-19 compared to the healthy controls. In addition, we detected differences in diversity structure between the microbiota of patients with mild, severe, and fatal COVID-19, as well as the presence of specific bacteria that correlated with clinical variables associated with increased risk of mortality. In summary, our results demonstrate that increased dysbiosis of the respiratory tract microbiota in patients with COVID-19 along with a continuous loss of microbial complexity structure found in mild to fatal COVID-19 cases may potentially alter clinical outcomes in patients. Taken together, our findings identify the respiratory microbiota as a factor potentially associated with the severity of COVID-19.

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Dysbiosis and structural disruption of the respiratory microbiota in COVID-19 patients with severe and fatal outcomes

10.1101/2021.05.19.21257485 ◽

2021 ◽

Author(s):

Alejandra Hernandez-Teran ◽

Fidencio Mejia-Nepomuceno ◽

Maria Teresa Herrera ◽

Omar Barreto ◽

Emma Garcia ◽

...

Keyword(s):

Clinical Outcomes ◽

Bacterial Infections ◽

Structural Complexity ◽

Immunological Response ◽

Study Groups ◽

Host Immune System ◽

Microbial Composition ◽

Acute Respiratory Diseases ◽

Potential Factor ◽

Respiratory Microbiota

COVID-19 outbreak has caused over 3 million deaths worldwide. Understanding disease pathology and the factors that drive severe and fatal clinical outcomes is of special relevance. Studying the role of the respiratory microbiota in COVID-19 is particularly important since it is known that the respiratory microbiota interacts with the host immune system, contributing to clinical outcomes in chronic and acute respiratory diseases. Here, we characterized the microbiota in the respiratory tract of patients with mild, severe, or fatal COVID-19, and compared with healthy controls and patients with non-COVID-19-pneumonia. We comparatively studied the microbial composition, diversity, and microbiota structure across study groups and correlated the results with clinical data. We found differences in diversity and abundance of bacteria between groups, higher levels of dysbiosis in the respiratory microbiota of COVID-19 patients (regardless of severity level), differences in diversity structure among mild, severe, and fatal COVID-19, and the presence of specific bacteria that correlated with clinical variables associated with increased mortality risk. Our data suggest that host-related and environmental factors could be affecting the respiratory microbiota before SARS-CoV-2 infection, potentially compromising the immunological response of the host against disease and promoting secondary bacterial infections. For instance, the high levels of dysbiosis coupled with low microbial structural complexity in the respiratory microbiota of COVID-19 patients, possibly resulted from antibiotic uptake and comorbidities, could have consequences for the host and microbial community level. Altogether, our findings identify the respiratory microbiota as a potential factor associated with COVID-19 severity.

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Abstract 16202: Changes in Hemoglobin After Pulmonary Artery Catheterization: Results From the ESCAPE Trial

Circulation ◽

10.1161/circ.130.suppl_2.16202 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Abdulla Damluji ◽

Conrad Macon ◽

Mohammed Al-Damluji ◽

Arieh Fox ◽

George R Marzouka ◽

...

Keyword(s):

Pulmonary Artery ◽

Clinical Outcomes ◽

Cox Regression ◽

Evaluation Study ◽

Cardiac Transplant ◽

Pulmonary Artery Catheterization ◽

Escape Trial ◽

Cox Regression Analysis ◽

Risk Of Mortality ◽

Increased Risk

Introduction: We sought to investigate the association between hemoglobin (Hgb) changes in patients with ADHF (with and without PACs) to mortality and clinical outcomes. Methods: We examined 433 patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Change of Hgb (g/dL) was defined as at least 1 (g/dL) drop by hospital discharge. Quartiles of % change of Hgb (g/dL) were calculated. We used multivariable Cox regression analysis to evaluate the effect Hgb change on mortality and composite end points of death, cardiac re-hospitalization, or cardiac transplant. Results: Of the 433 patients, 324 (75%) had baseline and discharge Hgb available for analysis. Of those, 64 (20%) had at least 1 (g/dL) drop of Hgb by time of discharge. Patients in the Hgb drop group were older than those without Hgb changes (59 vs. 55, p = 0.011). There were no baseline differences in gender, race, and etiology of HF between groups. Compared to patients without Hgb changes, patients with Hgb drop had lower systolic BP (99 vs. 106, p = 0.017), lower sodium (136 vs. 137, p =0.025), higher BUN (37 vs. 26, p <0.001), and higher Creatinine (1.6 vs. 1.3, p <0.001), respectively. Higher Hgb drop was observed in the PACs (vs. no PACs) randomized arm of the trial (2 g/dL: PACs 10% versus 3%, p =0.010; 3 g/dL: PACs 5% versus 0%, p =0.005). After adjustments, higher in-hospital Hgb was associated with lower mortality (HR 0.79, p =0.003). In addition, patients in the Hgb drop group had increased risk of mortality (Adjusted HR 2.38, p =0.003) and composite endpoints (Adjusted HR 1.43, p =0.055). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin (Mortality: Q1: HR 0.80, p 0.601, Q2 HR 0.79, p = 0.706, Q3 HR 0.34, p =0.101, Q4 HR 2.23, p =0.357). Conclusion: In-hospital decrease in Hgb is independently associated with increased long-term mortality and adverse cardiovascular events in severe HF. The ideal Hgb levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.

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To jump or not to jump? A multicentre propensity-matched study of sequential vein grafting of the heart

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz042 ◽

2019 ◽

Vol 29 (2) ◽

pp. 201-208 ◽

Cited By ~ 1

Author(s):

Jens K Skov ◽

Hans-Henrik Kimose ◽

Jacob Greisen ◽

Carl-Johan Jakobsen

Keyword(s):

Artery Bypass ◽

Postoperative Bleeding ◽

Study Groups ◽

Confidence Limits ◽

Risk Of Mortality ◽

Increased Risk ◽

Early Graft ◽

Matched Study ◽

Early Graft Failure

AbstractOBJECTIVESIn this propensity-matched study we investigated the outcome after grafting with either a single vein or a sequential vein grafting strategy. Outcomes were primarily risk of reintervention and death in the short, intermediate and long term (10 years).MATERIALSIn the period from 2000 to 2016, data from 24 742 patients undergoing coronary artery bypass grafting were extracted from the Western Denmark Heart Registry, where data are registered perioperatively. We used a propensity-matched study in which the study groups were matched on parameters primarily from the EuroSCORE. The numbers of patients in both groups after matching were 3380.RESULTSSingle grafts resulted in significantly more postoperative bleeding and were more time-consuming. No differences were seen regarding in-hospital events such as stroke, acute myocardial infarction, dialysis or arrhythmias. After 30 days, patients in the jump graft group showed an increased rate of reintervention due to ischaemia after adjusting for confounding factors [hazard ratio (HR) 2.08, 95% confidence interval 1.01–4.34]. In addition, after adjusting for known confounders, sequential grafts were found to increase the risk of mortality at 6 months (HR 1.51, 95% confidence limits 1.07–2.11) and 5 years (HR 1.23, 95% confidence limits 1.04–1.46).CONCLUSIONSThis propensity-matched analysis suggested, although discretely, that a jump graft as a grafting strategy is associated with a slightly increased risk of mortality and early graft failure and that a single grafting strategy to the coronary arteries should be preferred when feasible.

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Platelet reactivity and clinical outcomes in acute coronary syndrome patients treated with prasugrel and clopidogrel: a pre-specified exploratory analysis from the TROPICAL-ACS trial

European Heart Journal ◽

10.1093/eurheartj/ehz202 ◽

2019 ◽

Vol 40 (24) ◽

pp. 1942-1951 ◽

Cited By ~ 16

Author(s):

Dániel Aradi ◽

Lisa Gross ◽

Dietmar Trenk ◽

Tobias Geisler ◽

Béla Merkely ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Outcomes ◽

Independent Predictor ◽

Platelet Reactivity ◽

Academic Research ◽

Study Groups ◽

Cardiovascular Death ◽

Control Group ◽

Coronary Syndrome ◽

Increased Risk

Abstract Aims The value of platelet function testing (PFT) in predicting clinical outcomes and guiding P2Y12-inhibitor treatment is uncertain. In a pre-specified sub-study of the TROPICAL-ACS trial, we assessed ischaemic and bleeding risks according to high platelet reactivity (HPR) and low platelet reactivity (LPR) to ADP in patients receiving uniform prasugrel vs. PFT-guided clopidogrel or prasugrel. Methods and results Acute coronary syndrome patients with PFT done 14 days after hospital discharge were included with prior randomization to uniform prasugrel for 12 months (control group, no treatment modification) vs. early de-escalation from prasugrel to clopidogrel and PFT-guided maintenance treatment (HPR: switch-back to prasugrel, non-HPR: clopidogrel). The composite ischaemic endpoint included cardiovascular death, myocardial infarction, or stroke, while key safety outcome was Bleeding Academic Research Consortium (BARC) 2–5 bleeding, from PFT until 12 months. We identified 2527 patients with PFT results available: 1266 were randomized to the guided and 1261 to the control group. Before treatment adjustment, HPR was more prevalent in the guided group (40% vs. 15%), while LPR was more common in control patients (27% vs. 11%). Compared to control patients without HPR on prasugrel (n = 1073), similar outcomes were observed in guided patients kept on clopidogrel [n = 755, hazard ratio (HR): 1.06 (0.57–1.95), P = 0.86] and also in patients with HPR on clopidogrel switched to prasugrel [n = 511, HR: 0.96 (0.47–1.96), P = 0.91]. In contrast, HPR on prasugrel was associated with a higher risk for ischaemic events in control patients [n = 188, HR: 2.16 (1.01–4.65), P = 0.049]. Low platelet reactivity was an independent predictor of bleeding [HR: 1.74 (1.18–2.56), P = 0.005], without interaction (Pint = 0.76) between study groups. Conclusion Based on this substudy of a randomized trial, selecting prasugrel or clopidogrel based on PFT resulted in similar ischaemic outcomes as uniform prasugrel therapy without HPR. Although infrequent, HPR on prasugrel was associated with increased risk of ischaemic events. Low platelet reactivity was a strong and independent predictor of bleeding both on prasugrel and clopidogrel.

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P681Acute Myocardial Infarction in patients with Leukaemia: A national analysis of prevalence, predictors and outcomes in United States hospitalisations (2004 to 2014)

European Heart Journal ◽

10.1093/eurheartj/ehz747.0287 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M O Mohamed ◽

J C Lopez-Mattei ◽

C A Iliescu ◽

P Purwani ◽

A Bharadwaj ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Coronary Intervention ◽

Cardiac Complications ◽

Risk Of Mortality ◽

Cerebrovascular Events ◽

Increased Risk ◽

Percutaneous Coronary ◽

History Of ◽

National Analysis

Abstract Background Patients with leukaemia are at increased risk of cardiovascular events. There is limited outcomes data for patients with a history of leukaemia who present with an acute myocardial infarction (AMI). Purpose To examine the prevalence and clinical characteristics of patients with leukaemia presenting with AMI, and evaluate differences in clinical outcomes according to the subtype of leukaemia in comparison to patients without leukaemia. Methods We analysed the Nationwide Inpatient Sample (2004–2014) for patients with a primary discharge diagnosis of AMI and concomitant leukaemia, and further stratified according to the subtype of leukaemia into 4 groups; AML; ALL; CML; and CLL. Multiple logistic regression was conducted to identify the association between leukaemia and major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and bleeding. Results Out of 6,750,927 AMI admissions, a total of 21,694 patients had a leukaemia diagnosis. The leukaemia group experienced higher rates of MACCE (11.8% vs. 7.8%), mortality (10.3% vs. 5.8%) and bleeding (5.6% vs. 5.3%). Following adjustments, leukaemia was independently associated with increased odds of MACCE (OR 1.26 [1.20,1.31]) and mortality (OR 1.43 [1.37,1.50]) without an increased risk of bleeding (OR 0.86 [0.81,0.92]). Acute myeloid leukaemia (AML) was associated with approximately three-fold risk of MACCE (RR 2.81 [2.51, 3.13]) and a four-fold risk of mortality (RR 3.75 [3.34, 4.22]) (Figure 1). Patients with leukaemia were less likely to undergo coronary angiography (CA) (48.5% vs. 64.5%) and percutaneous coronary intervention (PCI) (28.2% vs. 42.9%) compared to those without leukaemia. Figure 1.Relative risk of adverse events Conclusion Patients with leukaemia, especially those with AML, are associated with poor clinical outcomes after AMI, and are less likely to receive CA and PCI compared to those without leukaemia. A multi-disciplinary approach between cardiologists and haematology oncologists may improve the outcomes of patients with leukaemia after AMI.

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Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study

Jornal Brasileiro de Pneumologia ◽

10.36416/1806-3756/e20210039 ◽

2021 ◽

pp. e20210039

Author(s):

Gabriel Valdivia1 ◽

Alexia Schmidt1 ◽

Bettina Schmidt1 ◽

Francisca Rivera1 ◽

Aileen Oñate2 ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Study Groups ◽

Hospitalized Patients ◽

Risk Of Mortality ◽

Obstructive Sleep ◽

Populations At Risk ◽

Increased Risk ◽

Obesity Hypertension ◽

A Prospective Study ◽

Score Risk

Objective: Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients. Methods: This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; = 3 score, risk of OSA; and = 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period. Results: The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores = 3 and = 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score = 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality. Conclusions: In this cohort of hospitalized patients, STOP-Bang scores = 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.

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Hyperkalemia excursions are associated with an increased risk of mortality and hospitalizations in hemodialysis patients

Clinical Kidney Journal ◽

10.1093/ckj/sfaa208 ◽

2020 ◽

Author(s):

Angelo Karaboyas ◽

Bruce M Robinson ◽

Glen James ◽

Katarina Hedman ◽

Carol P Moreno Quinn ◽

...

Keyword(s):

Clinical Outcomes ◽

Cox Regression ◽

Target Range ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Using Data ◽

Dialysis Outcomes ◽

Mortality Hazard Ratio ◽

New Strategies

Abstract Background Hyperkalemia is common among hemodialysis (HD) patients and has been associated with adverse clinical outcomes. Previous studies considered a single serum potassium (K) measurement or time-averaged values, but serum K excursions out of the target range may be more reflective of true hyperkalemia events. We assessed whether hyperkalemia excursions lead to an elevated risk of adverse clinical outcomes. Methods Using data from 21 countries in Phases 4–6 (2009–18) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), we investigated the associations between peak serum K level, measured monthly predialysis, over a 4-month period (‘peak K’) and clinical outcomes over the subsequent 4 months using Cox regression, adjusted for potential confounders. Results The analysis included 62 070 patients contributing a median of 3 (interquartile range 2–6) 4-month periods. The prevalence of hyperkalemia based on peak K was 58% for >5.0, 30% for >5.5 and 12% for >6.0 mEq/L. The all-cause mortality hazard ratio for peak K (reference ≤5.0 mEq/L) was 1.15 [95% confidence interval (CI) 1.09, 1.21] for 5.1–5.5 mEq/L, 1.19 (1.12, 1.26) for 5.6–6.0 mEq/L and 1.33 (1.23, 1.43) for >6.0 mEq/L. Results were qualitatively consistent when analyzing hospitalizations and a cardiovascular composite outcome. Conclusions Among HD patients, we identified a lower K threshold (peak K 5.1–5.5 mEq/L) than previously reported for increased risk of hospitalization and mortality, with the implication that a greater proportion (>50%) of the HD population may be at risk. A reassessment of hyperkalemia severity ranges is needed, as well as an exploration of new strategies for effective management of chronic hyperkalemia.

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The Impact of Obesity on Mortality and Clinical Outcomes in Patients with Acute Diverticulitis in the United States

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-2988 ◽

2021 ◽

Author(s):

Michael Makar ◽

Thomas John Pisano ◽

Weiyi Xia ◽

Patricia Greenberg ◽

Anish Vinit Patel

Keyword(s):

Morbid Obesity ◽

Length Of Stay ◽

Diverticular Disease ◽

Clinical Outcomes ◽

Acute Diverticulitis ◽

The United States ◽

Hospital Charges ◽

Surgical Interventions ◽

Risk Of Mortality ◽

Increased Risk

Background and Aims: Diverticular disease represents a leading cause of gastrointestinal-related hospitalizations. We sought to identify the adverse consequences of obesity on acute diverticulitis (AD) hospital admissions. By age 85, approximately two-thirds of individuals will develop diverticular disease and up to 25% will develop AD. Generally, obesity confers an increased risk of morbidity and mortality; however, its impact on hospitalized patients with AD are lacking. Methods: Utilizing ICD-9-CM codes from the National Inpatient Sample (January 2012 – October 2015) we identified patients with a primary discharge diagnosis of AD including 660,820 hospitalizations and 115,785 with obesity. Primary outcomes were mortality, length of stay, and hospitalization cost. Secondary outcomes were AD complications and the need for surgical interventions. Results: On multivariate analysis, obesity was not associated with an increased risk of mortality (OR=1.1, 95%CI: 0.87-1.41; p= 0.43). However, morbid obesity (BMI > 40 kg/m2) showed a significant increased risk of mortality (OR=1.69, 95%CI: 1.23-2.31; p<0.001). Obesity was associated with prolonged hospitalizations length of stay by 0.61 days (0.55-0.68; p <10-6), higher hospital charges $6,320 ($ 5,500-7,140; p<10-6), increased complicated diverticulitis 1.05 (1.01-1.1; p < 0.010) and required more surgical interventions for diverticulitis (OR=1.19, 95%CI: 1.15-1.23; p<10-6). Conclusion: Morbid obesity increases risk for mortality while obesity leads to longer hospitalization stays and greater healthcare cost as well as adverse clinical outcomes and more surgical interventions. Further interventions are required to address obesity and weight loss for patients with diverticulitis to improve clinical outcomes.

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Diabetes and COVID-19 Vaccination

Journal of Korean Diabetes ◽

10.4093/jkd.2021.22.4.221 ◽

2021 ◽

Vol 22 (4) ◽

pp. 221-224

Author(s):

Hae Dong Choi ◽

Jun Sung Moon

Keyword(s):

Immune Response ◽

Blood Glucose ◽

Clinical Outcomes ◽

Glucose Control ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Effective Strategy ◽

Risk Of Mortality ◽

Increased Risk ◽

Patients With Diabetes

Diabetes is one of the major comorbidities associated with increased risk of mortality and severe clinical outcomes in coronavirus disease 19 (COVID-19) patients. Thus, timely and appropriate vaccination is the most effective strategy for mitigating the risk of COVID-19 infection in people with diabetes. Recent studies have shown that immune response after vaccination is significant in both diabetes and non-diabetes groups, but slightly lower in patients with diabetes. Inadequate glucose control might impair the immune response. Blood glucose monitoring is required more often than usual for several days after vaccination. If a patient’s blood glucose is not controlled adequately, appropriate management should be provided.

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Longer Hospitalizations, Increased Inpatient Mortality and Costs Are Associated with Alloimmunization Among Patients with Myelodysplastic Syndromes

Blood ◽

10.1182/blood-2021-145874 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1075-1075

Author(s):

Eric Gehrie ◽

Elisabet Viayna ◽

Christopher Blanchette ◽

Geralyn Meny ◽

Ghislain Noumsi ◽

...

Keyword(s):

Intensive Care ◽

Clinical Outcomes ◽

Myelodysplastic Syndromes ◽

Diagnosis Related Groups ◽

Limited Resource ◽

Study Groups ◽

World Health ◽

Inpatient Mortality ◽

Cross Sectional ◽

Increased Risk

Abstract Red Blood Cell (RBC) transfusions remain an important part of the management of anemia caused by myelodysplastic syndromes (MDS). Almost 90% of patients diagnosed with MDS require at least one RBC transfusion and 30%-45% require chronic transfusions (Singhal Haematologica. 2017;102(12):2021-2029). Importantly, it is estimated that 11% of MDS patients form alloantibodies as a result of RBC transfusions. Despite this relatively high alloimmunization rate, MDS patients are almost never prophylactically transfused with RBCs from antigen-matched donors, a strategy which has been shown to reduce the incidence of alloimmunization among patients with sickle cell disease, but which also increases costs and utilizes a limited resource (antigen negative RBCs). Herein, we present the economic and clinical burden of RBC alloimmunization in MDS patients, in order to better inform decision making regarding prophylactic RBC antigen matching. A cross-sectional study using the Premier Hospital chargemaster dataset was performed. All outpatient and inpatient discharges from January 2015 to June 2019 were included. MDS was defined using ICD-10 code D.46. Because there is no diagnosis code for alloimmunization, alloimmunized patients were identified based on the presence of antiglobulin crossmatch (CXM) and RBC antibody identification (RAI) codes in Premier records. This approach was validated by comparing the published rate of alloimmunization observed in patients diagnosed with MDS as well as hereditary hemorrhagic telangiectasia (HHT; another population with a relatively high alloimmunization rate) to the prevalence of both CXM and RAI codes in the Premier dataset during 2018. The comparison showed that our approach successfully modeled the published alloimmunization rates in HHT (16.8% vs 15.3%) and MDS (11.5% vs 11%) (Zheng Transfusion. 2018;58(3):775-780, Singhal Haematologica. 2017;102(12):2021-2029). Demographic, clinical, and billing characteristics were gathered. Total cost per discharge, hospital and intensive care unit (ICU) length of stay, and inpatient mortality, were calculated for both study groups and compared. Bivariate comparisons were performed, assuming a two-tailed test of significance and an α level of 0.05. Multivariable regression models adjusting for sex, age, admission date, visit type (outpatient vs. inpatient) type of MDS based on the World Health Organization (WHO) classification and diagnosis-related groups (DRG) with an incidence ≥1% of inpatient visits were performed. Overall, 179,819 MDS patient encounters were identified. Of these, 11,948 were alloimmunized and 167,871 were not alloimmunized (Table 1). When assessing incremental economic and clinical outcomes for the alloimmunized MDS population, multivariate models showed that alloimmunization led to significantly worse economic and clinical outcomes through all variables assessed (Table 2). The incremental median cost per inpatient and outpatient visit for the alloimmunized population were $2,829 (p<0.0001) and $630 (p<0.0001) higher, respectively. Alloimmunized patients had significantly longer inpatient hospitalizations (7.2 vs 8.2 days; p<0.0001) as well as longer ICU stays (4.4 vs 6.8 days; p<0.0001). Alloimmunized)A patients also encountered a 38% increased risk of being admitted to intensive care, and a 30% higher risk of inpatient mortality. This analysis discloses that alloimmunization is associated with higher healthcare costs and worsened clinical outcomes in the MDS population. Further work is needed to clarify whether alloimmunization is causally related to these outcomes, or whether alloimmunization is incidentally more common among patients with worse disease. The present study was not designed to assess the effectiveness of prophylactic antigen matching in the prevention of alloimmunization in the transfused MDS population, and further work is needed to confirm the findings presented herein. However, decisions regarding provision of antigen-matched RBCs to MDS patients should consider the potential for downstream consequences of alloimmunization. Figure 1 Figure 1. Disclosures Gehrie: Grifols SSNA: Consultancy, Honoraria. Viayna: Grifols S.A.: Current Employment. Blanchette: Grifols SSNA: Consultancy; Novo Nordisk Inc.: Current Employment. Meny: Grifols SSNA: Current Employment. Noumsi: Grifols SSNA: Current Employment. Huber: Grifols SSNA: Current Employment. Runken: Grifols SSNA: Current Employment.

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