Search

Background: Risk factors for Clostridium difficile infection (CDI) include antibiotic use, prolonged hospitalization, cancer chemotherapy, hematopoietic stem cell transplantation (HSCT) and gastric acid suppression, all of which, are encountered in acute leukemia patients. We sought to examine the impact of CDI on inpatient outcomes and resource utilization, as well as, to evaluate the trends of CDI in acute leukemia patients. Methods: The Nationwide Inpatient Sample (NIS) database was queried to include all adults with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), who were admitted between 2012 and 2017 for inpatient chemotherapy and/or hematopoietic stem cell transplant (HSCT). Those with and without CDI were compared. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used to evaluate risk factors for CDI, as well as, inpatient mortality. Statistical tests for trends of resource utilization across six years were performed. Results: A total of 187,105 admissions met the inclusion criteria, of which, 5.3% had CDI. Mean age (51.3 years) and gender (male 56.4%) did not significantly differ between those with and without CDI. AML accounted for a larger proportion of the CDI group (72.4% vs 64.6%, p On multivariate analysis, independent risk factors for CDI included: AML, HSCT, neutropenia, higher comorbidity burden (in the form of Charlson comorbidity index) and being treated at a teaching hospital. Blacks had lower rates of CDI. After adjusting for demographic variables, comorbidities, and accounting for higher proportion of AML, HSCT and neutropenia in the CDI group, CDI still accounted for higher risk for inpatient mortality (aOR 1.76, 95% CI 1.48-2.10, p CDI rate in acute leukemia patients remained stable between 2012 to 2017. The mortality rates declined in both groups (9.8% in 2012 to 6.3% in 2017, p Conclusions: CDI has a substantial impact on outcomes in acute leukemia patients. Higher incidence of CDI in HSCT recipients may be explained by prolonged hospitalizations, increased antibiotic exposures, and extended periods of impaired host immunity. Additionally, GVHD may also play a role in the incidence of CDI and its outcomes. Despite improvement in outcomes over the years, mortality rates and financial burden of CDI on health care, is still substantially higher in those without CDI, therefore, there is a need to focus on preventive measures. Disclosures No relevant conflicts of interest to declare.

Background: Invasive aspergillosis (IA) is one of the most dreaded complications in neutropenic patients with hematologic malignancies; risk significantly increases with chemotherapy, particularly during induction. It dramatically worsens the overall prognosis of the underlying malignancy and predisposes patients to undergo secondary interventions, thereby prolonging the duration of treatment and hospital stay. While prophylactic antifungal therapy has remarkably lowered the rates of IA, it remains a persistent problem in cancer treatment. The primary objective of our study is to explore the risk factors of IA in neutropenic patients with acute leukemias and its role in hospital stay, in-hospital mortality, and hospitalization costs. Methods: The Nationwide Inpatient Sample (NIS) database was queried to include all adults with acute leukemia admitted from 2012 and 2017, whose course was complicated by neutropenia. Those with and without invasive aspergillosis were compared. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used to evaluate risk factors for aspergillosis, as well as, inpatient mortality. Statistical tests for trends of resource utilization across six years were performed. Results: A total of 141,835 admissions met the inclusion criteria, of which, 2.5% had aspergillosis. Mean age (55.4 years) and gender (male 55.5%) did not significantly differ in neutropenic patients with and without aspergillosis. AML accounted for a larger proportion of the aspergillosis group (84.3% vs 76.9%, p Independent risk factors for the development of aspergillosis included: Black race, receiving treatment at a teaching hospital, AML (compared to ALL) and poor nutritional status. On multivariate analysis, aspergillosis conferred an increased risk of inpatient mortality (aOR 2.57, 95% CI: 2.08-3.19, p Rates of aspergillosis decreased from 2.9% in 2012 to 2.2% in 2017 (trend P=0.03). In neutropenic acute leukemia patients without aspergillosis, there has been an improvement in inpatient mortality (from 7.3% in 2012 to 6.0% in 2017, trend P Conclusions: Aspergillosis represents a significant challenge in the management of hematological malignancies. There is a delicate interplay between neutropenia and IA, with neutropenic patients more susceptible to invasive fungal infections, and IA further contributing to neutropenia. The encouraging trend in decreasing prevalence along the years is reflective of more aggressive prophylactic antifungal usage in acute leukemias, with the revised IDSA guidelines for aspergillosis being a cornerstone. However, mortality and resource utilization remain unchanged despite advances in diagnosis and treatment of aspergillosis. This data highlights the importance of prophylactic antifungals and maintaining a high index of suspicion for IA in neutropenic acute leukemia and the need of early focused treatment to improve clinical outcomes. Disclosures No relevant conflicts of interest to declare.

Background: Avascular necrosis (AVN) afflicts up to 10% of patients with sickle cell disease (SCD), and results in significant impairment in mobility and quality of life. The femoral head is the most common site for involvement of AVN in SCD patients. Total hip arthroplasty has a higher rate of perioperative complications in SCD patients, when compared to the general population. In this study, we aimed to evaluate the rates of readmissions in SCD patients undergoing hip arthroplasty as well as examine the causes behind these readmissions. Methods: The Nationwide Readmissions Database (NRD) was queried to include all adults who underwent hip arthroplasty in the years 2016 and 2017. SCD patients with AVN of the hip were compared to those undergoing hip arthroplasty for other reasons. T-test was used to compare means of continuous variables and Chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used to evaluate risk factors for inpatient mortality, increased length of hospital stays, and hospitalization charges. We also examined risk factors for readmissions and the most common causes of readmissions in both sickle cell and non-sickle cell cohorts. Results: A total of 1,167,675 hip arthroplasties were performed in 2016 and 2017, of which 0.1% were for SCD patients with AVN. As expected, those with SCD were younger (mean age 40.6 vs 68.2 years, p On multivariate analysis, sickle cell patients were more likely to be readmitted within 60 days (aOR 5.25, 95% CI 4.01-6.87, p Conclusions: Hip arthroplasty is associated with inferior inpatient outcomes and higher resource utilization in those with sickle cell disease. This can be attributed to high incidence of sickle cell crises post-procedure, as well as, intraoperative surgical complications (femoral fractures and perforations) and high rates of postoperative infections in the functionally asplenic sickle cell disease population. Disclosures No relevant conflicts of interest to declare.

Background: Myelodysplastic syndromes (MDS) are a group of clonal stem cell-derived disorders characterized by cytopenias, ineffective hemopoiesis, and a considerable risk of progression to acute myeloid leukemia (AML). Patients with MDS have higher rates of cardiovascular mortality, when compared to age-matched population. This has been attributed to the effects of chronic anemia, iron overload and systemic inflammatory state. Erythropoiesis-stimulating agents (ESA) have also been implicated. The aim of this study is to compare inpatient outcomes and readmissions in MDS patients admitted with congestive heart failure (CHF), to those without MDS. Methods: Patients older than 65 years of age, with and without MDS, were queried for admissions of CHF between the years 2012 and 2017, from the Nationwide Inpatient Sample (NIS) database. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Statistical tests for trends of resource utilization across six years were performed. Multivariable logistic regression was used evaluate risk factors for inpatient mortality. Then, we utilized the Nationwide Readmissions Database (NRD) to evaluate the readmission rates, as well as, the causes of readmissions among patients, with and without MDS, admitted with CHF during index admission, from 2016 to 2017. Results: A total of around 4.3 million admissions met the inclusion criteria, of which, 0.75% had MDS, accounting for 32,305 admissions. Mean age was higher in those with MDS (82.3 v 79.8 years, p Patients with MDS had higher inpatient mortality (5% vs 3.5%, p There has been an increase in CHF admissions in MDS patients, from 7.96% in 2012 to 8.99% in 2017 (Trend p All-cause 30-day readmission rate was higher in those with MDS (27.7% vs 21.5%, p Conclusions: Therapy for MDS in the elderly is focused on improving quality of life, reducing deaths related to complications of cytopenias, or preventing progression to AML. Long-term survivors of MDS are more likely to suffer from cardiovascular disease, attributed to MDS itself or from complications of treatment. In our study, we have shown that MDS patients have higher mortality and resource utilization, as well as, higher rates of readmissions. In addition, hospitalization rates for CHF in MDS patients have been increasing. Some authors have advocated for addressing anemia early in the course of MDS to prevent downstream cardiac remodeling. Furthermore, attention to traditional cardiovascular disease risk factors in patients with MDS is imperative. Disclosures No relevant conflicts of interest to declare.

e19027 Background: Clostridiodes difficile infection (CDI) is reported to occur up to 9-fold higher in allogenic hematopoietic stem cell transplant (HSCT) recipients compared to the general population of hospitalized patients. This is attributed to disruption of gut microbiome by antibiotics, myeloablative regimens, neutropenia, prolonged hospitalization, and immunosuppressive regimens administered to prevent acute graft-versus-host disease (aGVHD). CDI by disruption of the intestinal microbiome may trigger gastrointestinal aGVHD. Previous studies from HSCT centers have reported conflicting data on the relationship between CDI and subsequent development of aGVHD. Methods: The Nationwide Readmissions Database was queried for admissions of adult allogenic HSCT patients between 2016 and 2018. Those with and without CDI during index admission were compared. Multivariable logistic regression was used to evaluate the primary outcome of risk of aGVHD in the index admission or within 100 days post-engraftment. Results: A total of 13518 allogenic HSCT patients were included in the study. Mean age was 52.4 years. 57.2% of patients were female. The most common underlying diagnoses were acute myeloid leukemia (38%), myelodysplastic syndrome (17%) and acute lymphoblastic leukemia (14%). 11.1% of the index admissions were complicated by CDI. Rates of aGVHD during the index admission or 100 days post-engraftment were similar between CDI and non-CDI groups: 13.8% vs. 12.1%, p=0.19 during index admission and 29.2% vs. 26.1%, p=0.09 during 100 days post-engraftment. Nonetheless, patients with CDI had longer length of hospital stay (34.6 vs 29.8 days, p

Introduction:HLH is a rare, life-threatening disorder, characterized by hyperstimulation of immune system leading to systemic inflammation and multi-organ failure. It is categorized as primary and secondary HLH. Secondary HLH usually affects adolescents and adults. It results from acquired immune dysregulation secondary to a number of etiologies, including infections, malignancy, and autoimmune diseases. Owing to less epidemiological data, adult HLH is thought to be underdiagnosed, making a true assessment difficult, however, some observational data suggest 40% of HLH cases occurs in adults. Disease presentation includes fever, cytopenias, organomegaly, liver function anomalies, elevated ferritin levels, and/or demonstration of macrophage activation in hematopoietic organs. In 2014, Fardet et al proposed the H-Score, a novel diagnostic score derived from 162 adult patients with HLH.We aim to report a retrospective review of Adult HLH in an urban safety-net hospital over the course of two decades along with predictive value of H-score in our patient population. Methods:We conducted a retrospective review of patients diagnosed with HLH at Cook County Health, Chicago between January 2000 and January 2019 after approval by the Institutional Review Board. Patients were identified from electronic records using ICD-10 codes D76.1, D76.2, and ICD-9 code 288.4. Patients under 18 years were excluded. MS excel was used for data collection and further descriptive statistics were calculated with frequencies and percentage. Results:After initial review, 12 confirmed and eligible cases were included in the study. Mean age at diagnosis of adult HLH at our center was 37, with male predominance(7 males, 4 females, and 1 female transgender). 5 were African-American, 6 were Hispanic, and 1 was Asian. Most common presentation was fever, seen in 10 out of 12 cases, along with variety of symptoms like fatigue, sore throat and jaundice.4 out of 12 patients (33%) had HIV/AIDS, with CD4 counts between 79 to 180. 3 were already receiving anti-retroviral therapy at the time of HLH diagnosis, while 1 was diagnosed with HIV/AIDS at the time of HLH diagnosis. Etiologic spectrum mainly included infectious (4 HIV and 3 EBV) and autoimmune (2 systemic lupus erythematous, 1 cold immune hemolytic anemia with immune thrombocytopenic purpura) causes. 1 patient had an underlying malignancy (diffuse large B-cell lymphoma). Etiology was not established in 1patient with no familial associations found in subsequent genetic evaluation. All patients had elevated liver enzymes. The mean ferritin level in our cohort was 19,198 ng/ml. Leucopenia was seen among most cases, 11 out of 12. The 1 patient noted to have a high white cell count was actually receiving corticosteroid therapy for cold immune hemolytic anemia. Most common bone marrow findings were hemophagocytosis (9 patients) and hypocellularity (7 patients). 2 had hypercelullar marrow and 1 had normal marrow. Genetic testing was performed in 4 patients; chromosomal abnormalities were not observed in any. Specific lab parameters in our cohort as included in HLH-2004 criteria is shown in Table 1. Calculated H scores in our cohort is shown in table 2. 11 patients fall under high probability for HLH. Conclusion:The most widely used diagnostic criteria for HLH is the HLH-2004 diagnostic criteria, derived from pediatric HLH study. It is often extrapolated for use in adults. There are several limitations to the HLH-2004 diagnostic criteria. sIL2r and NK function testing is not available in all centers, and many of the manifestations of HLH in adults are not included in the criteria. When using H score, a cutoff value of 169, corresponds to sensitivity of 93% and specificity of 86% in diagnosing HLH. In our study, 11 out of 12 patients (91.66) scored higher than 169, which is highly suggestive of HLH. The remaining 1 patient with H score of only 118, however, met the diagnosis of HLH by HLH-2004 criteria (score: 5/8). Therefore, although our study population was small, results of our study were in favor of using H-score as an appropriate diagnostic tool in adult-onset HLH, which also helps mitigate the restrictions of HLH-2004 criteria in adult population. Disclosures No relevant conflicts of interest to declare.

e20513 Background: Patients with Multiple Myeloma (MM) are at risk for developing sepsis due to defective humoral immunity, underlying disease factors like renal failure, iron overload, and treatment with immunosuppressive agents. Sepsis is a significant cause of morbidity and mortality in patients with MM. In this study, we aimed to study trends of inpatient outcomes and health care burden of patients with sepsis in MM. Methods: Adult patients with MM admitted to the hospital from 2012 to 2017 were identified from the Nationwide Inpatient Sample database and were stratified into two groups based on the diagnosis of sepsis. Multivariate regression analysis was used to adjust for confounders when calculating for mortality. Statistical tests for trends of mortality, length of stay and hospital charges were performed. Results: A total of 513,615 patients with MM met the inclusion criteria. Sepsis was found to be the most common cause of admission amongst these patients (12.2%) and of the patients with MM who died in the hospital, 38.1% carried the primary diagnosis of sepsis. Mean age of the patients was 70.1 years and they were predominantly Caucasian (62.1%) with male preponderance (57.7%). MM patients admitted with sepsis were found to have higher mortality (15.7 and 3.5% P < 0.0001),higher hospital costs (22,082$ vs 15,206; P < 0.0001) and longer hospital stays (8.1 days vs 6.0 P < 0.0001) when compared to those admitted for other reasons. Temporal trends have been noted to improve over the years, with mortality decreasing from 18% to 13.1%, (p trend < 0.001). Length of stay (in days) decreased from 8.3 to 7.7 days (p trend = 0.009) and hospital charges (in dollars) decreased from 22,407 to 21,209 (p trend < 0.001). Conclusions: Although the improving trends are promising, sepsis still continues to be significantly contributing to morality and morbidity in patients with MM. Measures to identify the changing spectrum of infectious diseases, their predisposing risk factors along with strategies to recognize and prevent early stages of sepsis could have a significant impact on lowering mortality and health care burden. [Table: see text]

Background: Over the years, splenectomy has dropped out of favor as a treatment option for Immune Thrombocytopenic Purpura (ITP) and is now considered only for patients who have failed multiple lines of therapy. One of the major concerns is surgical morbidity. We aim to study in-hospital outcomes following elective splenectomy in this population Methods: This is a retrospective cohort analysis of NIS database (years 2006 to 2014). Patients ≥18 years of age, who had an elective admission associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedure code for splenectomy were included in the study. Our cohort of interest was patients with ITP who underwent elective splenectomy (ITP ES). ICD-9-CM diagnosis codes were used to identify patients with ITP. All other patients who underwent elective splenectomy were labeled as non-ITP ES. Utilization of intensive care services was identified by procedure codes associated with vasopressor use, cardiopulmonary resuscitation, mechanical ventilation and initiation of dialysis in the absence of pre-existing end stage renal disease. Primary outcome was inpatient mortality and secondary outcome was length of stay (LOS). Associated factors were analyzed using multivariate logistic regression analysis. A p-value Results: A total of 102,698 admissions for elective splenectomies (ES) in adults were identified between the years 2006 and 2014,of which 11.36% (n= 11,668) were ITP ES. Inpatient mortality and mean LOS for all patients undergoing ES was 2.53% and 8.51 days respectively. Inpatient mortality and mean LOS in the ITP ES cohort was 0.86% and 4.37 days respectively. In the entire cohort of ES, inpatient mortality was lower in those with ITP versus non-ITP (OR 0.36, p Conclusion: Inpatient mortality and length of stay in admissions for elective splenectomy was significantly lower in ITP patients compared to non ITP patients. Also, in ITP patients undergoing elective splenectomy, older age and a charlson comorbidity index of 2 or above were associated with higher odds of dying in the same admission.These findings from real world data have practical implications for clinicians and patients, as they weigh the pros and cons of splenectomy as a treatment option for ITP. Table Disclosures Donthireddy: Viracta: Other: PI for Clinical Trial.

Introduction: Spleen tyrosine kinase (Syk), a cytoplasmic tyrosine kinase, is a member of the non-receptor type protein kinase family. Apart from the hematopoietic cells, it is also expressed in the epithelial and endothelial cells. Fostamatinib, a Syk inhibitor, has been proven beneficial in autoimmune disease like rheumatoid arthritis (RA) and immune thrombocytopenia (ITP). Murine models have shown a direct correlation between hypertension and level of R406, the active metabolite of fostamatinib. In this study, we sought to examine the cardiovascular profile of fostamatinib in published and unpublished randomized controlled trials. Methods: A systematic search of Pubmed, Medline and Scopus databases were done from inception till date to identify all phase 2 and 3 clinical trials of fostamatinib in patients with ITP and RA by two independent reviewers. Trials were included if they reported side effects including but not limited to cerebral ischemia or infarction, myocardial ischemia and myocardial infarction, hypertension and cardiac rhythm disorders. 35 trials were retrieved in the initial search which were excluded according to PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) guidelines. 11 trials met the eligibility criteria and were included in the final analysis. All statistical analysis was carried out using OpenMetaAnalyst software. Categorical variables from each study are presented as proportions. The proportions from each study were subjected to arcsine transformation and pooled using a random-effects model. This yielded the pooled estimate with 95% confidence intervals. The I2 statistic was used to assess heterogeneity and a value of I2 = 25%-50% was considered mild, 50%-75% as moderate, and > 75% as severe. A P value of Results: 11 trials included in final study had 3941 patients. Cardio-vascular side effects were reported by all trials which ranged from 0.7% to 19.2%. The pooled estimate was 11.7% (8.6%-15.3%, P Conclusion: Our study shows that the use of fostamatinib is significantly associated with cardiovascular side effects, of which hypertension is most significant adverse event. We also recorded a few serious adverse events like hypertensive crises, myocardial infarction, coronary artery disease and congestive heart failure in few patients, but at a very low rate. Larger longitudinal studies are needed to determine the side effect profile of fostamatinib. Disclosures No relevant conflicts of interest to declare.

Background: Chronic lymphocytic leukemia (CLL) has a very high prevalence in the Western hemisphere, secondary to increased life expectancy and improved therapeutic options. Infections are known to be the prime contributor to morbidity and mortality in this patient population, accounting for 50-60% of all deaths. This occurs secondary to humoral depression by the disease and immune suppression by the treatment. There is paucity of data regarding outcomes of sepsis in CLL patients. We aim to study in-hospital outcomes of sepsis in patients with CLL. Methods: This is a retrospective cohort analysis of National inpatient sample (NIS) database (year 2016). Patients with CLL who were admitted with a principal diagnosis of sepsis were identified using the associated ICD-10 codes. Admissions were further categorized based on remission status of CLL: group 1 was in remission, group 2 had not achieved remission and group 3 had relapse. Primary outcome was inpatient mortality and secondary outcome was the use of mechanical ventilation (as a surrogate for utilization of intensive care). Comparisons were made between the subgroups of CLL as listed above and non-CLL patients. Associated factors were analyzed using multivariable regression model. We used STATA for statistical analysis. Results: Among patients with CLL who were admitted, the most common principal diagnosis (reason for admission) was sepsis, accounting for 12.9% of all CLL admissions. Other common reasons for admissions were pneumonia (5.4%), acute kidney injury (2.3%), NSTEMI (1.8%) and COPD exacerbation (1.8%). A total of 9,315 admissions with sepsis in CLL patients were identified (780 in remission, 8280 had not achieved remission and 255 had relapse). Compared to non-CLL patients, CLL patients were older (mean age 75.1 vs 64.7, p=0.0001), had more males (62.3% vs 49.3%, p=0.00001) and higher percentage of Caucasians (81.8% vs 67.5%, p=0.00001). CLL patients had higher inpatient mortality (14% vs 10%, p=0.00001), longer length of stay (7.8 vs 7.3 days, p=0.003) and higher hospital charges ($83,000 vs $75,000, p=0.006). On multivariable logistic regression model, after adjusting for age, gender, race and number of comorbidities, CLL patients were comparable with non-CLL patients, in regard to mortality and mechanical ventilation. On analysis of subgroups of CLL, those with CLL in remission had lower mortality (OR 0.51, CI 0.28-0.91, p=0.024) when compared to non-CLL patients. Group 2 (CLL, not yet achieved remission) were not statistically significant, whereas, group 3 (CLL in relapse) had higher mortality (OR 2.97, CI 1.64-5.35, p=0.000). Only group 3 CLL patients had higher risk of requiring mechanical ventilation (OR 2.92, CI 1.52-5.61, p=0.001). Conclusions: Infectious complications continue to remain a major cause of mortality and morbidity in CLL. Sepsis constituted the most common principal diagnosis in CLL patients admitted to acute-care hospitals. CLL patients with sepsis had higher mortality, compared to their non-CLL counterparts, even after adjusting for age, gender and other variables. Patients with relapsed disease had higher inpatient mortality when admitted to sepsis and interestingly, those with CLL in remission had lower mortality when compared to non-CLL patients. Disclosures No relevant conflicts of interest to declare.

Introduction: Current expert recommendations recommend double therapy (DT) over triple therapy (TT) in atrial fibrillation patients post percutaneous coronary intervention (PCI) to prevent the incidence of stroke. Though previous studies have focused on DT (oral anticoagulant [OAC] + P2Y12 inhibitor (including clopidogrel, ticagrelor and prasugrel)) versus TT (OAC + P2Y12 inhibitor and aspirin) strategy, no study assessed which OAC was more effective in the prevention of cardiovascular events and stroke. To this end we performed a systematic review and meta-analysis to assess whether non-vitamin K oral anticoagulants (NOAC) based DT strategy is comparable with vitamin K antagonist-based TT in patients with AF after PCI. Methods: Embase, Ovid, Pubmed and Scopus were extensively searched for only phase 2 and 3 clinical trials comparing NOAC based DT with VKA based TT from inception of these databases till June 2019 by two independent reviewers. The endpoints were all-cause mortality, Thrombolysis in Myocardial Infarction (TIMI) major bleeding, cardiovascular mortality and myocardial infarction. Cochrane Collaboration's tool was used for risk of bias assessment. Statistical heterogeneity was quantified using I2 statistics. Publication bias was assessed with Eggers regression test. Estimates were reported as hazard ratios (HR) with 95% confidence intervals (CI) using random effect model. Rivaroxaban 15 mg once daily dose from PIONEER-AF was included. From REDUAL-PCI trial we included dabigatran 110 mg BID and 150 mg BID doses. AUGUSTUS trial used 5 mg BID or 2.5 mg BID dosing of apixaban. Results: 402 trials were retrieved in the initial search which were analyzed according to PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) guidelines. Three trials (Augustus, PIONEER AF-PCI and RE-DUAL PCI) were extracted that met the inclusion criteria and included in the final analysis evaluating 8754 patients. Twenty seven percent were females. Mean age was 71 years. PCI was done for acute coronary syndrome in 44% of the patients. Mean calculated CHA2DS2-VASc was 4 which qualifies the use of oral anticoagulants. Only PIONEER AF-PCI and RE-DUAL PCI trials described the type of stent used for PCI. Drug eluting stents were used in 71% of the patients. There was no evidence of publication bias in our analysis (P=.78). The studies overall had low risk of bias. Our analysis showed no statistically significant difference in usage of NOAC + P2Y12 inhibitor compared to triple therapy consisting vitamin K antagonist in regards to all-cause mortality, (HR 0.92, 95% CI 0.72-1.18, P=.52), thrombolysis in myocardial infarction (TIMI) major bleeding (HR 0.91, 95% CI 0.38-2.16, P=.83), cardiovascular mortality (HR 0.95, 95% CI 0.71-1.28, P=.75), stroke (HR 1.07, 95% CI 0.67-1.71, P=.78),stent thrombosis (HR 0.72, 95% CI 0.42-1.23, P=0.23) and myocardial infarction (HR 0.88, 95% CI 0.68-1.13, P=.32). Conclusion: We conclude that there is no difference between the usage of NOAC including rivaroxaban, dabigatran and apixaban in dual regimen vs triple therapy with VKA (warfarin). However, some limitations need to be considered such as heterogeneity across patients in terms of indication for PCI (elective vs emergency), choice of P2Y12 inhibitor (clopidogrel vs ticagrelor vs prasugrel), mean duration of therapy (range 6-12 months) and mean length of follow-up (range 6-14 months). In future clinical practice, post-PCI antithrombotic regimens in AF will likely consist of a single P2Y12 inhibitor plus NOAC. Disclosures No relevant conflicts of interest to declare.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of severe immune activation and dysregulation, characterized by hyperactive macrophages and lymphocytes, resulting in multi-organ damage and high mortality. Epidemiologic data of HLH in the adult population is limited. The aim of our study is to characterize HLH admissions in the US adult population. Methods: We performed a retrospective study using the Nationwide Inpatient Database for the year 2016. 330 admissions with principal diagnosis of HLH in adults were identified, using ICD code specific for HLH. Using ICD 10 codes for malignancies and rheumatologic conditions, we subdivided HLH admissions into malignancy-associated HLH, autoimmune disease-related HLH and non-malignancy, non-autoimmune HLH. Statistical analyses were performed using STATA. One-way ANOVA was used to compare means of continuous variables and chi-square test was used to compare proportions of categorical variables. Results: Mean age of our study group was 50.1, with women making up 44% of the population. 15% of the patients had an underlying malignancy, most common type being mature T/NK cell lymphoma. Also, 15% of the patients had a rheumatologic diagnosis, SLE constituting half of this sub-group. 47% of the total population under study underwent either bone marrow, liver or splenic biopsy. Mortality rate was 21.2% and average length of stay was 17 days. 25.8% received systemic chemotherapy during the admission. Within the subgroups, we did not find a statistically significant difference in the age, gender, race, percentage undergoing biopsy or inpatient chemotherapy. There was also no statistically significant difference in mortality or length of stay between the three groups. Discussion: HLH is a life-threatening condition of immune hyper-activation and may be divided into primary HLH, which is an autosomal recessive condition, caused by mutations impairing the cytotoxic function of NK cells and cytotoxic T lymphocytes. Secondary HLH is the more frequent presentation in adults, and frequently identified triggers include hematologic malignancies, infections and autoimmune conditions. Autoimmune-associated HLH is usually termed as macrophage activation syndrome (MAS). Mortality in secondary HLH varies based on underlying condition, around 8% when associated with JIA, compared to more than 80% in malignancy associated HLH in some studies. Our study sample was underpowered to detect notable differences between the study groups. This can be attributed to the rarity of this condition. HLH is primarily a pediatric disease. Incidence of HLH in the pediatric age group has been estimated to be around 1 in 100,000 children. Incidence in the adult population is less clear. In our study, we were able to represent the epidemiologic aspects of adults with HLH in the real world. We need large observational studies to further characterize HLH in the adult population. Disclosures No relevant conflicts of interest to declare.