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Kidneys influence the production of red blood cells by secreting most of the erythropoietin (EPO) in adults. Consequently, renal diseases often impact erythropoiesis and hemoglobin levels. Chronic kidney diseases lead to anemia due to EPO deficiency. However, erythrocytosis can occur in patients with cystic diseases of the kidney and renal artery stenosis due to upregulation of hypoxia-inducible factors (HIFs) and increased EPO production. Here, we present a patient with secondary polycythemia who was found to have atonic bladder and hydronephrosis. Resolution of hydronephrosis led to the reversal of erythrocytosis, highlighting the intricate regulation of red cell production.

Clinical risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HC) employs rules derived from American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines or the HCM Risk-SCD model (C-index ∼0.69), which utilize a few clinical variables. We assessed whether data-driven machine learning methods that consider a wider range of variables can effectively identify HC patients with ventricular arrhythmias (VAr) that lead to SCD. We scanned the electronic health records of 711 HC patients for sustained ventricular tachycardia or ventricular fibrillation. Patients with ventricular tachycardia or ventricular fibrillation (n = 61) were tagged as VAr cases and the remaining (n = 650) as non-VAr. The 2-sample ttest and information gain criterion were used to identify the most informative clinical variables that distinguish VAr from non-VAr; patient records were reduced to include only these variables. Data imbalance stemming from low number of VAr cases was addressed by applying a combination of over- and undersampling strategies. We trained and tested multiple classifiers under this sampling approach, showing effective classification. We evaluated 93 clinical variables, of which 22 proved predictive of VAr. The ensemble of logistic regression and naive Bayes classifiers, trained based on these 22 variables and corrected for data imbalance, was most effective in separating VAr from non-VAr cases (sensitivity = 0.73, specificity = 0.76, C-index = 0.83). Our method (HCM-VAr-Risk Model) identified 12 new predictors of VAr, in addition to 10 established SCD predictors. In conclusion, this is the first application of machine learning for identifying HC patients with VAr, using clinical attributes. Our model demonstrates good performance (C-index) compared with currently employed SCD prediction algorithms, while addressing imbalance inherent in clinical data.

e21599 Background: While there have been newer treatments that were developed in the last decade for metastatic melanoma, there is lack of data that directly looks at survival in melanoma before and after introduction of these new agents. We tried to explore the epidemiology of malignant melanoma including incidence to look at the trends of its incidence, survival and mortality in different groups over the last two decades. Methods: Data was obtained from the Surveillance, Epidemiology, and End Results Program (SEER Research Data, 18 Registries from 2000-2018) and data was cleaned and analyzed in STATA 16. 363,517 records were included in analysis from which baseline characteristics and median were obtained for survival time and survival analysis was done by Cox regression method to compare survival time between different groups. Pearson correlation was calculated to look for association between survival time and Breslow thickness. Results: Mean age group was 55-64 years, with 58% males and 42% females. 95% were White, 0.43% were Black, 0.63% were Asian and 3.79% were other races. 87% were localized, whereas 13% were metastatic. Mean Breslow thickness was 1.27mm (1.26-1.28). Overall median survival time was 62 months for malignant melanoma and 27 months for metastatic malignant melanoma. 42.63% were diagnosed before 2009 and 57.37% were diagnosed from 2009 to 2018. Cumulative incidence rate of melanoma increased from 4.78 to 6.57 per 100,000 persons whereas mortality rate increased from 0.29 to 2.23 per 100,000 persons from years 2000 to 2012 respectively. With contrast to age below 65, patients with age 65 and above had lower survival time (HR 4.78 95% CI 4.71-4.85, p < 0.01). There seemed to be an increase in incidence of melanoma among patients above 65 compared to below 65. When compared to males, females had significantly higher survival time (HR 0.62 95% CI 0.61-0.63, p < 0.01). Similarly, when compared to White population, Black and Asian population had lower survival time (HR 2.27 95% CI 2.11-2.43, p < 0.01 & HR 1.57 95% CI 1.14-1.68, p > 0.01) respectively. Comparing to localized disease, both regional and distant involvement had significantly lower survival time (HR 3.21 95% CI 3.15-3.28, p < 0.01 & HR 11.34 95% CI 11.07-11.61, p < 0.01) respectively. Breslow thickness had a negative correlation with survival months [regression coefficient (R) of -2.21 p < 0.01 (95% CI -2.35 to -2.07)]. Compared to patients who died before 2012, patients who died in 2012 or after had significantly better survival (HR 0.46, 95% CI 0.46-0.47, p < 0.01). Conclusions: Both, the incidence, and mortality of melanoma are rising, with more increase in age above 65 years. There appears to be an improvement in survival among patients who died after 2012, which may be an indirect indicator of the effectiveness of newer therapies. Risk factors for lower survival time were male sex, Black & Asian race, metastatic disease, and higher Breslow thickness.

Tumor lysis syndrome (TLS) is a severe metabolic complication that usually occurs in patients with aggressive tumors who undergo treatment with chemotherapy. Traditionally, it was mainly associated with hematologic malignancies. However, over the past 4 decades, there have been increasing reports of TLS in solid tumors. We report a case of TLS in a patient with gastric cancer, as a complication of FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy. Our patient was a 48-year-old man with metastatic gastric adenocarcinoma who presented with altered mental status and slurred speech. On examination, he was confused and disoriented, but the rest of his examination, including vitals, was unremarkable. Laboratory findings on admission were significant for an elevated uric acid of 14.5 mg/dL, creatinine of 4.1 mg/dL, and phosphorus of 6.9 mg/dL. He had received his first cycle of FOLFOX chemotherapy 4 days prior to admission. The constellation of electrolyte abnormalities and the temporal relationship to chemotherapy led to the diagnosis of chemotherapy-induced TLS. He was treated with aggressive fluid repletion and rasburicase, following which the electrolyte derangements resolved, and he improved clinically. This case highlights the importance of early recognition of TLS in patients with gastric cancer. Initiation of early treatment can reduce the high morbidity and mortality associated with this oncologic emergency.

Background Neurocysticercosis is a major cause of adult-onset epilepsy and premature death in adults. We aimed to describe the clinical and demographic features in a large patient population in Chicago of which published data is limited. Methods A retrospective chart search with ICD9/ICD10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. A descriptive analysis of the data is presented. Results Out of a total of 90 patients all of whom were immigrants, the country of origin was reported in 60% and the majority were from Mexico (83.3%). The mean age at the time of diagnosis was 32.3 years (median 29.5, range < 1 to 67). The most common presenting complaints were seizures (62.1%) and headache (27.6%). The most common type of seizure was generalized (48.8%) followed by focal (36.6%). Approximately a third of patients also had hydrocephalus (33.7%). Many patients had > 1 lesion on neuroimaging (70.7%) out of which the most common type were parenchymal lesions (60.9%) followed by ventricular and subarachnoid. Calcified (45.5%) and cystic lesions (44.2%) were found in about equal number of cases. A minority had both types of lesions (10.4%). Contrast enhancement or edema surrounding the lesion was found in about half (47.2%) of the cases. The number of years since the last visit to an endemic country before diagnosis was reported in 46.6% of cases and the mean was 9.8 years (range 0 to 30) and it was found that per year increase since the last visit increased the chance of having contrast enhancement/edema surrounding the lesion in neuroimaging or requiring treatment with antiparasitic medications. (OR 1.77 (1.08–2.90), P= 0.03). Conclusion Our study agrees with previously reported data regarding seizure being the most common presenting complaint, generalized seizures being the most common type. The increasing risk of active lesions with increasing duration since the last visit to an endemic country raises the concern of clinically consequential delay in diagnosis. Disclosures All Authors: No reported disclosures

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.

Scombroid poisoning, also known as histamine fish poisoning, typically occurs after eating dark meat fish. Higher levels of histidine, which is converted to histamine, causes anaphylaxis-like symptoms upon ingestion. There are few reported cases of scombroid in humans secondary to light meat fish. We present a case secondary to tilapia consumption.

e17007 Background: Bone is a frequent site of metastasis in prostate cancer and is involved in 88% of patients with metastatic prostate cancer. Metastasis to bone increases the risk of pathological fractures, which are associated with increased morbidity and mortality. We performed a retrospective analysis on inpatient outcomes of pathological fractures in prostate cancer metastatic to bone in comparison to men with osteoporotic fractures. We also examined the disposition of these patients. Methods: We queried the Nationwide Inpatient Sample between 2016 and 2018 to retrospectively identify adult males with osteoporotic fractures and those with pathological fractures secondary to metastatic prostate cancer. We used T-test and chi-square test to compare means of continuous variables and compare proportions of categorical variables respectively. Multivariate analysis of predictors of mortality, length of stay, hospitalization costs and disposition in this group were performed. Results: A total of 22,800 fractures, combining osteoporotic fractures and pathological fractures due to metastatic prostate cancer were identified, of which the latter accounted for 13.6%. Patients with pathological fractures secondary to metastatic prostate cancer were younger (mean age 73.5 vs 77.5 years, p < 0.0001) and more likely to be black (16.4% vs 4.6%, p < 0.0001) or Hispanic (8.4% vs 5.1%, p < 0.0001). Adjusting for demographic variables and comorbidity burden, pathological fractures in patients with prostate cancer metastasis to the bone were not associated with a significant increase in mortality (aOR 1.46, 95% CI 0.82-2.60, p = 0.20) or length of hospital stay. However, they did have higher hospitalization costs by $2,610 per admission (p = 0.01). Patients with pathological fractures secondary to prostate cancer are less likely to be discharged to a nursing facility (aOR 0.50, 95% CI 0.40-0.62, p < 0.001) and are more likely to be transitioned to home health care (aOR 1.49, 95% CI 1.20-1.84, p < 0.001). Conclusions: Pathological fractures secondary to prostate cancer are less frequent than osteoporotic fractures in men and are not independent predictors of mortality or length of stay. This is in keeping with the relatively indolent course of prostate cancer. However, there is an increased cost of hospital stay associated with pathological fractures in metastatic prostate cancer. Interestingly, these patients are more likely to be discharged with home health care and are less likely to go to a nursing facility, making disposition a crucial aspect in the care of these patients.

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

12115 Background: In the United States, an estimated 1 in 8 women will be diagnosed with breast cancer during her lifetime. Of those with metastasis, over half have bone metastases leading to risk for pathological fractures. Further, approximately 1 in 4 women over 65 years have osteoporosis of the femur neck or lumbar spine. We performed a retrospective analysis on outcomes in pathological fractures secondary to breast cancer metastasis in comparison to osteoporosis, including disposition at discharge. Methods: The Nationwide Inpatient Sample (NIS) database was queried to include all adult women admitted with osteoporotic fractures and pathological fractures due to metastatic breast cancer between 2016 and 2018. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariate analysis of predictors of pathological fractures in women with breast cancer metastatic to bone, as well as mortality, resource utilization and disposition in this group were performed. Results: A total of 91,494 fractures, combining osteoporosis and pathological fractures secondary to metastatic breast cancer were identified, of which the latter accounted for 4.9%. Patients with pathologic fractures secondary to metastatic breast cancer were younger (mean age 62.8 vs 79.5 years, p < 0.0001) and were more likely to be black (14.6% vs 3.1%, p < 0.0001) or Hispanic (8.3% vs 4.7%, p < 0.0001). Adjusting for demographic variables and comorbidity burden, pathological fractures secondary to metastatic breast cancer were not associated with a significant increase in inpatient mortality (aOR 1.57, 95% CI 0.84-2.95, p = 0.16), but were independently associated with increased length of hospital stay by 0.7 days per admission (p = 0.01) and higher hospitalization costs by $3,381 USD per admission (p < 0.01). Regarding disposition, patients with pathological fractures secondary to breast cancer were less likely to be discharged to a nursing facility (aOR 0.57, 95% CI 0.48-0.68, p < 0.001) and were more likely to be transitioned to home health care (aOR 1.46, 95% CI 1.20-1.78, p < 0.001). Conclusions: In adult women, pathological fractures secondary to breast cancer are less frequent than osteoporotic fractures and were not independent predictors of inpatient mortality. They do however prolong length of stay and increase healthcare costs. Further efforts should focus on risk prediction and prophylactic management of high risk bone lesions in order to enhance patient’s quality of life, decrease hospitalization admissions, stay and cost.

e19567 Background: With the advent combined anti-retroviral therapy (ART), the survival of people living with HIV has improved, thereby increasing their prevalence, while concurrently decreasing the incidence AIDS defining malignancies. Despite its decrease, AIDS-related Diffuse Large B-Cell Lymphoma (DLBCL) remains the 3rd most common malignancy in the HIV population and an important cause of cancer related morbidity and a leading cause cancer attributed mortality. Currently the treatment modalities between HIV and non-HIV DLBCL are similar, however a comparison of the infectious complications has never been assessed. We aim to explore the prevalence and outcomes of sepsis in persons living with HIV and DLBCL versus the non-HIV DLBCL patient population. Methods: We identified all adult DLBCL patients admitted between 2016–2018 from The Nationwide Inpatient Sample (NIS) with a primary diagnosis of sepsis. Patients with and without HIV were identified and compared for demographic differences and primary outcomes of inpatient mortality, length of stay (LOS) and hospital charges. Secondary outcomes studied included rates of septic shock, acidosis, Acute Kidney Injury (AKI), Tumor Lysis Syndrome (TLS) pancytopenia, anemia, neutropenia, protein energy malnutrition (PEM) and history of bone-marrow/stem-cell transplant. Statistics were performed using t-Test, chi-square test and multivariable logistic regression. Results: There was a total of 5740 HIV-DLBCL and 158,445 non-HIV-DLBCL inpatient admissions of which 480 (8.4%) and 16085 (10.1%) respectively had sepsis (p < 0.0001). Compared to non-HIV cohort, HIV-DLBCL patients were significantly younger (47.5 versus 67 years, p < 0.001), more likely to be male (66.7% vs 55.3%, p = 0.02), Black (43% vs 7.7%) or Hispanic (18% vs 11%) (p < 0.001), more likely to be on Medicaid (44.9% vs 8.2%, p < 0.001) and lived-in low-income zip-codes (p < 0.0001). Overall adjusted inpatient mortality was not significantly different between HIV and non-HIV groups (14.6% vs 16.9%, p = NS). But HIV-DLBCL patients had significantly high Chalrson co-morbidity index (p < .0001), longer inpatient LOS (8.75 vs 8.65 days, p < 0.0001) and higher total hospital charges (average $5338 higher for each admission, p < 0.0001). HIV-DLBCL cohort also reported significantly higher TLS (7.3% vs 2.6%, p = 0.005) and PEM (42.7% vs 28.9%, p = 0.004). Other secondary outcomes were not significantly different between the groups. Conclusions: Demographic differences between the two cohorts are reflective of known racial & socio-economic disparities associated with HIV. Lower rates of sepsis in HIV cohort were not translated into improved inpatient mortality. Longer LOS and hospitalization charges in HIV patients likely due to high comorbidity burden.

e19561 Background: Burkitt lymphoma (BL) is an aggressive AIDS-defining malignancy, the incidence of which has not declined over the last 2 decades despite use of antiretroviral therapy. HIV-BL is more advanced at diagnosis compared to non-HIV-BL with increased risks of immunosuppressive chemotherapy (Lancet Hematology 2020;7(8):e594-e600). We attempted to explore and quantify the prevalence, outcomes and healthcare utilization of HIV-BL vs non-HIV-BL patients admitted with sepsis. Methods: Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was queried to identify all adult HIV and non-HIV admissions with BL between 2016–2018 with a primary diagnosis of sepsis. The groups were compared for demographic differences, inpatient mortality, length of stay (LOS) and hospital charges. Secondary outcomes studied included rates of septic shock (SS), acidosis, acute kidney injury (AKI), tumor lysis syndrome (TLS), pancytopenia, anemia, neutropenia, protein energy malnutrition (PEM) and history of bone-marrow/stem-cell transplant. Statistics were performed using the t-test, z-test and chi-square test. Results: A total of 2310 HIV-BL admissions comprising 205 (8.9%) with sepsis and 11,950 non-HIV-BL admissions with 865 (7.2%) with sepsis (p = 0.006) were identified. Compared to non-HIV cohort, HIV-BL patients were significantly younger (mean age 43.6 versus 55.3 years, p = 0.001) with few over 65 years old (2.4% vs 36%, p = 0.001). Both groups had similar gender ratio, but a higher number of HIV-BL admissions were African American (AA) (51.4% vs 4.9%, p = 0.001), on Medicaid (31.7% vs 15.6%, p < 0.0001), from lowest quartile income zip codes (p < 0.0001) and more likely to be treated at teaching hospitals (73.2% vs 54.9%, p < 0.0001). The overall inpatient mortality was 21.9% in HIV-BL vs 15.6% in non-HIV-BL (p = 0.02). HIV-BL reported increased mean LOS (9 vs 8 days, p = NS) and average $39,599 more in hospital charges for each HIV-BL admission compared to non-HIV-BL with sepsis (amounting to over $8 million over 3 years). The rates of anemia, neutropenia, TLS, AKI, SS, TLS and PEM were similar (p = NS) between the groups. Conclusions: Nationwide, HIV-BL patients had significantly higher rates of sepsis despite being significantly younger. They were also more likely to be AA from lower socioeconomic zip codes and more likely to be on Medicaid. The mean inpatient LOS and hospital charges, although not statistically significant, were higher in HIV-BL compared to their non-HIV counterparts. Also, the difference in total charges for all HIV-BL admissions amounted to over $8 million extra compared to non-HIV-BL in 3 years. These trends need to be evaluated in prospective studies to help identify interventions to improve clinical outcomes and healthcare utilization.

e17055 Background: Primary mediastinal germ cell malignancies (PMGCM) account for up to 5% of all germ cell tumors. Different clinical and epidemiological factors have been known to have important prognostic implications as they contribute to a wide range of long term survival in individuals with PMGCM. Methods: We obtained data from the Surveillance, Epidemiology and End Results (SEER) database from years 1975-2016 to include cases with confirmed primary mediastinal germ cell tumors. After complete gathering of selected data, a total of 1,328 number of cohorts were obtained which were stratified by age, sex, race, type of malignancy, size of primary tumor, site, grade etc. and were analyzed by Cox regression using proportional hazard model. Kaplan Meier curves were also obtained to visualize all cause survival and stratified survival according to the types of malignancy. Results: In our study, we found the incidence of PMGCM to be 0.18 per 1,000 people with malignant cancer with a median age at diagnosis of 28 years, the age range being 21-50 years. 92.9% patients were males and 7.1% were females with more common occurrence in White patients (54.5%). Most common type of PMGCM was found to be Seminoma (23.4%) and 56.32% were poorly differentiated (Grade III), excluding unknown cases. About half (52%) of all was found to arise from the anterior mediastinum. 36% of all cases died from primary cancer. 42.7% underwent surgery, however there was no data for chemotherapy or radiotherapy. Mean survival time among all PMGCM was 37.5 months (p p of 0.12 (p < 0.001). On survival analysis, age was a significant factor for decreased survival time with patients more than 50 years having a HR of 2 (p

244 Background: Options for clinically localized prostate cancer include radical prostatectomy, radiation therapy and active surveillance. Robot-assisted radical prostatectomy (RARP) is increasingly being used, and now accounts for the majority of radical prostatectomies performed in the United States. The aim of our study was to evaluate differences in the patient population undergoing open versus robot-assisted prostatectomy, and to compare 60-day readmissions after index hospitalization for radical prostatectomy. Methods: We utilized the Nationwide Readmission database (NRD) to obtain data on patients with prostate cancer admitted in 2016 and 2017 for radical prostatectomy in the United States. We used T-test to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used evaluate risk factors for 60-day unplanned readmissions. Results: A total of 115,551 patients met the inclusion criteria, of which 80.1% underwent RARP. Patients undergoing RARP were slightly older (64.8 vs 63.1 years, p < 0.0001), more likely to have private insurance (51.7% vs 44.3%, p < 0.0001) and undergo surgery at a teaching hospital (83% vs 74.6%, p < 0.0001). Importantly, open prostatectomy (OP) patients had higher rates of co-morbidities, including, hypertension, diabetes mellitus, chronic kidney disease, obstructive lung disease, heart failure, coronary artery disease and malnutrition (p < 0.01 for these co-morbidities). Hospital stay was longer in those who underwent OP (3.1 vs 1.7 days, p < 0.0001), and they were more likely to be discharged to nursing facility (3.0% vs 0.4%, p < 0.0001) or with home health care (10.9% vs 4.8%, p < 0.0001). Hospitalization charges were higher in the RARP population ($60k vs 57k, p = 0.04). Inpatient mortality was low in both groups (0.3% for OP and ~0% for RARP, p < 0.001). 60-day readmission rate was higher in those who underwent OP (9.3% vs 5.0%, p > 0.0001). Overall, the three leading causes for readmission included sepsis (10.6%), post-procedure infection (8.4%) and venous thromboembolism (VTE, 8.3%). Even after adjustment for age and comorbidities, those who underwent OP had higher risk of all-cause readmission (aOR 1.39, 95% CI 1.25-1.53, p < 0.001) and readmissions for sepsis (aOR 1.36, 95% CI 1.02-1.81, p = 0.03) and post-procedure infection (aOR 1.38, 95% CI 1.06-1.81, p = 0.02). Risk of readmission for VTE was similar in both groups. Conclusions: Nationwide, there are differences in demographics and comorbid illness burden in prostate cancer patients selected for open and robot-assisted radical prostatectomy. Better short-term outcomes in the RARP cohort may be partially attributed to lower comorbidity burden in this group. However, despite adjustment for comorbidities, higher risk for all-cause readmissions and readmissions for infectious complications persisted in the OP group.

466 Background: Malignancies are associated with a high prevalence of cachexia, protein energy malnutrition (PEM) and failure to thrive. We analyzed the National inpatient Sample database (NIS) to understand the temporal trends and differences between gastrointestinal cancers (GIC) patients with and without malnutrition. Methods: All adults admitted with GIC including esophageal, gastric, pancreatic, hepatic, gall bladder, small and large intestine and anal cancers from 2012-2016 were identified from the NIS using the ICD 9 and ICD 10 codes. We analyzed the temporal trends of mortality and resource utilization. Multivariable logistic regression was used to evaluate the risk factors for malnutrition in patients with GIC. Results: There were 2,645,285 GIC inpatient admissions between 2012-2016, out of which 6.1% patients died. 11.1% (±0.22) patients had PEM and three most common GIC associated with PEM were Esophageal (19.7±0.24%), gastric (16.5±0.22%) and small intestine (15.2±0.41%). On multivariate analysis, PEM was more common in male gender (OR: 1.07, 95% CI:1.05-1.08, P=2(OR:1.5, 95% 1.42-1.51, P

Background Neurocysticercosis is a Neglected Tropical Disease and an important public health issue. Our goal was to collect and analyze data regarding clinically significant gender differences among our Neurocysticercosis patients. Methods A retrospective chart search with ICD 9/ ICD 10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between years 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Results Among 90 total patients included, male (49.4%) and female (50.6%) distribution were nearly identical. The mean age in females was found to be higher than males (52.5 vs 42.0, P < 0.0001). Almost an equal number of males and females presented with either seizures (63.6% vs 57.8%, P= 0.85), headaches (25.0% vs 28.9%, p= 0.85), or other symptoms (11.4% vs 13.3%, p= 0.85). Males had more generalized seizures compared to females (60% vs 38%, P= 0.37), although this result was not statistically significant. Females were more likely to present with > 1 lesion (82.2% vs 56.8%, P= 0.01). Males were more likely to have cystic lesions (64.7% vs 27.9%, P < 0.001) compared to females who had more calcified lesions on presentation (65.1% vs 20.6%, P < 0.001). Male patients were more likely to have contrast enhancement or edema surrounding the lesions (61.4% vs 33.3%, P= 0.01) and were more likely to require treatment with Albendazole/Praziquantel (75.8% vs 31.7%, P < 0.001). Conclusion Although previously reported data is limited, there is a suggestion that there are gender differences in host immune response and that inflammation surrounding parenchymal lesions is more intense in females. This study suggests that men either present early in the disease phase or have different immune responses than women and require anti-parasitic therapy more frequently. More research in this aspect is needed. Disclosures All Authors: No reported disclosures

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.

e19257 Background: Hepatic failure (HeF) accounts for 6% of all liver-related mortality and 7% liver transplants (LT) in the US. Epidemiologically, while viral hepatitis, acetaminophen and drug injuries are common; malignancy-related HeF remains relatively unexplored. Methods: We performed a retrospective study using nationwide inpatient database (NIS) 2016, which is the largest US inpatient database. HeF admissions were identified as primary diagnosis (through ICD-10 codes) and stratified into two major groups with and without cancer. The cancer group was subdivided into solid (excluding hepato-cellular cancer (HCC)) and non-solid malignancies. Primary outcome was inpatient mortality while secondary outcomes included Length of stay (LOS), Total charge (TCHG), LT and respiratory failure requiring ventilation (MV). Results: 71,000 inpatients met inclusion criteria for HeF, of which 7,715(10.87%) had an underlying malignancy. 39.4%( n = 3,045) had solid malignancies (excluding HCC), 8.4%( n = 650) had non-solid malignancies and 56%( n = 4,020) had HCC. Mean LOS was 5.4 days (95% CI 5.4-5.6, p = 0.23) and mean TCHG was 63,240$(95% CI 57,258$-69,222$, p = 0.03). African Americans (61.2 % vs 53.6%, p = 0.001) and males (12.05% vs 8.71%, p = 0.001) were preponderant in the cancer group. Inpatient mortality was higher in the cancer group (15.3% vs 5.5% p = 0.000), among which solid cancer (20.39%) predominated over non-solids (13.85%) and HCC (11.71%). LT was higher in cancer group (3.7 % vs 2%), whereas no difference in MV was found. Multivariable analysis results are summarized in the table below. Conclusions: HeF patients with underlying malignancy have higher mortality, LOS, TCHG and LT rates. Furthermore, high median income, large center admissions, HCC and Charlson index < = 3 among others were associated with higher odds of undergoing LT in HeF. This study sheds light on the epidemiology and impact of HeF in cancers, as well as disparities in LT among GI cancer patients with HeF. [Table: see text]

e15131 Background: Immune checkpoint inhibitors (ICI) are associated with multiple immune related adverse events (irAE). Cardiotoxicities are rare but fatal complications. Since PD-1 and PD-L1 are expressed on human cardiomyocyte, there is an increased risk of cardiotoxicity with use of ICI. We performed a systematic review and meta-analysis to assess cardiotoxicities associated with PDL1 and CTLA4 inhibitors. Methods: The Embase, Ovid, Pubmed and Scopus were searched from inception to 2019 by two independent reviewers. All Phase II and III clinical trials reporting cardiotoxicities with the combination of, or monotherapy with anti-PD-1/PD-L1 and/or anti-CTLA4 were included. Our primary outcome was assessment of cardiotoxicity of all grades that included, hypertension, arrythmias, pericardial effusion, myocardial infarction, myocarditis, cardiomyopathy and cardiac arrest. Statistical heterogeneity was quantified using I2 statistics. The publication bias was assessed with Eggers regression test. The estimates were reported as odds Ratio (OR) with 95% confidence intervals (CI) using random effect model. Results: A total of 2,876 trials retrieved in the initial database search were analyzed according to PRISMA guidelines. Twenty trials met the inclusion criteria and were included in the final analysis. A total of 8,905 patients were included in these trials. There was no statistically significant difference in reported overall cardiotoxicity with ICI compared to placebo or standard of care (OR 0.953 95% CI 0.542-1.675, I2 89.49 p < 0.001). Also, no statistical significance associated with myocardial infarction (OR 0.76, 95% CI 0.76-3.298 I2 0%, P = 0.83), pericardial effusion (OR 1.44, 95% CI 0.72-2.90. I2= 0%, P = 0.613) or hypertension (OR 0.543, 95% CI 0.219-1.346. I2 = 94.98, P < 0.001). Myocarditis was reported in 8 patients with a statistically non-significant increased risk compared to standard of care or placebo (OR 2.16, 95% CI 0.719-6.828 I2= 0%, P = 0.885). Other reported cardiac irAE included cardiac arrest in 4 patients, QT prolongation in 2 patients and cardiac tamponade in 1 patient. Conclusions: The overall risk of cardiac related irAE is not significantly higher with ICI when compared with placebo or standard of care. The reported events of severe cardiac irAE like myocarditis and cardiac arrest are very low in the reported trials.

e16594 Background: The association between liver fibrosis and hepatocellular cancer (HCC) is well established, however there is limitation of data on liver fibrosis and non-HCC cancers. The aim of this study was to explore the link between the degree of liver fibrosis and other cancers. Methods: We searched the electronic medical records of Stroger Hospital who underwent liver elastography from January 1st, 2014 to December 31st, 2018 and had cancer. We extracted variables: demographics, cancer histology and metastatic status and then stratified patient into categories based the fibrosis stage. Results: Our analysis identified 103 patients with non-advanced fibrosis (F0-F2) and 74 with advanced fibrosis (F3-F4). HCC was seen in 33.3% of the patients with advanced fibrosis while genitourinary (GU) was the second most common cancer. Adenocarcinoma comprised 21% of these cancers and around 46% were metastatic. Of the 104 patients with non-advanced fibrosis, HCC was seen in 3.77% while gastrointestinal (GI) and GU cancers were seen in 24.27% and 12.62% respectively. Adenocarcinoma was most common (40%) in this group as well (Table). Conclusions: Our study not only reiterates the fact that the degree of liver fibrosis is proportional to the presence of HCC, but it also reports the association of liver fibrosis with several non-HCC cancers. The meaning of these associations is unclear, but it provides an area of further research to explore if causality exists. [Table: see text]

4045 Background: Sepsis is a frequent cause of morbidity and mortality in patients with malignancy. However, there is paucity of literature on mortality, hospital charges and overall healthcare utilization among patients with GI malignancy, which we hope to characterize in this study. Methods: We queried retrospective data from the Nationwide Inpatient Sample (NIS) database for the year 2016. Sepsis (Dx1) was identified using ICD-10 code as primary diagnosis in patients with known GI malignancies (Dx2). Univariate and multivariate Poisson regression analysis was done to study outcomes. Propensity score matching was done to minimize confounding factors. Primary outcome was inpatient mortality. Secondary outcomes were Length of Stay (LOS), Total Charge (TOTCHG) and ICU admission. Results: A total of 43,240 patients with GI malignancy were admitted in 2016 with sepsis. Two most common GI malignancies admitted with sepsis were colorectal (35%) and hepato-cellular cancer (HCC) (28.2%). Overall mortality in GI cancer was 19.8% vs 10.2% in all cancers (p

e19093 Background: Occurrence of venous thromboembolism is well known to have increased mortality in cancer patients with pulmonary embolism known to be the leading contributor. However, risk of mortality and healthcare burden with deep venous thrombosis (DVT) alone is not well elucidated, and primary prophylaxis is still controversial. We sought to evaluate risk of hospitalization, mortality, as well as, differences in resource utilization in patients with and without cancer, who were diagnosed in the emergency department (ED) with acute DVT alone. Methods: Adult patients diagnosed with acute DVT from January 2016 to December 2017 were identified from the Nationwide Emergency Department Samples (NEDS) database. Univariate and Multivariate logistic regression analysis was used to compare the risk of admission from the ED and inpatient mortality in DVT patients with cancer and those without. Secondary outcomes assessed were length of hospital stay (LOS), inpatient hospital charges, risk of GI bleed, and rates of inferior vena cava (IVC) filter placement and thrombolysis. Results: A total of 404,121 patients were diagnosed with acute DVT only, of which 8% had an underlying malignancy. Most common primary cancers were GI tract (20.1%), hematologic (16.5%) and lung (13.5%). Patients with cancer were older (mean age 66.4 vs 59.8 years, p

e15096 Background: Immune checkpoint inhibitors (ICI) are associated with multiple immune related adverse events (irAE). Moderate to severe neurotoxicity is reported in less than 1% of all patients treated with ICI. We performed a systematic review and meta-analysis to assess neurotoxicity associated with anti-PD-1/PD-L1 and anti-CTLA4 therapy. Methods: The Embase, Ovid, Pubmed and Scopus database were comprehensively searched by two independent reviewers, from inception to 2019, to include Phase II and III clinical trials reporting neurotoxicity with the combination of, or monotherapy with anti-PD-1/PD-L1 and/or anti-CTLA4 therapies. Our primary outcome was assessment of neurologic irAE of all grades. We divided neurotoxicity into two groups: peripheral nervous system (PNS) including peripheral neuropathy (PeN), fatigue, Guillain-Barre syndrome (GBS), myelitis; and central nervous system (CNS) including stroke, myasthenia gravis (MG), encephalopathy/encephalitis, altered mental status (AMS), decreased appetite and headache. Statistical heterogeneity was quantified using I2 statistics and publication bias was assessed with Eggers regression test. The estimates were reported as odds Ratio (OR) with 95% confidence intervals (CI) using random effect model. Results: A total of 2,876 full text articles retrieved in the initial database search were analyzed according to PRISMA guidelines. The final analysis included 39 trials, evaluating 10,595 patients in the control arm and 13,110 patients in the immunotherapy arm. All-grade neurotoxicity events with ICI were significantly lower compared to placebo or standard of care (OR 0.55, 95% CI 0.38-0.81, I2 96.82%, P < 0.001). Only significant CNS irAE observed was fatigue (OR 0.82, CI 0.71-0.96, I2 81.75%, P < 0.001). Other CNS irAE including AMS (OR 1.318, 95% CI 0.86-2.0, I2 0%, P = 0.442), encephalopathy/encephalitis (OR 1.36, 95% CI 0.38-4.96, I2 0%, P = 0.82) and seizures (OR 1.96, 95% CI 0.64-6.02, I2 0%, P = 0.56) had statistically non-significant increased risk in ICI group. Only one case of myelitis was reported in placebo group. The ICI arm had statistically significant lower rates of PeN (OR 0.28, CI 0.16-0.49, I2 87.31, P < 0.001). One trial reported 1 patient with MG and 5 trials reported 1 patient each of GBS in the ICI arm. Conclusions: Our meta-analysis concludes that use of ICI is associated with lower rate of neurotoxicity overall. Fatigue and PeN are lower with ICI compared to standard of care or placebo. Although, CNS irAE are increased with ICI, they do not reach statistical significance.

1098 Background: Up to three-quarters of women with advanced breast cancer develop bone metastases, predisposing to Skeletal Related Events (SRE), which are associated with a significant health care burden, poor prognosis, loss of functional independence and a decrease in quality of life. We performed a retrospective analysis on predictors of SRE in this population. We also evaluated temporal trends of outcomes and resource utilization in those with SRE. Methods: Adult breast cancer patients with metastases to bone, admitted from January 2012 to September 2015 were identified from the Nationwide Inpatient Sample database. Based on previous studies, SRE was defined by using ICD-9 codes for pathologic fracture, spinal cord compression, necessity for radiation to bone or surgery to bone. Multivariable analysis of predictors of SRE in patients with breast cancer metastatic to bone, as well as mortality in the SRE group were performed. Temporal trends of resource utilization across the years were evaluated. Results: A total of 143,455 patients with breast cancer with metastases to bone were identified, of which 17.2% had SRE. Patients with SRE had a mean age of 66 years and were predominantly white (70.2%). After adjusting for confounders, African Americans and Hispanics were less likely than Whites to develop SRE. On multivariable analysis, only comorbidity burden (in the form of high Charlson comorbidity index) predicted inpatient mortality. Rates of SRE in breast cancer patients with bone metastases did not change over the years (17.2% to 17.1%). Inpatient mortality of patients with SRE remained stable (3.76% to 3.79%). There was a statistically significant increase in surgical intervention (43.4% to 47.7%, p

e13625 Background: Tuberculosis (TB) is a major public health concern. Patients with malignancy are at increased risk of developing TB as a result of depressed cellular immunity. The aim of the study is to analyze the prevalence, mortality and healthcare resource utilization of cancer patients with TB. Methods: Adult patients with malignancy and TB (cases) were identified using ICD10 code from Nationwide Inpatient Sample database 2017 and their data was compared to cancer patients without TB (controls). Univariate and multivariable logistic and Poisson regression models were used to analyze mortality and healthcare resource utilization. Results: Among 2,099,294 adult cancer patients admitted in 2017, 1115 were found to have TB. Majority (84%) had pulmonary TB. Mean age of patients was 60.3 years with 65% males and white predominance (33%). Overall prevalence of TB in cancer population was 51.3/100,000 patients, with highest being in Hodgkin lymphoma (182.6/100,000) followed by and MDS/ MPN patients (113.2/100,000) (p < 0.01). Among solid organ malignancies, lung cancer had the highest prevalence of TB (92.1/100,000). After adjusting for the demographic and patient related variables, TB was found to be an independent risk factor for mortality in cancer patients (adjusted HR 1.7, 95% CI 1.13-2.66, p = 0.017). The mortality of cases during inpatient stay was 10.2% compared to 6.2% in controls. The mean length of stay for cases was 12.4 days vs 6.3 days in controls (adjusted coef +6.12, 95% CI 3.64-8.59, P < 0.001) and mean hospital charges in cases was $136,026 vs $67,381 in controls (adjusted coef 68,680, 95% CI 39,053.5-98,306.9, p < 0.001). On multivariate analysis, predictors of mortality in cancer patients with TB were older age, malnutrition, uninsured status, higher Charlson comorbidity score ( = > 3), ICU care, venous thrombo-embolism and Acute renal failure requiring dialysis. Conclusions: TB significantly increases the morbidity and mortality in cancer patients. Widespread TB screening, prompt recognition of infection and treatment can considerably reduce health care costs. [Table: see text]

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]

e19027 Background: Palliative care during the end of life is associated with greater patient satisfaction, improved quality of life and lower health care costs. Our aim was to study temporal trends of aggressive end of life care and palliative care during terminal hospitalizations in patients with metastatic cancer. We also studied disparities in palliative care in this population. Methods: Adult patients with metastatic cancer who died in the hospital from January 2012 to December 2017 were identified from the Nationwide Inpatient Sample database. Statistical tests for temporal trends of resource utilization were performed. Multivariable logistic regression was used to evaluate predictors of utilization of palliative care. Results: A total of 443,360 patients met the inclusion criteria. Mean age was 66.5 years. Patients were predominantly white (66.6%) with a slight male preponderance (51.9%). Most common primary cancers were lung (27.1%), GI tract (23.6%) and breast (7.6%). Use of chemotherapy and radiation decreased from 3.4% to 2.4% ( P < 0.001) and 2.8% to 1.4% ( P < 0.001), respectively, over the years. There was no statistically significant change in ICU care (26.6% to 27.2%, P= 0.61) or hospitalization costs ($22k to $23k, P =0.14). There was an increase in use of palliative care, from 45.7% to 61.2% ( P < 0.001). Patients were more likely to receive palliative care if they were older, female or treated at teaching hospitals. Blacks and Hispanics were less likely receive palliative care. Compared to patients insured by Medicare, those with Medicaid and private insurance were more likely to be offered palliative care. ICU care and chemotherapy predicted decreased use of palliative services. Conclusions: There is an overall trend towards increased use of palliative services and decrease in chemotherapy and radiation in terminal admissions. There are racial disparities in the utilization of palliative care services, with previous studies attributing knowledge gap, with mistrust of the system in African Americans, and language barriers in Hispanics to be causes for racial disparities. There is a need to increase efforts towards development of palliative care programs in non-academic hospitals. [Table: see text]

e18531 Background: Failure to thrive (FTT), encompassing malnutrition and cachexia, is a common comorbidity afflicting Head and Neck cancer (HNC), brought about either by progression of disease or complications of treatment. FTT can exacerbate infections or cytopenias and delay wound healing, and has shown to affect survival in HNC. This study aims to explore the effects of FTT on mortality and resource utilization among hospitalized patients with HNC. Methods: Adult patients with HNC admitted from 2012-2017 were identified from the Nationwide Inpatient Sample database. Temporal trends of resource utilization across six years were evaluated. Multivariable logistic regression was used to evaluate risk factors for malnutrition and mortality in patients with HNC. Results: A total of 448,255 patients met inclusion criteria, of which 27.2% had FTT. Mean age was 66.3 years. Patients were predominantly male (71.8%) and white (70.4%). Patients with FTT had higher mortality (6.3% vs. 3.6%, p

4109 Background: Laparoscopic colectomy (LC) has become an accepted safe and alternative technique to open surgical colectomy (OC) as a treatment option for colon cancer. We compared inpatient mortality, hospital resource utilization and complications in patients who underwent LC vs OC. Methods: All patients with known diagnosis of colon cancer who underwent elective colonic resection were identified using Nationwide Inpatient Sample (NIS) 2017. Univariate and multivariate linear and logistic regression was performed to compare the outcomes of patients who underwent LC vs OC. Results: In our cohort, 171, 480 adult patients with colon cancer were identified. The number of males and females were equal. The mean age was 67.2 years. They were predominantly Caucasians (67.6%). OC was performed on 3,869 patients. Of 1,345 patients who underwent LC, 385 were converted to OC. As compared to OC, LC was associated with lower postoperative complications including anastomotic leak, stricture, intestinal obstruction(1% vs 10.8%, p

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.