Oral Presentation Session I

Background/Significance:

Ectopic pregnancy (EP) requires timely diagnosis and treatment as delays increase the risk of rupture and maternal morbidity/mortality. Delays to reproductive healthcare access due to legal ambiguity, clinic closures, and widespread misinformation post-Dobbs vs. Jacksonmay have increased the incidence of ruptured EPs in Wisconsin. Similar delays may have also been experienced during COVID- 19 increasing ruptured EPs.

Purpose:

To examine the impact of restricted reproductive healthcare access in Wisconsin post-Dobbson EP rupture incidence proportion (IP), presentation, and management.

Methods:

Our retrospective cohort study looked at EPs within one healthcare system at 63 facilities located predominately in Southeastern Wisconsin across 3 segmented study periods of 15, 27, and 15 months, respectively: 1-pre-Dobbsand no COVID-19 restrictions, 1/1/2019-3/31/2020; 2-pre-Dobbsand COVID-19 restrictions, 4/1/2020-6/30/2022; and 3-post-Dobbsand no COVID-19 restrictions, 7/1/2022-9/30/2023. Using ICD-10–identified cases, we calculated the IP of ruptured EPs by time, and assessed differences in presentation and management, including demographics, gestational age, laboratory values, blood loss, and transfusion needs. We fitted a weighted segmented linear regression interrupted time series (ITS) allowing for the assessment of immediate change in proportion and change in trend following the interventions. The significance level was set at α=0.05.

Results:

We identified a total of 913 EPs. There were no significant differences in the IP of ruptured EPs among the three periods (49.1% vs 44.3% vs 44.6%, p = 0.46). Results from ITS showed that the baseline rupture IP was about 49.7%. The outbreak of COVID-19 led to no significant immediate level change in IP of ruptured EPs (β = -4.27, 95% CI -19.13 to 10.59, p = 0.58), nor a change in trend (β = 0.02, 95% CI -1.48 to 1.52, p = 0.98). Dobbsalso led to no significant immediate level change in IP of ruptured EPs (β = -3.84, -18.03 to 10.35, p = 0.60), nor a change in trend (β = 0.58, 95% CI -0.83 to 2.00, p = 0.42). There were no differences in demographics, gestational age, laboratory values, blood loss, and transfusion needs across the time periods (all p’s > 0.05).

Conclusion:

Despite increased challenges and barriers to care post-Dobbsand during COVID-19, our study found no evidence of baseline trend or level/trend changes in EP rupture IP, suggesting our system continued to provide comprehensive care.

Background/Significance:

Iron-deficiency anemia (IDA) commonly complicates cardiovascular disease, but its association with outcomes in stress cardiomyopathy (SC) is not well defined.

Purpose:

We examined whether IDA in SC is associated with higher in-hospital mortality and greater resource utilization.

Methods:

Using the National Inpatient Sample (2016–2022), we identified adult SC hospitalizations and stratified admissions by IDA status. Survey-weighted multivariable logistic regression evaluated the association of IDA with in-hospital mortality (primary outcome).Key secondary outcomes—cardiogenic shock (CS), mechanical circulatory support (MCS), acute kidney injury (AKI), vasopressor use, length of stay (LOS), and total hospital charges (THC)—adjusting for demographics, comorbidities, and hospital characteristics.

Results:

Among 199,920 SC hospitalizations, 53,530 (26.8%) had IDA. Compared with SC without IDA, SC with IDA had higher in-hospital mortality (9.6% vs 5.5%; aOR 1.14, 95% CI 1.03–1.28) and higher rates of CS (9.7% vs 5.4%; aOR 1.25, 95% CI 1.12–1.39), MCS (2.1% vs 1.0%; aOR 1.39, 95% CI 1.12–1.71), AKI (3.5% vs 1.8%; aOR 1.74, 95% CI 1.63–1.85), and vasopressor use (6.9% vs 3.0%; aOR 1.61, 95% CI 1.41–1.86). Resource utilization was substantially greater with IDA, with longer median LOS (11 vs 5 days) and higher median THC ($160,524 vs $80,501) (all p<0.001).

Conclusion:

In a contemporary national cohort of SC hospitalizations, IDA was independently associated with higher in-hospital mortality, greater hemodynamic decompensation, increased renal injury, and markedly higher resource utilization. IDA identifies a high-risk SC phenotype and supports prospective evaluation of targeted anemia/iron-deficiency management strategies in this population.

Background/Significance:

Severe community-acquired pneumonia (CAP) is associated with significant morbidity and mortality in critically ill patients. Adjunctive corticosteroid therapy remains controversial. IDSA guidelines recommend routine steroid use in severe CAP, while SCCM guidelines support corticosteroids based on the recent landmark trial, CAPE COD.

Purpose:

This study evaluated the effect of adjunctive steroid therapy versus no steroid therapy on clinical outcomes in patients admitted to the intensive care unit (ICU) with severe CAP and real-world adherence to guideline endorsed steroid regimens. Risk factors associated with clinical failure were also assessed.

Methods:

We conducted a multi-center retrospective evaluation of adults ≥18 years admitted to the ICU with CAP from January 1, 2024, to June 30, 2025. Patients with hospital- or ventilator-acquired pneumonia, viral pneumonia, recent systemic corticosteroid use (≥5 mg prednisone equivalent within 7 days), or steroid initiation for non-CAP indications were excluded. Clinical failure was defined as death attributed to CAP, failure to return to pre-morbid oxygen status or escalation of oxygen requirements within 4 days of ICU admission. Baseline characteristics were compared between groups; regression analysis was used to identify predictors of clinical failure.

Results:

In total, 405 patients were included; 179 (44%) received steroids and 226 (56%) did not. Patients in the steroid cohort had higher rates of acute respiratory distress syndrome (ARDS) on admission, increased oxygen and vasopressor requirements, and longer ICU and hospital length of stay. Among patients meeting CAPE COD severe criteria, clinical success rates were higher in the non-steroid group versus the steroid group, 52.6% vs 61.7% (p=0.05). Within the steroid treatment group, only 62.6% of patients received steroids per guideline approved dosing strategies. Regression analysis identified older age, higher SAPS-2 score, severe pneumonia classification, vasopressor use, and immunosuppression as predictors of clinical failure. Treatment with steroids was not independently associated with success.

Conclusion:

In this real-world retrospective evaluation, adjunctive steroid therapy for severe CAP did not improve rates of clinical success. Variables associated with poorer outcomes were advanced age, higher SAPS- 2 score, severe pneumonia classification, vasopressor use, and immunosuppression.