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score (p = 0.01) and a lower preponderance of diffuse alveolar damage (DAD) on CT (p = 0.19) although there was no difference in overall extent of CT abnormality. (Table 1). Conclusions The use of ECMO and early immunosuppression led to a 58.3% survival in a group of ILD associated SRF who would otherwise have been highly likely to die. The responders were characterised by a more acute and more inflammatory presentation. We suggest that ECMO and immunosuppression should be considered in patients with ILD and SRF who are failing mechanical ventilation. Introduction and objectives New data from the US IPFNET PANTHER Study 1 has failed to demonstrate efficacy of NAC in adult IPF patients with mild to moderate disease. However, use of NAC in adults with Idiopathic Pulmonary Fibrosis (IPF) is commonplace in the UK 2 despite weak clinical evidence and limited support from clinical guidelines. NICE recently estimated that between 30 and 45% of patients with moderate IPF are treated with NAC monotherapy at an annual cost of £158 per patient 3 . We wanted to estimate the cost burden of NAC prescribing in England based on the actual acquisition cost to the NHS. Methods We obtained the actual prices of NAC at a dose of 600 mg TDS from 11 different sources in England including IPF specialist centres, UK Medicines Information and guidance from Area Prescribing Teams and applied the average price into the NICE IPF costing template assuming 45% of moderate IPF (just over 3000 patients) patients receive NAC and 90% are still taking treatment at 52 weeks. ResultsThe average annual cost of NAC from 11 different sources was £675.63 (425% greater than NICE cost assumptions) with costs ranging from £144-£1078 per annum. This equates to an estimated annual cost of NAC in England of £2,070,266. Conclusion NAC is unlicensed with a recent trial demonstrating limited benefit in treating IPF. The estimated annual cost burden of NAC to the NHS in England is very high. In light of the current financial position of the NHS more should be done to reduce the use of ineffective treatments that offer poor value for money. Physicians should re-evaluate the use of NAC in the management of IPF.

Coronavirus disease 2019 (COVID-19) currently represents a major health emergency worldwide. Early recognition of severe forms of this virus is essential to align effective management and treatment strategies. Presepsin (PSP), the soluble cluster of differentiation (CD14) subtype; is a useful biomarker not only for early diagnosis of sepsis but also could be used as a predictive for the severity and mortality in septic patients, as well as in pneumonia. This study aimed to investigate the potential utility of PSP as a predictive indicator of disease severity in COVID-19 patients. A total of 42 COVID-19 patients were enrolled in this study and stratified into moderate and severe groups, in addition to 15 healthy patients as controls. The PSP levels were measured using Enzyme Linked Immuno-Sorbent Assay (ELISA) within 24 h (1 day) as well as on the 5 th day of admission to the Geriatrics hospital, Ain Shams University, Cairo, Egypt, in addition to other relevant laboratory tests performed during the study period from July to October, 2020. Results showed that the PSP levels were significantly higher in COVID-19 patients compared to the controls (p< 0.001), and were also noticeably elevated in severe group than in moderate group on the 1 st day 1 (p= 0.008) and the 5 th day (p= 0.003) of hospital admission. Significant correlation between PSP level and hospital stay (r = 0.332, p= 0.032) was detected; however, no significant correlation was recorded with the different laboratory parameters. For severity prediction, PSP revealed significant values for the 1 st day and the 5 th day (AUC 0.737; p= 0.003 and AUC 0.810; p< 0.001), respectively. Data obtained in this study suggested the potential utility of PSP as a predictive indicator of severity in COVID-19 patients, thus allowing for earlier identification of high-risk patients and those who will be hospitalized for longer periods.

Background Idiopathic Pulmonary Fibrosis (IPF) is an increasingly important respiratory illness in the UK. Rising prevalence of disease, emerging treatments, development of clinical guidelines for diagnosis and management and a NHS England service specification 1 increase demands on healthcare providers who are required to enhance capacity or reconfigure services to manage patients. Aims Estimate the patient care pathways across service providers in England compared with pathways recommended by NICE guidelines 2 and the NHS England Service Specification; in terms of time and cost per patient by 'diagnosis', 'management' and 'monitoring', and then levels of reimbursement to providers for current levels of care and those recommended. Methods Structured interviews with clinicians and coders ascertained current levels of service provision, excluding drug costs, by 14 NHS specialist ILD providers. Data were analysed utilising a bottom-up costing approach to estimate the total pathway costs. Comparison with services and costs as recommended by NICE guidelines and service specification allowed estimation of NHS providers' profit or loss. Results The estimated mean cost per patient for the first year of diagnosis, management and monitoring was £1,414, which is approximately £418 (42%) more than is reimbursed by the PBR tariff. 3 By comparison, the equivalent cost of the NICE/service specification pathway is approximately £477 (41%) more than reimbursed by the tariff. In particular, it was noted that significant staff time is required for MDT discussion, but that this is not reimbursed. Conclusions Results suggest that current NHS tariffs for ILD are insufficient to support current service provision. This is true for current levels of care as well as for the levels of care Abstract M271 Figure 1 Moderated posters

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