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Journal Article Epublish 11 citations

PubMed: 35715729 DOI: 10.1186/s12879-022-07520-1

Symptomatic, clinical and biomarker associations for mortality in hospitalized COVID-19 patients enriched for African Americans.

BMC Infect Dis 22(1):552

Authors: Hassan Ashktorab, Antonio Pizuorno, Folake Adeleye, Adeyinka Laiyemo, Maryam Mehdipour Dalivand, Farshad Aduli, Zaki A Sherif, Gholamreza Oskrochi, Kibreab Angesom, Philip Oppong-Twene, Suryanarayana Reddy Challa, Nnaemeka Okorie, Esther S Moon, Edward Romos, Boubini Jones-Wonni, Abdoul Madjid Kone, Sheldon Rankine, Camelita Thrift, Derek Scholes, Chiamaka Ekwunazu, Abigail Banson, Brianna Mitchell, Guttu Maskalo, Jillian Ross, Julencia Curtis, Rachel Kim, Chandler Gilliard, Geeta Ahuja, Joseph Mathew, Warren Gavin, Areeba Kara, Manuel Hache-Marliere, Leonidas Palaiodimos, Vishnu R Mani, Aleksandr Kalabin, Vijay Reddy Gayam, Pavani Reddy Garlapati, Joseph Miller, Lakshmi Gayathri Chirumamilla, Fatimah Jackson, John M Carethers, Farin Kamangar, Hassan Brim

Affiliations

  • Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W. Washington, DC, USA.
  • Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W. Washington, DC, USA.
  • Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA.
  • College of Engineering and Technology, American University of the Middle East, Salmiya, Kuwait.
  • Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
  • Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Department of Trauma, Acute and Critical Care Surgery, Duke University Medical Center, Durham, NC, USA.
  • Dartment of Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, NY, USA.
  • Department of Medicine, Interfaith Medical Center, New York, NY, USA.
  • Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
  • Division of Gastroenterology and Hepatology, Department of Internal Medicine, Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
  • Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA.

Abstract

BACKGROUND AND AIMS

Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality.

METHODS

We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected.

RESULTS

The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort.

CONCLUSION

Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.

MeSH

Diabetes Mellitus, Glucocorticoids, Procalcitonin, Comorbidity, Mortality, Troponin, Multiple Chronic Conditions, Biomarkers, Covid-19, Ferritins, Sex, Communicable Diseases

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