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Background: Coronavirus disease 2019 (COVID-19) and associated outcomes manifest differently depending on patients' background and pre-existing conditions. It remains unclear how African Americans with and without cancer have been affected. Aim: To determine epidemiological, clinical comorbidities, and laboratory test results to identify markers associated with mortality in COVID-19 cancer patients. Methods: We reviewed all COVID-19 hospitalized patient records from Dec. 2019 to Nov. 2021 at Howard University Hospital. Patients having a history of, or active cancer status were reviewed. All the clinical, treatment, lab values, and pathological data were extracted. Statistical analysis of the COVID-19 cancer patients and comparison with non-cancer COVID-19 patients were performed using univariate and multivariate analyses. Results: Out of 800 COVID-19 infected patients, a total of 49 patients were identified with different types of cancer, with both active and previous history. Females consisted of 26 cancer patients (53%). Cancer patients were older than non-cancer patients (mean age-70.6 vs. 56.3 years) and had an increased length of hospital stay (mean 13.9 vs 9.4 days). Among cancer patients, breast cancer was more prevalent in females and prostate cancer in males, (54% and 52% respectively). In both cases and controls, univariate and multivariate analyses did not show any correlation between individual symptoms or clinical comorbidities and death. Higher reduction in albumin level in cancer cases, from the time of admission to day five, was significantly associated with death during the same hospital stay compared to those who were discharged (p<0.001). In controls, lymphocytes count, AST, and Albumin have shown an association with increased mortality. Comparison of patients with active vs. previous cancer showed no significant difference in the clinical outcome, death vs discharge (P=0.34). Conclusion: Albumin level has shown to have an inverse relationship with clinical outcomes among all COVID infected African American patients. Reduction in Albumin level during the hospital stay, particularly in COVID-19 cancer patients should be considered as a predictor of mortality. No significant difference was noticed in the clinical outcome in patients with previous versus active cancer. Further research with a large cohort size is needed to verify and identify other predictors of outcome in COVID-19 cancer patients and develop appropriate treatment modalities.
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Background and Aims: Cancers are known to worsen the clinical course of SARS-CoV-2 infection. We aimed to assess health outcome effectors in Coronavirus 19 (COVID-19) cancer patients from different centers in the US. Methods: We retrospectively evaluated medical records of 364 COVID-19 cancer patients from 3 centers in the US (New York, Michigan, and DC) admitted to the hospital between Dec. 2019 to Oct. 2021. Outcomes, symptoms, labs, and comorbidities of cancer patients with COVID 19 (Cases), were analyzed and compared with non-cancer COVID-19 patients (Controls). Results: Among 1934 hospitalized COVID-19 patients, 18.7% (n=364) have an active or previous history of cancer. Cancer patients were older when compared with non-cancer controls (69.7 vs 61.3 years). Among these 364 cancer patients, 222 were African Americans (61.7%) and 121 were Caucasians (33.2%). Cancer patients had an increased length of hospitalization compared to controls (8.24 vs. 6.7 days). The most common types of cancer in cases are prostate cancer (41.5%) and hematological malignancies (10.1%) among males, and breast cancer (41.5%), and head and neck cancers (11.4%) in females. In both genders, lung cancer is associated with high mortality. Patients with a previous history of cancer were more prone to death (p=0.04) than active cancer patients. Cough (23.1%) and fever (19.5%) are the most common symptoms among the cases. In univariate and multivariate analyses, predictors of death among cancer patients were male sex, older age, African American ethnicity/race, asthma, presence or absence of fever, elevated troponin, mechanical ventilation, and previous history of cancer. There is no significant difference in mortality in cancer patients when compared to controls. Abdominal pain (2.2%), diarrhea (3.8%), and vomiting (2%) occurred both in cases and controls but did not associate with death. Albumin is also significantly associated with mortality in cases (p=0.042). AST (54.6%), ALT (12.5%), and Bilirubin (16%) were elevated in the majority of cases. Both AST and ALT alterations have an effect on mortality. Univariate analysis shows that AST is strongly and significantly associated with mortality in cases (p=0.001) but not in controls. ALT is also associated with mortality in cases at the 10% level (p=0.057). Diarrhea is strongly associated with mortality in control (p <0.001) but not in cases. Conclusion: In this retrospective cohort study, we found male sex, and African American race is associated with high mortality. Elevated troponin levels and LFT’s during the hospital stay were significantly associated with poor outcomes. Patients with a previous history of cancer were more prone to death when compared to active cancer COVID-19 patients. Early recognition of cancer COVID-19 patients can help determine appropriate treatment and management plans for better prognosis and outcome.
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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=5,852) from 8 hospitals. 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 dead patients' mean ages 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, and EA were 14.8%, 7.3%, and 16.3%. 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, respiratory failure, 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 a higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables were age (over 45 years old), male sex, EA, patients hospitalized in Indiana, Michigan, Georgia, and District of Columbia. 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, predictors of mortality include male gender, diarrhea, elevated AST, comorbidities, respiratory symptoms and failure, and elevation of inflammatory- related biomarkers. These 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 a high frequency of comorbidities and older age among AA.
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Background: Coronavirus disease 2019 (COVID19) disproportionately struck minority populations.It is important to find out the determinants of such differences in outcomes. Methods:We collected data on 403 hospitalized COVID19 patients at Howard University Hospital.Statistical analysis of symptoms, comorbidities, and lethality was performed using SPSS.Results: There were 257 (63.7%) African Americans (AAs), 102 (25.3%) Hispanics, and 26(6.45%) Whites. The mean age was 55.6 years old (+/-18.5). However, the Hispanic's meanage was the lowest (43.66 years vs. 61.23 for Whites vs. 60 for AAs). 64 (15.8%) patientsdied. Age and race were risk factors for poor outcomes. Elevated Creatinine, Ferritin, CRPand D-dimers were associated with death (35.75% vs. 2.61%), (24.72% vs. 9.9%), (22.7%vs. 7.8%), and (21% vs. 0%), respectively. Hydroxychloroquine treatment did not associatewith a better prognosis (25.92% vs. 14.23%). Abdominal pain, anorexia, diarrhea, nausea,and vomiting did not have any effect on the outcome. Elevated liver enzymes associatedwith poor outcome. There was more mortality in patients with cardiac diseases (25.67%vs. 14.33). Immunocompromised patients had a higher mortality rate (40% vs. 15.31%).Cough and fever were the top symptoms in our patients, but they were unrelated to theoutcome. As for treatment, patients receiving glucocorticoid displayed higher mortality(39.1% vs. 11.8%). Also, patients with shortness of breath (21.6 vs. 7.3%), those undergoingIntubation (66.6% vs. 14.5%), and mechanical ventilation (70.1% vs. 5.1%) had a highmortality rate. Conclusion: Overall, elevated liver enzymes, ferritin, CRP, and D-dimers arerobust markers of poor prognosis. The African Americans in our study displayed the highestmortality as they consisted of an older population when compared to the Hispanic group.GI symptoms did not correlate with outcome, however, they are likely important to followas the virus persists within the GI system, even after clearing from the respiratory system.
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Coronavirus (SARS-CoV-2) has caused a severe outbreak in the United States and theworld, and currently causing a global pandemic. SARS-CoV-2 mostly causes respiratory andgastrointestinal symptoms (GI). Clinical manifestations range from mild cold-like symptomsto more severe diseases such as bronchitis, pneumonia, severe acute respiratory distresssyndrome, multi-organ failure, and even death. Coronaviruses (SARS-CoV-1, MERS-CoV,and SARS-CoV-2) seem to less commonly affect children and cause fewer symptoms andless severe disease in this age group compared with adults. We aimed to study SARS-COV-2 and associated GI symptoms in pediatric patients (<18 years) in the USA. Methods: Weanalyzed data from SARS-CoV-2 positive patients evaluated at healthcare centers and hospitalsin the USA (N=6,639) including at least 208 centers/hospitals between January 20th, 2020,and November 5th, 2020. The US consists of a total pediatric population that exceeds 74.2million. Demographics, comorbidities, and clinical symptoms were collected. Statisticaldescriptive analysis and correlation analyses of symptoms were performed. Results: Of 6,639hospitalized COVID-19 pediatric patients, 2,566 (38.6%) were White, 1,974 (29.7%) wereAfrican Americans, 2,040 (30.7%) were Hispanics and 986 (14.8%) were others. The averageage was 15 years and 51% were male. The most common symptoms in our overall cohortwere fever (43%) and cough (32%). Vomiting (11.5%) followed by diarrhea (9.7%) werethe main GI symptoms (9.7%), particularly in African American children. Conclusion: Wereport that cough and fever are the primary symptoms in hospitalized pediatric COVID-19patients in the US. Vomiting, abdominal pain, and diarrhea were common among thesepatients, with vomiting as the most prevalent GI symptom. Most hospitalized patients (~60%)were from African American and Hispanic minority populations.
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Background: It Is Well Known That Minorities Have Lower Access To Healthcare And At The Same Time Are Widely Affected By Many Comorbidities. This Predisposes Them To Worse Outcomes Compared To Others In The Current Pandemic. We Aimed To Study The Gastrointestinal (Gi) Symptoms, Comorbidities, And Clinical That Associate Covid-19 Outcomes In These Populations. Methods: We Analyzed Prospective And Retrospective Data From Sars-Cov-2 Positive Hospitalized Patients (N=5,932) From 9 Hospitals Including New York (3 Hospitals), Indiana, Rhode Island, District Of Columbia, Georgia, Michigan, And Maryland Between March And September 2020. Demographics, Comorbidities, Clinical Symptoms, And Median Laboratory Values Were Collected. The Primary Outcome Was The Rate Of In-Hospital Death. Secondary Outcomes Included Frequency And Duration Of Invasive Mechanical Ventilation, Frequency Of Treatment, And Liver Function Following Admission. Statistical Analysis Of Symptoms, Comorbidities, And Lethality Was Performed By Using Spss. Results: There Were 3713 With (62.7%) African Americans (Aa), 294 (5%) Hispanics, 1,418 (23.9%) Whites, 94 (1.5%) Asian, And 187 (3.2%) Others, 64 (1.1%) Decline, 150 (2.5%) Unknown. From 5,631 Known Ethnicity, The Average Age For Alive And Dead Was, 58 And 68 For Aa, 58 And 77 For Whites, 44 And 61 For Hispanic, And 51 And 63 Years For Asians. Males Were 47%, 41%, 47%, And 43% Among Aas, Hispanics, Whites, And Asians, Respectively. Lethality Rates Were 14.3%, 6.4%, 15.6%, Among Aas, Hispanics, And Whites, Respectively. In Chi-Squared Analysis, An Association With Lethality Was Found For Elevated Bun 14 (21.10%), Creatinine 14 (21.10%), Ferritin, Crp 304 (16.20%), D-Dimers 267 (18.00%), Ast 264 (21.10%), Prc, Troponin, Low Hemoglobin, Coronary Artery Disease, Cancer, Cardiac Disease, Hypertension (18.8%), Copd, Diabetes 281(17.20%), Diarrhea14 (21.10%), Fatigue 14 (21.10%). Use Of Glucocorticoid, Intubation, Mechanical Ventilation, Respiratory Failure, Shortness Of Breath Correlated With Death In A Significant Manner. Male Gender 311 (18.00%) And White And African Races Have A Higher Rate Of Death. These Symptoms And Commodities Were Seen Across The Board In All Races, However, Diarrhea Was Among The Most Common Gi Symptom In African Americans 50 (21.90%). Conclusion: Our Study Is Among The Largest Minority Covid-19 With Gi Manifestation That Shows Diarrhea And Elevated Liver Enzyme Ast Is Associated With Death. High Lethality Rate In African Americans In Comparison With Hispanics Is Likely Related To High Frequencies Of Comorbidities Such As Cardiovascular (Hypertension), And Diabetes. Prospective Investigations Will Likely Help A Better Characterization Of Minority Covid-19 Patients And A Better Understanding Of Factors Underlying The Observed Disparities