IMPACT OF FULL DOSE ANTICOAGULATION IN HOSPITALIZED PREDOMINANTLY BLACK PATIENTS WITH SARS-COV-2 INFECTION: A RETROSPECTIVE SINGLE CENTER EXPERIENCE

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The SARS-CoV-2 coronavirus (COVID-19) infection can be associated with coagulopathy and a high incidence of thromboembolic events. Our study investigated the impact of full dose anticoagulation versus standard prophylaxis anticoagulation in hospitalized, predominantly Black patients with COVID-19 infection METHODS: This is a retrospective observational study based on chart review of patients admitted to the University Hospital of Brooklyn in New York City from March 23rd, 2020 through April 23rd, 2020. Inclusion criteria included age ≥ 18 years, confirmed COVID-19 infection, and available baseline D-dimer level. Patients were studied under two groups: full dose anticoagulant (AC) versus prophylactic dose (non-AC). The variables collected included demographics, comorbidities, laboratory results, type of anticoagulation, major bleeds, and Sepsis-Induced Coagulopathy (SIC) score. Follow-up clinic and telehealth visit notes were utilized to establish survival at 28 days RESULTS: A total of 138 hospitalized patients met the inclusion criteria. 119 (86.2%) were Black, 77 (56%) were males, 60 (44%) were females, and the average age of all was 66.6 years. 120 (85.5%) received full dose AC. Median hospital course for all patients was 12 days [IQR 7.00 to 24.25]. Kaplan Meier median survival was 25 days for AC group [95% CI 21.9-28.1] and 9 days [95% CI 6.4–11.6] for non-AC. Unadjusted proportional hazard ratio (HR) showed that full dose AC resulted in decreased mortality with a HR of 0.387 [95% CI 0.204 - 0.734;p=0.004], with multivariate proportional hazard adjusted for D-dimer, SIC score and CRP level of 0.159 [HR=0.159, 95% CI 0.070 - 0.361;p<0.001]. Patients who received full dose AC had higher D-dimer, CRP and SIC scores at baseline. Survival based on agent used showed no difference between direct oral anticoagulants (DOAC) and low molecular weight heparin (LMWH). Kaplan Meier median survival for DOAC was 20 days (95% CI 11.1-28.9) versus LMWH median survival of 25 days (95% CI 17.7-32.3). AC was stopped in a total of 11 patients (9 for major bleeds, 2 for down trending hemoglobin);with a Pearson’s chi-square=4.716 (p=0.09) which is statistically insignificant. CONCLUSIONS: In hospitalized patients with SARS-CoV-2 infection, administration of full dose anticoagulation showed a 28-day survival benefit in a predominantly Black population, especially those with a higher D-dimer, CRP, and SIC score at baseline. Further investigation with a randomized control trial of full dose anticoagulation in COVID -19 infection is warranted CLINICAL IMPLICATIONS: Empiric full dose anticoagulation has a role to play in the clinical management of high-risk hospitalized patients with COVID -19 infection while awaiting definitive therapies. DISCLOSURES: No relevant relationships by rishard abdul, source=Web Response No relevant relationships by Alla akivis, source=Web Response No relevant relationships by Yonatan Akivis, source=Web Response No relevant relationships by Aaliya Burza, source=Web Response No relevant relationships by Michael Farina, source=Web Response No relevant relationships by Bana Hadid, source=Web Response No relevant relationships by Ishmam Ibtida, source=Web Response No relevant relationships by Sridesh Nath, source=Web Response No relevant relationships by Yara Perez, source=Web Response No relevant relationships by Duarxy Sainvilien, source=Web Response No relevant relationships by Ghassan Samaha, source=Web Response No relevant relationships by Baho Sidiqi, source=Web Response No relevant relationships by Maya Srinivasan, source=Web Response No relevant relationships by Samrat Worah, source=Web Response No relevant relationships by Unaiza Zaman, source=Web Response

Higher comorbidities and early death in hospitalized African-American patients with Covid-19.

BACKGROUND: African-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions. METHODS: We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a 52-day period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population. RESULTS: Of the 1103 consecutive patients who tested positive for COVID-19, 529 required hospitalization and were included in the study. 88% of patients were Black; and a majority (52%) were 61-80 years old with a mean body mass index in the "obese" range. 98% had one or more comorbidities. Hypertension was the most common (79%) pre-existing condition followed by diabetes mellitus (56%) and chronic kidney disease (17%). Patients with chronic kidney disease who received hemodialysis were found to have lower mortality, than those who did not receive it, suggesting benefit from hemodialysis Age > 60 years and coronary artery disease were independent predictors of mortality in multivariate analysis. Cox proportional hazards modeling for time to death demonstrated a significantly high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil:lymphocyte ratio (8.3:10.0) were predictive of mortality on admission and at 48-96 h. Of the 529 inpatients 48% died, and one third of them died within the first 3 days of admission. 159/529patients received invasive mechanical ventilation, of which 86% died and of the remaining 370 patients, 30% died. CONCLUSIONS: COVID-19 patients in our predominantly Black neighborhood had higher in-hospital mortality, likely due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients.

Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis.

BACKGROUND: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested against the use of corticosteroids unless in clinical trials until the recent publication of the RECOVERY trial. Here, we analyzed the treatment effect of methylprednisolone on patients with AKI and ARDS during the initial 2 months of COVID-19 and detail the learning effect within our institution. METHODS: Between March 1 and April 30, 2020, 75 AA patients met our inclusion criteria for ARDS and AKI, of which 37 had received corticosteroids. Twenty-eight-day mortality, improvement in PaO2/FiO2 ratio, and renal function were analyzed. The impact of methylprednisolone treatment was assessed with multivariable methods. RESULTS: Survival in the methylprednisolone group reached 51% at 21 days compared to 29% in the non-corticosteroid group (P < .001). Methylprednisolone improved the likelihood of renal function improvement. PaO2/FiO2 ratio in the methylprednisolone group improved by 73% compared to 45% in the non-corticosteroid group (P = .01). Age, gender, BMI, preexisting conditions, and other treatment factors did not show any impact on renal or PaO2/FiO2 ratio improvement. The use of anticoagulants, the month of treatment, and AKI during hospitalization also influenced outcomes. CONCLUSION: In AA COVID-19 positive patients with ARDS and AKI, IV methylprednisolone lowered the incidence of mortality and improved the likelihood of renal and lung function recovery. Further investigation with a randomized control trial of corticosteroids is warranted.