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=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.
ABSTRACT
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.
ABSTRACT
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