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
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.