African Americans Possessed High Prevalence of Comorbidities and Frequent Abdominal Symptoms, and Comprised A Disproportionate Share of Covid-19 Mortality among 9,873 Us- Hospitalized Patients Early in the Pandemic.

Archives of internal medicine research Pub Date : 2024-01-01 Epub Date: 2024-02-16 DOI:10.26502/aimr.0163
Hassan Ashktorab, Antonio Pizuorno, Lakshmi Gayathri Chirumamilla, Folake Adeleye, Maryam Mehdipour Dalivand, Zaki A Sherif, Gholamreza Oskrochi, Suryanarayana Reddy Challa, Boubini Jones-Wonni, Sheldon Rankine, Chiamaka Ekwunazu, Abigail Banson, Rachel Kim, Chandler Gilliard, Elizabeth Ekpe, Nader Shayegh, Constance Nyaunu, Chidi Martins, Ashley Slack, Princess Okwesili, Malachi Abebe, Yashvardhan Batta, Do Ly, Ogwo Valarie, Tori Smith, Kyra Watson, Oluwapelumi Kolawole, Sarine Tahmazian, Sofiat Atoba, Myra Khushbakht, Gregory Riley, Warren Gavin, Areeba Kara, Manuel Hache-Marliere, Leonidas Palaiodimos, Vishnu R Mani, Aleksandr Kalabin, Vijay Reddy Gayam, Pavani Reddy Garlapati, Joseph Miller, Fatimah Jackson, John M Carethers, Vinod Rustgi, Hassan Brim
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Abstract

Background and aim: Identifying clinical characteristics and outcomes of different ethnicities in the US may inform treatment for hospitalized COVID-19 patients. Aim of this study is to identify predictors of mortality among US races/ethnicities.

Design setting and participants: We retrospectively analyzed de-identified data from 9,873 COVID-19 patients who were hospitalized at 15 US hospital centers in 11 states (March 2020-November 2020). Main Outcomes and Measures: The primary outcome was to identify predictors of mortality in hospitalized COVID-19 patients.

Results: Among the 9,873 patients, there were 64.1% African Americans (AA), 19.8% Caucasians, 10.4% Hispanics, and 5.7% Asians, with 50.7% female. Males showed higher in-hospital mortality (20.9% vs. 15.3%, p=0.001). Non- survivors were significantly older (67 vs. 61 years) than survivors. Patients in New York had the highest in-hospital mortality (OR=3.54 (3.03 - 4.14)). AA patients possessed higher prevalence of comorbidities, had longer hospital stay, higher ICU admission rates, increased requirement for mechanical ventilation and higher in-hospital mortality compared to other races/ethnicities. Gastrointestinal symptoms (GI), particularly diarrhea, were more common among minority patients. Among GI symptoms and laboratory findings, abdominal pain (5.3%, p=0.03), elevated AST (n=2653, 50.2%, p=<0.001, OR=2.18), bilirubin (n=577, 12.9%, p=0.01) and low albumin levels (n=361, 19.1%, p=0.03) were associated with mortality. Multivariate analysis (adjusted for age, sex, race, geographic location) indicates that patients with asthma, COPD, cardiac disease, hypertension, diabetes mellitus, immunocompromised status, shortness of breath and cough possess higher odds of in-hospital mortality. Among laboratory parameters, patients with lymphocytopenia (OR2=2.50), lymphocytosis (OR2=1.41), and elevations of serum CRP (OR2=4.19), CPK (OR2=1.43), LDH (OR2=2.10), troponin (OR2=2.91), ferritin (OR2=1.88), AST (OR2=2.18), D-dimer (OR2=2.75) are more prone to death. Patients on glucocorticoids (OR2=1.49) and mechanical ventilation (OR2=9.78) have higher in-hospital mortality.

Conclusion: These findings suggest that older age, male sex, AA race, and hospitalization in New York were associated with higher in-hospital mortality rates from COVID-19 in early pandemic stages. Other predictors of mortality included the presence of comorbidities, shortness of breath, cough elevated serum inflammatory markers, altered lymphocyte count, elevated AST, and low serum albumin. AA patients comprised a disproportionate share of COVID-19 death in the US during 2020 relative to other races/ethnicities.

在大流行病早期的 9873 名美国住院病人中,非裔美国人合并症和腹部频繁症状的发病率很高,在 Covid-19 死亡病例中所占比例过高。
背景和目的:确定美国不同种族的临床特征和结果可为住院 COVID-19 患者的治疗提供参考。本研究旨在确定美国不同种族/族裔的死亡率预测因素:我们回顾性分析了在美国 11 个州的 15 家医院中心住院的 9873 名 COVID-19 患者的去标识化数据(2020 年 3 月至 2020 年 11 月)。主要结果和测量指标:主要结果是确定住院COVID-19患者的死亡率预测因素:在9873名患者中,非裔美国人(AA)占64.1%,白种人占19.8%,西班牙裔占10.4%,亚洲人占5.7%,女性占50.7%。男性的院内死亡率较高(20.9% 对 15.3%,P=0.001)。未存活者的年龄(67 岁对 61 岁)明显高于存活者。纽约患者的院内死亡率最高(OR=3.54 (3.03 - 4.14))。与其他种族/族裔相比,AA 族患者的合并症发生率更高,住院时间更长,入住重症监护室的比例更高,机械通气的需求增加,院内死亡率更高。胃肠道症状(GI),尤其是腹泻,在少数族裔患者中更为常见。这些研究结果表明,在大流行早期阶段,年龄较大、性别为男性、AA 种族以及在纽约住院与 COVID-19 较高的院内死亡率有关。其他预测死亡率的因素包括合并症、呼吸急促、咳嗽、血清炎症指标升高、淋巴细胞计数改变、谷草转氨酶升高和血清白蛋白低。与其他种族/族裔相比,2020 年美国 COVID-19 死亡病例中的 AA 患者比例过高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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