Raavi Gupta1, Raag Agrawal2, Zaheer Bukhari2, Absia Jabbar2, Donghai Wang2, John Diks2, Mohamed Alshal2, Dokpe Yvonne Emechebe2, F Charles Brunicardi3, Jason M Lazar4, Robert Chamberlain5, Aaliya Burza6, M A Haseeb7. 1. SUNY Downstate Medical Center, Departments of Pathology and Cell Biology, 450 Clarkson Ave. MSC #37, Brooklyn, NY, 11203, USA. raavi.gupta@downstate.edu. 2. Department of Pathology, SUNY Downstate Medical Center, Brooklyn, USA. 3. Department of Surgery, SUNY Downstate Medical Center, Brooklyn, USA. 4. Division of Cardiology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, USA. 5. Department of Anesthesiology, SUNY Downstate Medical Center, Brooklyn, USA. 6. Division of Pulmonary Medicine and Critical Care, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, USA. 7. SUNY Downstate Medical Center, Departments of Pathology and Cell Biology, 450 Clarkson Ave. MSC #37, Brooklyn, NY, 11203, USA.
Abstract
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.
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-19patients 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-19patients 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.
Entities:
Keywords:
ACE inhibitors; African-Americans; Angiotensin II receptor blockers; COVID-19; Chronic kidney disease; Comorbidities; Dialysis; Health disparities
Authors: Elizabeth Wrigley-Field; Sarah Garcia; Jonathon P Leider; David Van Riper Journal: Health Aff (Millwood) Date: 2021-09-15 Impact factor: 9.048
Authors: Firoozeh V Gerayeli; Stephen Milne; Chung Cheung; Xuan Li; Cheng Wei Tony Yang; Anthony Tam; Lauren H Choi; Annie Bae; Don D Sin Journal: EClinicalMedicine Date: 2021-03-18