Elevated Liver Enzymes, Ferritin, C-reactive Protein, D-dimer, and Age Are Predictive Markers of Outcomes Among African American and Hispanic Patients With Coronavirus Disease 2019

Abstract

S evere acute respiratory syndrome coronavirus 2 caused a worldwide outbreak. Its associated disease, coronaviruses disease 2019 (COVID-19), causes respiratory, gastrointestinal (GI), inflammatory, and neurologic symptoms. 1 In the United States, minorities such as African Americans (AA) and Hispanics (HSP) have shown a higher incidence of the disease. 2,3 . However, no detailed characterization of the disease's features in these populations has been performed. 4 Although the initial focus was on saving lives and developing and delivering vaccines and therapeutics, the focus is shifting toward an assessment of specific features of the disease in different patient groups, variables that affect outcome, and, more importantly, factors that correlate with persistent and recurring symptoms. 5 In this study we describe the demographics, clinical features, and GI symptoms of hospitalized minority patients with confirmed severe acute respiratory syndrome coronavirus 2 infection at a tertiary hospital located in Washington, DC. We also sought to determine how these features relate to outcomes and which can be considered for prognosis assessment. Methods Patient SelectionA list of 447 hospitalized adult (March to September 2020 at Howard University Hospital) COVID-19 patients was obtained. This study was approved by the Institutional Review Board. Demographics, clinical values, comorbidities, laboratory test results, and treatment data were collected from patient charts.

Symptomatic, clinical and biomarker associations for mortality in hospitalized COVID-19 patients enriched for African Americans

“…The United States is one of the most ethnically and racially diverse countries in the world encompassing 13.4% African Americans (AA) and 18.5% Latinos/Latinas (LAT) [1]. Disparities among various ethnic groups span many aspects of health [2][3][4], and specific racial/ethnic minority populations have been disproportionately affected by the morbidity and mortality related to COVID-19 [5][6][7]. Reports across the US indicate that African American and Hispanic populations have higher COVID-19 related hospitalization and mortality than Caucasians.…”

“…The majority of the AA and LAT are essential workers/ frontline workers who need to work in person and are at even higher risk of contracting COVID-19. There may also be differences in the provisions of hospital care by racial/ethnic groups [4,12], but there has not been adequate data on hospital outcomes by race or ethnicity that adjusts for potential confounders. Four major reasons may explain the higher risk for COVID-19, Age, co-morbidities (such as diabetes, obesity, hypertension, cardiovascular Asthma, chronic obstructive pulmonary disease (COPD), and chronic kidney disease), access to health care and social economic status particularly for minority [4,12,14].…”

“…There may also be differences in the provisions of hospital care by racial/ethnic groups [4,12], but there has not been adequate data on hospital outcomes by race or ethnicity that adjusts for potential confounders. Four major reasons may explain the higher risk for COVID-19, Age, co-morbidities (such as diabetes, obesity, hypertension, cardiovascular Asthma, chronic obstructive pulmonary disease (COPD), and chronic kidney disease), access to health care and social economic status particularly for minority [4,12,14]. The race and ethnicities to be strong risk factors for infection and COVID-19 includes those of African descent and Native Americans [12,14].…”

Role of transaminases, CRP and LDH in COVID-19 patients with and without respiratory failure during the disease outbreak

“…Also, in another recent study CRP and transaminases emerged as risk factors of mortality in COVID-19 hospitalized patients. 33 Since CRP is elevated in most inflammatory conditions, so as pneumonia 34 , its prognostic role need to be carefully weighted. Indeed, with such awareness, regular monitoring of CRP values during hospitalization should be carried out in relation to clinical features.…”

Gastrointestinal manifestations and SARS-CoV-2 infection

“…In comparison, a large dataset from Chile, reported [ 20 ] that diarrhea was present in 7.3%, and abdominal pain in 3.7% in a cohort of 7,016 patients. In the US which is the country with most positive confirmed cases in the world, Ashktorab et al [ 21 ] reported that in 447 patients with a majority of them being African Americans, diarrhea was predominant in 19.45%, abdominal pain present in 15.8%. African Americans had the highest diarrhea prevalence of 22.4%.…”