Higher Comorbidities and Early Death is Characteristic of Hospitalized African-American Patients with COVID-19

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. Method We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a five-week 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 Result Of the 1,070 consecutive patients who tested positive for COVID-19, 496 critically ill patients were hospitalized and included in the study. 88% of patients were Black; and a majority (53%) were 61-80 years old with a mean body mass index in the 'obese' range. 97% had one or more comorbidities. Hypertension was the most common (84%) pre-existing condition followed by diabetes mellitus (57%) and chronic kidney disease (24%). Patients with chronic kidney disease and end-stage renal disease who received hemodialysis were found to have significantly lower mortality, then those who did not receive it, suggesting benefit from hemodialysis (11%, OR, 0.35, CI, 0.17 - 0.69 P=0.001). 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 (8.5, 10.0) were predictive of mortality on admission and at 48-96 hrs. Of the 496 inpatients, 48% died, one third of patients died within the first three days of admission. 54/488 patients received invasive mechanical ventilation, of which 87% died and of the remaining patients, 32% died. CONCLUSIONS COVID-19 patients in our predominantly Black neighborhood had higher 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.

COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis

“…Six studies initially identified in preprint were subsequently excluded since they had not been peer-reviewed and published by 28 th January 2021; additionally, one study that was initially included based on preprint was subsequently removed since the peer-reviewed version did not meet our study's inclusion criteria. In total, 59 studies [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] were selected for the qualitative synthesis, of which 39[ [23] , [24] , [25] , …”

High admission blood glucose independently predicts poor prognosis in COVID-19 patients: A systematic review and dose-response meta-analysis

“…Table S4). In quantitative analysis, 10 studies were excluded as seven [21][22][23][24][25][26][27] only reported Pvalue and three [28][29][30] reported different effect measures.…”

High admission blood glucose is an independent risk factor of poor prognosis in COVID-19: A systematic review and dose-response meta-analysis

“…Consequently, a total of 35 studies with 14,502 patients were included in this systematic review, where 7918 patients were male (54.6%), and hypertension (4940 [34.1%]) as well as diabetes (4540 [31.3%]) were the most reported comorbidities (Appendix Table S4 ). In quantitative analysis, 10 studies were excluded as seven 18–24 only reported P-value and three 25–27 reported different effect measures.…”

“…The initial search yielded 1177 articles, of which 636 were deduplicated and 482 were excluded following title and abstracts screening, resulting in the retrieval of 59 records for full-text assessments-among which 13 Table S4). In quantitative analysis, 10 studies were excluded as seven [18][19][20][21][22][23][24] only reported P-value and three [25][26][27] reported different effect measures.…”

“…From 35 included studies, more than half were conducted in China (23 studies), while the others were five each in America 18,21,[27][28][29] and Europe 20,25,[30][31][32] , and one each in Hong Kong 33 and South Korea 34 . FBG was utilized in 23 studies, while RBG in 13 studies.…”