Race-Related disparities in COVID-19 thrombotic outcomes: Beyond social and economic explanations

Chaudhary, Rahul; Bliden, Kevin P.; Kreutz, Rolf P.; Jeong, Young Hoon; Tantry, Udaya S.; Levy, Jerrold H.; Gurbel, Paul A.

doi:10.1016/j.eclinm.2020.100647

Cited by 21 publications

(26 citation statements)

References 10 publications

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“…Prior studies have found racial/ethnic differences in the baseline levels of thromboinflammatory biomarkers, including D-dimer levels and CRP. 107 Because the inherent differences in the thromboinflammatory milieu across races could theoretically affect clinical outcomes, especially in COVID-19 infection, we evaluated the differences in a subgroup analysis. Most reported studies included only the East Asian population (80% of studies with Chinese patients) with only 15 studies from other countries.…”

Section: Discussionmentioning

confidence: 99%

Thromboinflammatory Biomarkers in COVID-19: Systematic Review and Meta-analysis of 17,052 Patients

Chaudhary

Garg

Houghton

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective To evaluate differences in thrombo-inflammatory biomarkers between patients with severe COVID-19 infection/death and mild infection. Patients and Methods Medline, Cochrane Central Register of Controlled Trials, Embase, EBSCO, Web of Science, and CINAHL databases were searched for studies comparing thrombo-inflammatory biomarkers in COVID-19 among severe/non-survivors and non-severe/survivors from January 1, 2020 through July 11, 2020. Inclusion criteria: (1) hospitalized patients ≥18 years comparing severe/non-survivors vs. non-severe/survivors; (2) biomarkers of inflammation and/or thrombosis. A random-effects model was used to estimate the weighted mean difference (WMD) between the two groups of COVID-19 severity. Results Seventy-five studies were included (17,052 patients). Patients with severe COVID-19/non-survivors were older, a greater proportion were men, had a higher prevalence of hypertension, diabetes, cardiac or cerebrovascular disease, chronic kidney disease, malignancy, and COPD. The thrombo-inflammatory biomarkers were significantly higher in patients with severe disease including D-dimer (WMD 0.60, 0.49-0.71, I 2 =83.85%), fibrinogen (WMD 0.42, 0.18-0.67, I 2 =61.88%, p<0.001), CRP (WMD 35.74, 30.16-41.31, I 2 =85.27%), high sensitivity-CRP (WMD 62.68, 45.27-80.09, I 2 =0%), Interleukin-6 (WMD 22.81, 17.90-27.72, I 2 =90.42%) and, ferritin (WMD 506.15, 356.24-656.06, I 2 =52.02%). Moderate to significant heterogeneity was observed for all parameters. Sub-analysis based on disease severity, mortality, and geographic region of studies demonstrated similar inferences. Conclusions Thrombo-inflammatory biomarkers (D-dimer, Fibrinogen, CRP, hs-CRP, ferritin, and IL-6) and marker of end-organ damage (hs-Troponin I) are associated with increased severity and mortality in COVID-19 infection.

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Section: Discussionmentioning

confidence: 99%

Thromboinflammatory Biomarkers in COVID-19: Systematic Review and Meta-analysis of 17,052 Patients

Chaudhary

Garg

Houghton

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

Self Cite

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“…The comparison of major biologic pathways with biomarkers or surrogates provide important clues to explain the racial difference in ASCVD prognosis ( Table 1 ). 1) 20) However, most CHD biomarker research has been conducted in Caucasians, and little is known regarding the actual generalizability of these biomarkers to other ethnic groups. 7) Previous studies indicated that there are marked differences between the races in traditional CV risk factors and the linkage of risk score with observed clinical events, 21) 22) making it difficult to generalize the clinical data derived from current biomarkers and image criteria to all ethnicities.…”

Section: Racial Differences In Thrombogenicity Componentsmentioning

confidence: 99%

“… This table was modified from the original version. 1) 20) APC = activated protein C; CRP = C-reactive protein; PAI-1 = plasminogen activator inhibitor-1; PAR = proteinase-activated receptor; vWF = von Willebrand factor. …”

Section: Racial Differences In Thrombogenicity Componentsmentioning

confidence: 99%

“… 52) Their vulnerability is not fully explained by the differences in social and economic factors. 20) Activity of coagulation-inflammation cascade and predisposition to the development of coagulopathy varies between the races, with African Americans trending toward a more prothrombotic state ( Tables 1 and 2 ). 1) 4) 20) 99) Low level of thrombo-inflammatory activity in East Asians may be related to the better outcomes following COVID-19 infection, 29) but this hypothesis needs more supportive experimental data.…”

Section: Emerging Issues Related With Thrombogenicitymentioning

confidence: 99%

“…Despite observed elevation in D-dimer in patients with severe COVID-19, VTE was not evident in the majority. 20) High D-dimer in COVID-19 may be associated with a prothrombotic state, a hypofibrinolytic state, or both. Whole blood viscoelastic analysis can be rapidly performed by TEG or ROTEM, which measure the whole blood capability to make and sustain clot formation including the dynamics of coagulation, platelet function and fibrinolysis.…”

Section: Emerging Issues Related With Thrombogenicitymentioning

confidence: 99%

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Ethnic Difference of Thrombogenicity in Patients with Cardiovascular Disease: a Pandora Box to Explain Prognostic Differences

et al. 2021

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Author's summary It is common practice that most countries follow western cardiovascular (CV) treatment guidelines from major clinical trials mainly including Caucasians. Recent researches indicate racial differences in intrinsic thrombogenicity and response to antithrombotic agents. Thrombogenic property is closely related to atheroma progression and clinical manifestation of atherothrombotic events, with African Americans trending toward the most thrombogenic state and East Asians having the lowest thrombogenic milieu. The time has come to develop the “thrombogenicity-tailored CV treatment strategy” based on specific biomarkers or functional assays. Future studies should focus on establishing a particular footprint of these properties for achieving maximum net clinical benefits.

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Association between thromboembolic events and COVID-19 infection within 30 days: a case–control study among a large sample of adult hospitalized patients in the United States, March 2020–June 2021

Huang

Yusuf

Adamski

et al. 2022

J Thromb Thrombolysis

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The association between thromboembolic events (TE) and COVID-19 infection is not completely understood at the population level in the United States. We examined their association using a large US healthcare database. We analyzed data from the Premier Healthcare Database Special COVID-19 Release and conducted a case–control study. The study population consisted of men and non-pregnant women aged ≥ 18 years with (cases) or without (controls) an inpatient ICD-10-CM diagnosis of TE between 3/1/2020 and 6/30/2021. Using multivariable logistic regression, we assessed the association between TE occurrence and COVID-19 diagnosis, adjusting for demographic factors and comorbidities. Among 227,343 cases, 15.2% had a concurrent or prior COVID-19 diagnosis within 30 days of their index TE. Multivariable regression analysis showed a statistically significant association between a COVID-19 diagnosis and TE among cases when compared to controls (adjusted odds ratio [aOR] 1.75, 95% CI 1.72–1.78). The association was more substantial if a COVID-19 diagnosis occurred 1–30 days prior to index hospitalization (aOR 3.00, 95% CI 2.88–3.13) compared to the same encounter as the index hospitalization. Our findings suggest an increased risk of TE among persons within 30 days of being diagnosed COVID-19, highlighting the need for careful consideration of the thrombotic risk among COVID-19 patients, particularly during the first month following diagnosis. Supplementary Information The online version contains supplementary material available at 10.1007/s11239-022-02735-0.

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Race-Related disparities in COVID-19 thrombotic outcomes: Beyond social and economic explanations

Cited by 21 publications

References 10 publications

Thromboinflammatory Biomarkers in COVID-19: Systematic Review and Meta-analysis of 17,052 Patients

Thromboinflammatory Biomarkers in COVID-19: Systematic Review and Meta-analysis of 17,052 Patients

Ethnic Difference of Thrombogenicity in Patients with Cardiovascular Disease: a Pandora Box to Explain Prognostic Differences

Association between thromboembolic events and COVID-19 infection within 30 days: a case–control study among a large sample of adult hospitalized patients in the United States, March 2020–June 2021

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