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

Abstract

Background and Aims Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. Methods We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected. Results The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort. Conclusion Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.

Analyzing the role of ACE2, AR, MX1 and TMPRSS2 genetic markers for COVID-19 severity

“…Moreover, we also found that age is a significant variable, age over 55 is associated with an increased risk of COVID-19 severe cases. Moreover, data published by H.Ashktorab et al[ 32 ] confirmed our results, indicating that when analyses were adjusted for disease severity, significant variables were age over 65 years old, male sex, as well as having shortness of breath, elevated CRP and D-dimer. Although there are controversial data about the protection of influenza vaccine to COVID-19, here we did not find any representative protection role.…”

Predictors of Mortality among COVID-19 Patients Admitted to Intensive Care Units: A Single-Center Study in Tehran, Iran

“…8 Although in our study the association between sex and mortality was not statistically significant, there was a trend toward higher death among men in adjusted analyses. Some previous studies [9][10][11] have also shown that the severity of disease is generally higher and prognosis is poorer in men.…”

Cognitive dysfunction associated with COVID-19: Prognostic role of circulating biomarkers and microRNAs

“…In COVID-19 patients, elevated serum levels of IL-6, IL-1β, TNF- α, IL-10, and CRP have been measured and discussed ( Chen et al, 2020 ; Han et al, 2020 ; Islam et al, 2021a ; Lavillegrand et al, 2021 ; Lu et al, 2021 ; Acosta-Ampudia et al, 2022 ; Ferrando et al, 2022 ; Hirzel et al, 2022 ; Leretter et al, 2022 ; Montazersaheb et al, 2022 ; Peluso et al, 2022 ; PHOSP-COVID Collaborative Group, 2022 ; Schultheiss et al, 2022 ). IL-6, CRP, and IL-10 and have also been associated with disease severity amongst COVID-19 patients, correlating with severe clinical outcomes and fatality ( Han et al, 2020 ; Lavillegrand et al, 2021 ; Alshammary et al, 2022 ; Ashktorab et al, 2022 ; Azaiz et al, 2022 ; Galliera et al, 2022 ; Jafrin et al, 2022 ; Mainous et al, 2022 ). CRP was found specifically to be positively correlated with two parts of a Continuous Performance Test (CPT) conducted in patients who had resolved COVID-19 infections ( Zhou et al, 2020a ) and was found at significantly elevated concentration in COVID-19 patients with moderate to severe cognitive dysfunction ( Arica-Polat et al, 2022 ).…”