Higher comorbidities and early death in hospitalized African-American patients with Covid-19
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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.
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SciScore for 10.1101/2020.07.15.20154906: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: 8 This study was approved by the SUNY Downstate Institutional Review Board [1587476-1]. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Multivariate analysis of laboratory data was not performed due to sample size limitations. Peripheral blood analysis showed that a high median NLR …
SciScore for 10.1101/2020.07.15.20154906: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: 8 This study was approved by the SUNY Downstate Institutional Review Board [1587476-1]. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Multivariate analysis of laboratory data was not performed due to sample size limitations. Peripheral blood analysis showed that a high median NLR at admission and at 48-96 hr was an independent predictor of adverse outcome in COVID-19 patients, as had been reported in other studies.24 The presence of COVID-19 associated coagulopathy (CAC), a condition characterized by elevation in fibrinogen and D-dimer levels, high PT, relatively normal aPTT, and mild thrombocytopenia without evidence of microangiopathy, was confirmed in our study.25 The mechanisms underlying CAC remain poorly understood, but it can possibly result from activation of extrinsic coagulation pathway, leading to excess consumption of Factor-VII following endothelial cell infection by the virus.26,27 Elevated D-dimer levels at the second evaluation time point were associated with higher mortality, likely reflecting coagulation activation from sepsis, “cytokine-storm”, or impending organ failure. By the end of our 5-week study, 48.5% of the inpatients had died, including 87% of patients who received invasive mechanical ventilation. Reported mortality rates from other retrospective cohort studies ranged from 21% (New York metropolitan area) to 26% (Lombardy region, Italy) and 33% (UK).4,6,28 Our mortality rate was elevated relative to other studies, which we believe is due to the largely poor and disadvantaged neighborhood that our hospital serves. Race was not found to be an independent predictor of mortality. Th...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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