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• W3147420125 abstract "Severe 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.1Parasa S. et al.JAMA Netw Open. 2020; 3e2011335Crossref PubMed Scopus (274) Google Scholar In the United States, minorities such as African Americans (AA) and Hispanics (HSP) have shown a higher incidence of the disease.2Ashktorab H. et al.Gastroenterology. 2017; 153: 910-923Abstract Full Text Full Text PDF PubMed Scopus (154) Google Scholar,3Sherif Z.A. et al.Dig Dis Sci. 2016; 61: 1214-1225Crossref PubMed Scopus (111) Google Scholar. However, no detailed characterization of the disease’s features in these populations has been performed.4Carethers J.M. J Intern Med. 2020; 289: 463-473Crossref Scopus (74) Google Scholar 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.5Tanne J.H. BMJ. 2021; 372: n42Crossref PubMed Scopus (8) Google Scholar 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. A 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. Patient demographics, symptoms, comorbidities, treatment, and clinical values in relation to outcome was assessed in the overall cohort and in a subgroup analysis of AA, whites (CAU), and HSP. Correlation coefficients were calculated together with a multivariate binary logistic regression analysis to establish associations with death as an outcome. SPSS version 26 (SPSS Inc, Chicago, IL) was used for these analyses. Our cohort consisted of 447 patients, with 309 AA (69.1%), 27 CAU (6%), and 111 HSP (24.8%) with 71 deaths overall (15.5%). AA and CAU had similar death rates, 18.1% and 18.5%, respectively, whereas HSP had 7.3% deaths. The overall age was 56.1 years, with 53.9 years for survivors vs 68.6 years for those who died. HSP were the youngest, at 44.9 years, whereas CAU were the oldest, at 61.1 years. There were more men (51.1%) than women (48.9%). Our cohort had an average body mass index of 30.6 kg/m2, with HSP having lowest BMI (27.4 kg/m2) vs AA with the highest (31.6 kg/m2) (Table 1).Table 1Demography, Clinical Manifestations, and Comorbidities of COVID-19 PatientsAAPCAUPHSPPOverallPTotal no. of cases309 (69.1)27 (6)111 (24.8)447 (100)Deceased56 (18.1)5 (18.5)8 (7.3)71 (15.5).023aComparing mortality rate between ethnicities.Average age, y59.7<.00161.1.02144.9.00956.1<.001 Survivors57.657.743.853.9 Deceased69.276.260.168.6Sex.53.825.479.41 Men157 (50.8)15 (55.6)54 (49.5)227 (51)Survivors122 (77.7)12 (80)50 (90.9)184 (81.1)Deceased35 (22.3)3 (20)5 (9.1)43 (18.9) Women152 (49.2)12 (44.4)55 (50.5)218 (49)Survivors131 (86.2)10 (83.3)51 (94.4)192 (88.1)Deceased21 (13.8)2 (16.7)3 (5.6)26 (11.9)Mean body mass index, kg/m231.6.15530.5.21627.4.28830.6.223 Normal127 (31.2)Survivors65 (76.5)6 (75)31 (91.2)102 (80.3)Deceased20 (23.5)2 (25)3 (8.8)25 (19.7) Overweight0.4500.6400.658126 (31.4).552Survivors68 (81.9)6 (75)33 (94.3)107 (84.9)Deceased15 (18.1)2 (25)2 (5.7)19 (15.1) Obese154 (37.8)Survivors100 (83.3)9 (90)21 (87.5)130 (84.4)Deceased20 (16.7)1 (10)3 (12.5)24 (15.6)Fever171 (56.4)16 (59.2)55 (52.9)242 (55.8) Survivors139 (81.3).77314 (87.5).33249 (89.1).192202 (83.5).580 Deceased32 (18.7)2 (12.5)6 (10.9)40 (16.5)Cough196 (65.7)18 (66.6)57 (57)271 (63.8) Survivors162 (82.7).63115 (83.3).72652 (91.2).743229 (84.5).841 Deceased34 (17.3)3 (16.7)5 (8.8)42 (15.5)Shortness of breath198 (65.7)16 (61.5)57 (55.3)271 (63) Survivors155 (78.3).03213 (81.3).93749 (86).008217 (80.1).002 Deceased43 (21.7)3 (18.8)8 (14)54 (19.9)Abdominal pain43 (15.4)3 (13)17 (17.3)63 (15.8) Survivors40 (93).753 (100).32816 (94.1).82459 (93.7).050 Deceased3 (7)0 (0)1 (5.9)4 (6.3)Diarrhea67 (22.4)6 (23)10 (9.7)83 (19.4) Survivors56 (83.6).6815 (83.3).8569 (90).78170 (84.3).994 Deceased11 (16.4)1 (16.7)1 (10)13 (15.7)Nausea41 (14.2)2 (8.3)12 (12)55 (13.3) Survivors35 (85.4).6612 (100).44912 (100).31149 (89.1).382 Deceased6 (14.6)0 (0)0 (0)6 (10.9)Vomiting38 (12.9)3 (11.5)11 (10.6)52 (12.3) Survivors33 (86.8).4653 (100).36911 (100).31147 (90.4).239 Deceased5 (13.2)0 (0)0 (0)5 (9.6)Fatigue94 (47.4)11 (50)25 (35.2)130 (44.7) Survivors81 (86.2).7829 (81.8).53422 (88).428112 (86.2).391 Deceased13 (13.8)2 (18.2)3 (12)18 (13.8)Loss of appetite86 (33.8)1 (4.7)19 (20.9)106 (29) Survivors143 (85.1).4451 (100).56718 (94.7).79389 (84).522 Deceased25 (14.9)0 (0)1 (5.3)17 (16)Loss of taste19 (8)2 (9)7 (8.1)28 (8.1) Survivors17 (89.5).4632 (100).4217 (100).45026 (92.9).247 Deceased2 (10.5)0 (0)0 (0)2 (7.1)GI bleed17 (5.6)1 (3.7)1 (1)19 (4.4) Survivors11 (64.7).0571 (100).6270 (0).00112 (63.2).009 Deceased6 (35.3)0 (0)1 (100)7 (36.8)Pancreatitis3 (1)0 (0)1 (1)4 (0.9) Survivors2 (66.7).4770 (0)N/A1 (100).7693 (75).594 Deceased1 (33.3)0 (0)0 (0)1 (25)Cholecystitis6 (1.9)0 (0)1 (1)7 (1.6) Survivors5 (83.3).9180 (0)N/A1 (100).7696 (85.7).911 Deceased1 (16.7)0 (0)0 (0)1 (14.3)Cardiac disease71 (24)9 (34.6)5 (5.1)85 (20.2) Survivors55 (77.5).3346 (66.7).1845 (100).49666 (77.6).084 Deceased16 (22.5)3 (33.3)0 (0)19 (22.4)Diabetes mellitus128 (43.1)9 (34.6)25 (25.3)162 (38.4) Survivors102 (79.7).5765 (55.6).01820 (80).11127 (78.4).021 Deceased26 (20.3)4 (44.4)5 (20)35 (21.6)Hypertension188 (63.3)16 (61.5)29 (29.3)233 (55.2) Survivors154 (81.9).65611 (68.8).04924 (82.8).031189 (81.1).118 Deceased34 (18.1)5 (31.2)5 (17.2)44 (18.9)History of liver disease14 (4.7)1 (3.8)3 (3)18 (4.3) Survivors9 (64.3).0951 (100).6193 (100).60613 (72.2).171 Deceased5 (35.7)0 (0)0 (0)5 (27.8)History of inflammatory bowel disease4 (1.3)0 (0)1 (1)5 (1.2) Survivors3 (75).7420 (0)N/A1 (100).7684 (80).812 Deceased1 (25)0 (0)0 (0)1 (20)History of gastroesophageal reflux disease/peptic ulcer disease33 (11.1)4 (15.3)5 (5)42 (10) Survivors28 (84.8).5853 (75).7505 (100).50136 (85.7).734 Deceased5 (15.2)1 (25)0 (0)6 (14.3)Immunocompromised22 (7.2)2 (8)4 (3.8)28 (6.5) Survivors15 (68.2).0962 (100).4613 (75).18220 (71.4).060 Deceased7 (31.8)0 (0)1 (25)8 (28.6)Alcohol use45 (19.9)6 (27.2)12 (15.4)63 (19.3) Survivors42 (93.3).0795 (83.3).91011 (91.7).93358 (92.1).133 Deceased3 (6.7)1 (16.7)1 (14.3)5 (7.9)Elevated ferritin166 (61.2)14 (66.6)47 (62.7)227 (61.9) Survivors125 (75.3).00410 (71.4).46941 (87.2).445176 (77.5).02 Deceased41 (24.7)4 (28.6)6 (12.8)51 (22.5)Elevated D-dimer244 (90)18 (85.7)62 (86.1)324 (89) Survivors193 (79.1).03113 (72.2).29655 (88.7).263261 (80.6).008 Deceased51 (20.9)5 (27.8)7 (11.3)63 (19.4)Elevated C-reactive protein148 (58.4)14 (70)47 (62.7)210 (60) Survivors109 (73.2)<.00110 (71.4).57340 (85.11).124159 (75.7)<.001 Deceased40 (26.8)4 (28.6)7 (14.9)51 (24.3)Elevated procalcitonin98 (38.5)7 (31.8)20 (29.4)125 (36.3) Survivors56 (57.1)<.0013 (42.9).00914 (70).00373 (58.4)<.001 Deceased42 (52.9)4 (57.1)6 (30)52 (41.6)Mean elevated creatinine55.534.623.448.7 Survivors0.46<.0010.190.0020.18<.0010.37<.001 Deceased0.961.000.870.95Elevated IL-693 (98.9)8 (100)28 (100)129 (99.2) Survivors71 (76.3).775 (62.5)N/A27 (96.4)N/A103 (79.8).800 Deceased22 (23.7)3 (37.5)1 (3.6)26 (20.2)Abnormal platelet count35.3 (109).1822.2 (6).57131 (27.9).360Low 146 (32.9).0223.6 (73)25.9 (7)22 (19.8)Elevated 102 (23.1)Abnormal lymphocyte count1 (3).5821 (3.7).782106 (95.5).814Low 1.3 (6).628295 (95.1)25 (92.6)2 (1.8)Elevated 95.3 (434)Elevated cholesterol5 (6)1 (9)0 (0)6 (5.2) Survivors5 (100).1661 (100).6210 (0)N/A6 (100).174 Deceased0 (0)0 (0)0 (0)0 (0)Elevated low-density lipoprotein4 (1.3)1 (3.7)0 (0)5 (4.4) Survivors4 (100).2101 (100).6210 (0)N/A5 (100).208 Deceased0 (0)0 (0)0 (0)0 (0)Elevated high-density lipoprotein1 (1.2)0 (0)0 (0)1 (0.9) Survivors1 (100).5420 (0)N/A0 (0)N/A1 (100).583 Deceased0 (0)0 (0)0 (0)0 (0)Elevated triglycerides34 (38.6)3 (27.2)6 (30)43 (36.1) Survivors24 (70.6).7212 (66.7).4253 (50).00429 (67.4).118 Deceased10 (29.4)1 (33.3)3 (50)14 (32.6)Elevated liver function test values on admission107 (37)12 (52.1)44 (51.2)163 (41) Survivors72 (67.3)<.0018 (66.7).15941 (93.2).417121 (74.2)<.001 Deceased35 (32.7)4 (33.3)3(6.8)42 (25.8)Mean elevated alanine aminotransferase peak25 (78.1)1 (33.3)11 (84.6)37 (77.1) Survivors60.1.25865.6.38658.8.32660.1.878 Deceased113.351.2703.3180.1Mean elevated aspartate aminotransferase peak15 (46.9)2 (66.7)7 (53.8)24 (50) Survivors75.5.22874.2.38656.3.61270.6.121 Deceased246.877.21518.5388.1Pneumonia255 (84.4)23 (85.1)71 (68.9)349 (80.8) Survivors202 (79.2).00718 (78.3).30263 (88.7).048283 (81.1)<.001 Deceased53 (20.8)5 (21.7)8 (11.3)66 (18.9)Values are n (%) unless otherwise defined. N/A, Chi square statistical test is not applicable.a Comparing mortality rate between ethnicities. Open table in a new tab Values are n (%) unless otherwise defined. N/A, Chi square statistical test is not applicable. Overall, diarrhea was the most common GI symptom (19.4%) followed by abdominal pain (15.8%). GI bleeding was reported in 4.4%, pancreatitis in 0.9%, and cholecystitis in 1.6%. Diarrhea frequency was highest in AA (22.4%), whereas abdominal pain was highest in HSP (17.3%). Of note, 24% of the overall cohort presented these GI manifestations after admission. The most common comorbidities in our study were hypertension (55.2%) followed by diabetes (38.4%) and cardiac disease (20.2%). With respect to GI comorbidities, the most common was history of liver disease (4.3%) and history of gastroesophageal reflux disease (10%). HSP had the lowest level of pre-existing liver disease, whereas CAU had the highest rate of gastroesophageal reflux disease/peptic ulcer disease history (15.3%), and only 1.3% of AA had a previous diagnosis of inflammatory bowel disease (Table 1). Overall, 41% of our cohort had abnormal levels in their liver function test panel. CAU had the highest proportion of such patients (52.1%). Elevated alanine aminotransferase was reported in 77.1% of tested patients; this rate was the lowest in CAU (33.3%). Elevated aspartate aminotransferase was reported in 50% and was highest in CAU (66.7%). Other abnormal test results were elevated D-dimer in 89%, abnormal IL-6 in 99.2%, and elevated ferritin in 61.9% (Table 1). Older age (P < .001), shortness of breath (P < .001), abdominal pain (P = .050), GI bleeding (P = .009), diabetes (P = .021), elevated ferritin (P = .02), D-dimer (P = .008), C-reactive protein (P < .001), elevated procalcitonin (P < .001), elevated creatinine (P < .001), altered platelet (P = .002), high liver function test values on admission (P < .001), pneumonia (P < .001), intensive care unit admission/transfer (P ≤ .001), sepsis (P ≤ .001), vasopressors (P < .001), and mechanical ventilation (P < .001) were statistically associated with death in the overall cohort (Supplementary Table 1). For AA, shortness of breath (P = .032), elevated ferritin (P = .004), D-dimer (P = .031), C-reactive protein (P < .001), procalcitonin (P < .001), liver function test values on admission (P < .001), pneumonia (P = .007), intensive care unit admission (P ≤ .001), intensive care unit transfer (P < .001), sepsis (P < .001), vasopressors (P < .001), and mechanical ventilation (P = .020) were significantly associated with death (Supplementary Table 1). For HSP, shortness of breath (P = .008), GI bleeding (P = .001), hypertension (P = .031), elevated procalcitonin (P = .003), elevated triglycerides (P = .004), pneumonia (P = .048), intensive care unit admission (P = .004), intensive care unit transfer (P < .001), sepsis (P = .004), extracorporeal membrane oxygenation (P = .020), vasopressors (P < .001), Remdesivir (P = .043), and mechanical ventilation (P < .001) were associated with death as an outcome (Supplementary Table 1). For CAU, only associated with death were diabetes (P = .018), hypertension (P = .049), elevated procalcitonin (P = .009), mechanical ventilation (P = .023), and vasopressors (P = .033; Supplementary Table 1). In the overall cohort analysis, age was a major effector of outcome. This was further confirmed in subgroup analyses. Indeed, HSP, the youngest group, had the lowest death rate, whereas CAU, the oldest group, had the highest death rate. Respiratory issues such as shortness of breath and pneumonia requiring intensive care unit care and mechanical ventilation were strongly associated with poor outcome in our patients, regardless of race. Elevated procalcitonin was also a common risk factor. Procalcitonin is primarily increased in response to bacterial-triggered inflammation, pointing to potential opportunistic pathogen activity in the course of COVID-19. Vasopressor use in critically ill patients was also associated with poor outcome, attesting to unstable hemodynamics independent of race.6Michard F. et al.Intensive Care Med. 2021; 47: 254-255Crossref PubMed Scopus (20) Google Scholar The association of diabetes with poor outcome was noted in CAU only, whereas hypertension was common with HSP. This finding reflects the weight of metabolic syndrome in CAU that were the oldest group in our cohort. The small number of CAU in our cohort is a limitation of the study. Within HSP, high triglyceride level was a risk factor reflecting the negative impact of blood fat in coronary artery disease and outcome. Although HSP had a lower body mass index compared with AA, the cumulative effects of high triglyceride levels and hypertension point to the impact of the metabolic syndrome in this group, even though it was the youngest. GI bleeding was reported as a risk factor in HSP as well. Whether this symptom is a cause or consequence risk of hemodynamic instability remains to be explored. Indeed, such cases were reported in patients with thromboembolism.7Kumar M.A. et al.BMJ Case Rep. 2021; 14: e241059https://doi.org/10.1136/bcr-2020-241059Crossref Scopus (15) Google Scholar Elevated ferritin, D-dimer, and C-reactive protein were major and unique risk factors to AA in the subgroup analysis, highlighting the prevalence of systemic inflammation and coagulopathies in this group. Of note, elevated liver function test values on admission were significantly associated with poor outcome in our study cohort. A study reported that patients with chronic liver disease were more likely to develop severe COVID-19.8Guerra Veloz M.F. et al.Rev Esp Enferm Dig. 2021; 113: 103-109PubMed Google Scholar However, liver function alterations were also reported as a result of COVID-19 or antiviral treatment during hospitalization. Diarrhea frequency and abdominal pain were highest in AA and HSP, respectively. They are likely to affect postdischarge patient condition because the virus persists longer in the GI tract after clearance from the respiratory system. Hassan Ashktorab, PhD (Conceptualization: Lead; Funding acquisition: Lead; Supervision: Lead; Writing – review & editing: Lead). Antonio Pizuorno, MD (Data curation: Equal; Writing – review & editing: Supporting). Farshad Aduli, MD (Writing – review & editing: Equal). Adeyinka O Laiyemo, MD (Writing – review & editing: Equal). Gholamreza Oskrochi, PhD (Formal analysis: Lead). Hassan Brim, PhD (Conceptualization: Equal; Writing – review & editing: Equal). Download .pdf (.03 MB) Help with pdf files Supplemental Table 1Association between treatment and death as an outcome." @default.
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• W3147420125 title "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" @default.
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