COVID-19 among African Americans and Hispanics: Does gastrointestinal symptoms impact the outcome?
Hassan Ashktorab1, Adeleye Folake2, Antonio Pizuorno3
1Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States. hashktorab@howard.edu.
Insights
African Americans experienced higher COVID-19 mortality due to age and comorbidities. Shortness of breath and elevated liver enzymes, ferritin, and procalcitonin significantly impacted outcomes, while gastrointestinal symptoms did not.
Area of Science:
- Medical research
- Infectious diseases
- Public health
Background:
- Coronavirus disease 2019 (COVID-19) disproportionately impacted African Americans (AA) and Hispanics (HSP).
- Understanding risk factors for severe outcomes in minority populations is crucial.
Purpose of the Study:
- To analyze significant outcome predictors in African American COVID-19 patients.
- To emphasize the role of gastrointestinal symptoms, laboratory values, and comorbidities.
Main Methods:
- Retrospective analysis of 386 COVID-19 patients at Howard University Hospital (March-May 2020).
- Assessment of symptoms, gastrointestinal manifestations, comorbidities, and mortality using logistic regression.
Main Results:
- African Americans (63.7%) had the highest mortality rate (20.6%).
- Shortness of breath, elevated AST, procalcitonin, ferritin, and lymphopenia were associated with increased mortality.
- Hypertension and diabetes were common comorbidities; Glucocorticoid treatment correlated with higher mortality.
Conclusions:
- Older age and comorbidities contributed to higher mortality in African Americans.
- Elevated liver enzymes, ferritin, and procalcitonin indicate poor prognosis.
- Gastrointestinal symptoms did not influence outcomes; judicious use of glucocorticoids and monitoring of liver function are recommended, especially for AA and HSP patients.
Background:
The coronavirus disease 2019 (COVID-19) disproportionately affected African Americans (AA) and Hispanics (HSP).
Aim:
To analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal (GI) symptoms, laboratory values and comorbidities.
Methods:
We retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020. We assessed the symptoms, including the GI manifestations, comorbidities, and mortality, using logistic regression analysis.
Results:
Of these 386 COVID-19 positive patients, 257 (63.7%) were AAs, 102 (25.3%) HSP, and 26 (6.45%) Whites. There were 257 (63.7%) AA, 102 (25.3%) HSP, 26 (6.45%) Whites. The mean age was 55.6 years (SD = 18.5). However, the mean age of HSP was the lowest (43.7 years vs 61.2 for Whites vs 60 for AAs). The mortality rate was highest among the AAs (20.6%) and lowest among HSP (6.9%). Patients with shortness of breath (SOB) (OR2 = 3.64, CI = 1.73-7.65) and elevated AST (OR2 = 8.01, CI = 3.79-16.9) elevated Procalcitonin (OR2 = 8.27, CI = 3.95-17.3), AST (OR2 = 8.01, CI = 3.79-16.9), ferritin (OR2 = 2.69, CI = 1.24-5.82), and Lymphopenia (OR2 = 2.77, CI = 1.41-5.45) had a high mortality rate. Cough and fever were common but unrelated to the outcome. Hypertension and diabetes mellitus were the most common comorbidities. Glucocorticoid treatment was associated with higher mortality (OR2 = 5.40, CI = 2.72-10.7). Diarrhea was prevalent (18.8%), and GI symptoms did not affect the outcome.
Conclusion:
African Americans in our study had the highest mortality as they consisted of an older population and comorbidities. Age is the most important factor along with SOB in determining the mortality rate. Overall, elevated liver enzymes, ferritin, procalcitonin and C-reactive protein were associated with poor prognosis. GI symptoms did not affect the outcome. Glucocorticoids should be used judiciously, considering the poor outcomes associated with it. Attention should also be paid to monitor liver function during COVID-19, especially in AA and HSP patients with higher disease severity.
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