Bhargava Ashish, Sharma Mamta, Riederer Kathleen, Fukushima Elisa Akagi, Szpunar Susanna M, Saravolatz Louis
Department of Internal Medicine, Thomas Mackey Center for Infectious Diseases Research, Ascension St. John Hospital, Detroit, Michigan, USA.
Clin Infect Dis. 2021 Dec 6;73(11):e4005-e4011. doi: 10.1093/cid/ciaa1468.
Racial disparities are central in the national conversation about coronavirus disease 2019 (COVID-19) , with Black/African Americans being disproportionately affected. We assessed risk factors for death from COVID-19 among Black inpatients at an urban hospital in Detroit, Michigan.
This was a retrospective, single-center cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (the COVID-19 virus) on qualitative polymerase chain reaction assay who were admitted between 8 March 2020 and 6 May 2020. The primary outcome was in-hospital mortality.
The case fatality rate was 29.1% (122/419). The mean duration of symptoms prior to hospitalization was 5.3 (3.9) days. The incidence of altered mental status on presentation was higher among patients who died than those who survived, 43% vs 20.0%, respectively (P < .0001). From multivariable analysis, the odds of death increased with age (≥60 years), admission from a nursing facility, Charlson score, altered mental status, higher C-reactive protein on admission, need for mechanical ventilation, presence of shock, and acute respiratory distress syndrome.
These demographic, clinical, and laboratory factors may help healthcare providers identify Black patients at highest risk for severe COVID-19-associated outcomes. Early and aggressive interventions among this at-risk population may help mitigate adverse outcomes.
种族差异是关于2019冠状病毒病（COVID-19）全国讨论的核心问题，黑人/非裔美国人受到的影响尤为严重。我们评估了密歇根州底特律市一家城市医院中黑人住院患者死于COVID-19的风险因素。
这是一项回顾性单中心队列研究。我们回顾了2020年3月8日至2020年5月6日期间因严重急性呼吸综合征冠状病毒2（COVID-19病毒）定性聚合酶链反应检测呈阳性而入院患者的电子病历。主要结局是院内死亡率。
病死率为29.1%（122/419）。住院前症状的平均持续时间为5.3（3.9）天。死亡患者出现精神状态改变的发生率高于存活患者，分别为43%和20.0%（P<0.0001）。多变量分析显示，死亡几率随年龄（≥60岁）、从护理机构入院、Charlson评分、精神状态改变、入院时较高的C反应蛋白、需要机械通气、休克的存在以及急性呼吸窘迫综合征而增加。
这些人口统计学、临床和实验室因素可能有助于医疗保健提供者识别出发生严重COVID-19相关结局风险最高的黑人患者。对这一高危人群进行早期积极干预可能有助于减轻不良结局。
