Ashktorab Hassan, Folake Adeleye, Pizuorno Antonio, Oskrochi Gholamreza, Oppong-Twene Philip, Tamanna Nuri, Mehdipour Dalivand Maryam, Umeh Lisa N, Moon Esther S, Kone Abdoul Madjid, Banson Abigail, Federman Cassandra, Ramos Edward, Awoyemi Eyitope Ola, Wonni Boubini Jones, Otto Eric, Maskalo Guttu, Velez Alexandra Ogando, Rankine Sheldon, Thrift Camelita, Ekwunazu Chiamaka, Scholes Derek, Chirumamilla Lakshmi Gayathri, Ibrahim Mohd Elmugtaba, Mitchell Brianna, Ross Jillian, Curtis Julencia, Kim Rachel, Gilliard Chandler, Mathew Joseph, Laiyemo Adeyinka, Kibreab Angesum, Lee Edward, Sherif Zaki, Shokrani Babak, Aduli Farshad, Brim Hassan
Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Faculty of Medicine, La Universidad del Zulia, Maracaibo 4002, Zulia, Venezuela.
World J Clin Cases. 2021 Oct 6;9(28):8374-8387. doi: 10.12998/wjcc.v9.i28.8374.
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 61.2 for Whites 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.
背景：2019年冠状病毒病（COVID-19）对非裔美国人（AA）和西班牙裔（HSP）的影响尤为严重。 目的：分析非裔美国患者群体中影响预后的重要因素，并特别关注胃肠道（GI）症状、实验室检查值和合并症。 方法：我们回顾性评估了2020年3月至5月在霍华德大学医院住院的386例COVID-19阳性患者的病历。我们使用逻辑回归分析评估了症状，包括胃肠道表现、合并症和死亡率。 结果：在这386例COVID-19阳性患者中，257例（63.7%）为非裔美国人，102例（25.3%）为西班牙裔，26例（6.45%）为白人。非裔美国人有257例（63.7%），西班牙裔有102例（25.3%），白人有26例（6.45%）。平均年龄为55.6岁（标准差=18.5）。然而，西班牙裔的平均年龄最低（43.7岁，白人为61.2岁，非裔美国人为60岁）。死亡率在非裔美国人中最高（20.6%），在西班牙裔中最低（6.9%）。呼吸急促（SOB）患者（OR2 = 3.64，CI = 1.73 - 7.65）、AST升高（OR2 = 8.01，CI = 3.79 - 16.9）、降钙素原升高（OR2 = 8.27，CI = 3.95 - 17.3）、AST（OR2 = 8.01，CI = 3.79 - 16.9）、铁蛋白（OR2 = 2.69，CI = 1.24 - 5.82）和淋巴细胞减少（OR2 = 2.77，CI = 1.41 - 5.45）的死亡率较高。咳嗽和发热很常见，但与预后无关。高血压和糖尿病是最常见的合并症。糖皮质激素治疗与较高的死亡率相关（OR2 = 5.40，CI = 2.72 - 10.7）。腹泻很普遍（18.8%），胃肠道症状不影响预后。 结论：在我们的研究中，非裔美国人死亡率最高，因为他们年龄较大且存在合并症。年龄是与呼吸急促一起决定死亡率的最重要因素。总体而言，肝酶、铁蛋白、降钙素原和C反应蛋白升高与预后不良相关。胃肠道症状不影响预后。鉴于糖皮质激素治疗与不良预后相关，应谨慎使用。在COVID-19期间，还应注意监测肝功能，尤其是在疾病严重程度较高的非裔美国人和西班牙裔患者中。
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