Symptomatic, clinical and biomarker associations for mortality in hospitalized COVID-19 patients enriched for African Americans
Authors: Ashktorab Hassan , Pizuorno Antonio , Adeleye Folake , Laiyemo Adeyinka , Dalivand Maryam Mehdipour , Aduli Farshad , Sherif Zaki A. , Oskrochi Gholamreza , Angesom Kibreab , Oppong-Twene Philip , Challa Suryanarayana Reddy , Okorie Nnaemeka , Moon Esther S. , Romos Edward , Jones-Wonni Boubini , Kone Abdoul Madjid , Rankine Sheldon , Thrift Camelita , Scholes Derek , Ekwunazu Chiamaka , Banson Abigail , Mitchell Brianna , Maskalo Guttu , Ross Jillian , Curtis Julencia , Kim Rachel , Gilliard Chandler , Ahuja Geeta , Mathew Joseph , Gavin Warren , Kara Areeba , Hache-Marliere Manuel , Palaiodimos Leonidas , Mani Vishnu R. , Kalabin Aleksandr , Gayam Vijay Reddy , Garlapati Pavani Reddy , Miller Joseph , Chirumamilla Lakshmi Gayathri , Jackson Fatimah , Carethers John M. , Kamangar Farin , Brim Hassan 
Published: June 2022

Abstract
Background and Aims
Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality.

Methods
We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected.

Results
The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort.

Conclusion
Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.