RT Journal Article
SR Electronic
T1 Clinical Characteristics, Respiratory Mechanics and Outcomes in Critically Ill Subjects with COVID-19 Infection in an Underserved Urban Population
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.08319
DO 10.4187/respcare.08319
A1 Siddique Chaudhary
A1 Sadia Benzaquen
A1 Jessica G. Woo
A1 Jack Rubinstein
A1 Atul Matta
A1 Jeri Albano
A1 Robert De Joy, III
A1 Kevin Bryan Lo
A1 Gabriel Patarroyo-Aponte
YR 2021
UL http://rc.rcjournal.com/content/early/2021/01/14/respcare.08319.abstract
AB Background: The COVID-19 outbreak in the United States has disproportionately affected African-Americans, but little is known about the factors that underlie this observation. Herein, we describe these associations with mortality in a largely minority underserved population.Methods: This single center retrospective observational study included all adult subjects with laboratory confirmed SARS-Cov-2 treated in our ICU between March 15th and May 10th, 2020.Results: 128 critically-ill adult subjects were included in the study (median age 68 Interquartile range(IQR) 61–76), 45% female, and 64% African-American); 124 (97%) required intubation. Eighty (63%) died during their inpatient stay, which did not differ by race/ethnicity. Compared with other racial/ethnic groups, African-Americans had a greater proportion of women (52% vs. 30%, p=0.02), and hypertensives (91% vs. 78%, p=0.035). Asthma (p=0.026) was associated with lower inpatient death, primarily among African-Americans (p=0.02). Among African-Americans, increased age (OR [95% CI]: 1.06[1.05-1.22]per year], positive fluid balance (1.06 [1.01-1.11]per 100 mL), and treatment with Tocilizumab (25.0 [3.5-180]) were independently associated with inpatient death, while higher platelets (0.65 [0.47-0.89]per 50 x 103/ml) and treatment with intermediate dose anticoagulants (0.08 [0.02, 0.43]) were protective. Among other race/ethnic groups, higher total bilirubin (1.75 [0.94, 3.25]per 0.2 mg/dL) and higher maximal lactate (1.43 [0.96, 2.13]per mmol/L) were marginally associated with increased death, while Tocilizumab treatment was marginally protective (0.24 [0.05, 1.25]). During first 72 hours of ventilation, those who died had less increase in PaO2/FiO2 (p=0.046), and less reduction in positive end-expiratory pressure (PEEP) (p=0.01), and FiO2 requirement (p=0.002); these patterns did not differ by race/ethnicity.Conclusions: African-American and other race/ethnicity subjects had similar mortality rates from Covid-19, but differed in factors that were associated with increased risk of death. In both groups, subjects who died were older, had a positive fluid balance and less improvement of PaO2/FiO2 ratio, PEEP, and FiO2 requirement on ventilation.