Abstract
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 15 and May 10, 2020.
RESULTS: 128 critically ill adult subjects were included in the study (median age 68 y [interquartile range 61–76], 45% female, and 64% African-American); 124 (97%) required intubation. Eighty (63%) subjects died during their in-patient 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 = .02) and subjects with hypertension (91% vs 78%, P = .035). Asthma (P = .026) was associated with lower in-patient death, primarily among African-American subjects (P = .02). Among African-American subjects, increased age (odds ratio 1.06 [95% CI 1.05–1.22] per year), positive fluid balance (odds ratio 1.06 [95% CI 1.01–1.11] per 100 mL), and treatment with tocilizumab (odds ratio 25.0 [95% CI 3.5–180]) were independently associated with in-patient death, while higher platelets (odds ratio 0.65 [95% CI 0.47–0.89] per 50 × 103/mL) and treatment with intermediate dose anticoagulants (odds ratio 0.08 [95% CI 0.02–0.43]) were protective. Among other race/ethnic groups, higher total bilirubin (odds ratio 1.75 [95% CI 0.94–3.25] per 0.2 mg/dL) and higher maximum lactate (odds ratio 1.43 [95% CI 0.96–2.13] per mmol/L) were marginally associated with increased death, while tocilizumab treatment was marginally protective (odds ratio 0.24 [95% CI 0.05–1.25]). During first 72 h of ventilation, those who died had less increase in PaO2/FIO2 (P = .046) and less reduction in PEEP (P = .01) and FIO2 requirement (P = .002); these patterns did not differ by race/ethnicity.
CONCLUSIONS: African-American and other race/ethnicity subjects had similar mortality rates due to 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 in PaO2/FIO2, PEEP, and FIO2 requirement on ventilation.
Footnotes
- Correspondence: Siddique Chaudhary MD, Einstein Medical Center, Philadelphia, 5501 Old York Road Philadelphia PA 19141. E-mail: chaudhsi{at}einstein.edu
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