Biomarkers Predicting COVID-19 Outcomes in African American, Hispanic Patients

Among hospitalized patients with coronavirus disease 2019 (COVID-19) belonging to minority groups, several factors such as age, adverse respiratory events, and certain biomarkers such as procalcitonin, ferritin, and D-dimer may influence outcomes in this patient population, according to study results published in Gastroenterology.

Although certain minority groups in the US, such as African Americans and Hispanic peoples, show a higher incidence of COVID-19, there is a lack of information on the detailed characteristics of the disease in this demographic. As aims surrounding the treatment of COVID-19 have evolved from saving lives to vaccine development, studies now attempt to better understand the variables that contribute to patient outcomes and which factors might be associated with symptom persistence and recurrence.

To address these knowledge gaps, a team of investigators reviewed patient data from hospitalized Hispanic and African American patients with confirmed severe acute respiratory disease coronavirus-2 (SARS-CoV-2) infection to report demographics, clinical data, and gastrointestinal symptoms, and to determine how these characteristics are associated with patient outcomes.

The researchers collected data from 447 patients (51.1% men; mean age 56.1 years) with COVID-19 who were hospitalized at Howard University Hospital in Washington, D.C.; 309 patients were African American, 111 patients were Hispanic, and 27 patients were Caucasian.

Of the 71 deaths reported in the cohort, mortality rates for African American, Hispanic, and Caucasian groups were 18.1%, 7.3%, and 18.5%, respectively. Of the cohort, the average ages among surviving patients and those who died were 53.9 years and 68.6 years, respectively. The average body mass index (BMI) was 30.6, with the highest average BMI in the African American group (mean, 31.6) and the lowest in the Hispanic group (mean, 27.4).

The most common gastrointestinal symptoms included diarrhea (19.4%), abdominal pain (15.8%), and nausea (13.3%). Gastrointestinal bleeding was reported in 5.6% of African American, 3.7% of Caucasian, and 1% of Hispanic patients (4.4% of total; P =.009). The most commonly reported comorbidities included hypertension (55.2%), diabetes (38.4%), and cardiac disease (20.2%).

The most common elevated biomarkers included D-dimer (89%; P =.008), ferritin (61.9%; P =.02), C-reactive protein (60%; P <.001), and procalcitonin (36.3%; P <.001).

In addition to these biomarkers, the following variables were also significantly associated with mortality outcomes: elevated creatinine (P = <.001), abnormal platelet count (P =.02), age (P <.001), gastrointestinal bleeds (P =.009), abdominal pain (P =.050), elevated liver function test (LFTs) (P <.001), shortness of breath (P =.002), diabetes (P =.021), and pneumonia (P <.001).

The investigators noted that results of another study suggested that patients with chronic liver diseases were more likely to develop severe COVID-19, which is in line with this study’s results of elevated LFTs on admission. “However, liver function alterations were also reported as a result of COVID-19 or antiviral treatment during hospitalization,” the investigators noted.

The researchers also noted that patients belonging to the African American and Hispanic minority groups had higher incidences of diarrhea and abdominal pain, respectively. These outcomes are “likely to affect post-discharge patients’ conditions as the virus persists longer in the [gastrointestinal] tract after clearance from the respiratory system,” the authors concluded. 

Reference

Ashktorab H, Pizuorno A, Aduli F, Laiyemo AO, Oskrochi G, Brim H. Elevated liver enzymes, ferritin, CRP, D-dimer, and age are predictive markers of outcomes among COVID-19 African Americans and Hispanic patients. Gastroenterol. Published online March 31, 2021. doi: 10.1053/j.gastro.2021.03.043