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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
COVID-19 among African Americans and Hispanics: Does gastrointestinal symptoms impact the outcome?
Hassan Ashktorab, Adeleye Folake, Antonio Pizuorno, Gholamreza Oskrochi, Philip Oppong-Twene, Nuri Tamanna, Maryam Mehdipour Dalivand, Lisa N Umeh, Esther S Moon, Abdoul Madjid Kone, Abigail Banson, Cassandra Federman, Edward Ramos, Eyitope Ola Awoyemi, Boubini Jones Wonni, Eric Otto, Guttu Maskalo, Alexandra Ogando Velez, Sheldon Rankine, Camelita Thrift, Chiamaka Ekwunazu, Derek Scholes, Lakshmi Gayathri Chirumamilla, Mohd Elmugtaba Ibrahim, Brianna Mitchell, Jillian Ross, Julencia Curtis, Rachel Kim, Chandler Gilliard, Joseph Mathew, Adeyinka Laiyemo, Angesum Kibreab, Edward Lee, Zaki Sherif, Babak Shokrani, Farshad Aduli, Hassan Brim
Hassan Ashktorab, Adeleye Folake, Philip Oppong-Twene, Nuri Tamanna, Maryam Mehdipour Dalivand, Lisa N Umeh, Esther S Moon, Abdoul Madjid Kone, Abigail Banson, Cassandra Federman, Edward Ramos, Eyitope Ola Awoyemi, Boubini Jones Wonni, Eric Otto, Guttu Maskalo, Alexandra Ogando Velez, Sheldon Rankine, Camelita Thrift, Chiamaka Ekwunazu, Derek Scholes, Lakshmi Gayathri Chirumamilla, Mohd Elmugtaba Ibrahim, Brianna Mitchell, Jillian Ross, Julencia Curtis, Rachel Kim, Chandler Gilliard, Joseph Mathew, Adeyinka Laiyemo, Angesum Kibreab, Edward Lee, Zaki Sherif, Babak Shokrani, Farshad Aduli, Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
Antonio Pizuorno, Faculty of Medicine, La Universidad del Zulia, Maracaibo 4002, Zulia, Venezuela
Gholamreza Oskrochi, College of Engineering and Technology, American University of Middle East Kuwait, Egaila 54200, Kuwait
Zaki Sherif, Department of Biochemistry and Molecular Biology, Howard University College of Medicine, Washington, DC 20060, United States
Hassan Brim, Pathology and Cancer Center, Department of Biochemistry and Molecular Biology, Howard University College of Medicine, Washington, DC 20060, United States
Author contributions: Ashktorab H contributed to study concept and design; Ashktorab H and Brim H wrote the paper; Pizuorno A, Brim H, Folake A, Oppong-Twene P, Tamanna N, Ibrahim ME, Umeh LN, Moon ES, Kone AM, Banson A, Federman C, Ramos E, Awoyemi EO, Wonni BJ, Otto E, Maskalo G, Velez AO, Rankine S, Ekwunazu C, Mathew J, ER, Scholes D, Kibrea A, Shokrani B, Sherif Z, Dalivand MM, Chirumamilla LG, Mitchell B, Ross J, Curtis J, Kim R, Gilliard C, Aduli F, Thrift C, Laiyemo A, Kibreab A and Lee E collected and analyzed the clinical data; Oskrochi G performed statistical analysis; Ashktorab H obtained the funding; Ashktorab H and Brim H contributed to material support; all authors evaluated the manuscript for intellectual content and approved the manuscript.
Supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health, No. G12MD007597.
Institutional review board statement: This study was approved and reviewed by Howard University Hospital Institutional Review Board (No: The Howard University IRB Federal Wide Assurance number is FWA00000891).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used de-identified data clinical data that were obtained after each patient agreed to treatment by written consent
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hassan Ashktorab, PhD, Professor, Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC 20060, United States.
hashktorab@howard.edu
Received: June 12, 2021
Peer-review started: June 12, 2021
First decision: July 18, 2021
Revised: July 19, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: October 6, 2021
Processing time: 108 Days and 8.5 Hours
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 vs 61.2 for Whites vs 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
Core Tip: The Coronavirus disease 2019 (COVID-19) disproportionately affected African Americans and Hispanics. Understanding the transmission dynamics, a different array of symptoms and the impact of the presence of other chronic diseases in minority patients can provide important hints about the progression of the pandemic and treatment options, especially in areas where access to equal health services is limited, unequal and challenging for underserved populations is broad. This study presents the findings of a comprehensive analysis of COVID-19 patients in a Washington DC tertiary hospital that caters primarily to minority populations. The main objective of this study was to define major effectors of outcome in this patient population. We sought to determine clinical and gastrointestinal (GI) factors associated with differences in outcomes. Special emphasis was made on GI symptoms, laboratory values and comorbidities.
