COVID-19 among African Americans and Hispanics:Does gastrointestinal symptoms impact the outcome?

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.

Clinical characteristics,gastrointestinal manifestations and outcomes of COVID-19 patients in Iran;does the location matters?

BACKGROUND Coronavirus disease 2019(COVID-19)started in Asia,and Iran was one of its first epicenters.AIM To study the gastrointestinal(GI)symptoms and comorbidities associated with this pandemic in four different regions of Iran.METHODS We analyzed data from severe acute respiratory syndrome coronavirus 2 positive patients evaluated at four hospitals of Iran(n=91),including South(Shiraz),Southeast(Dezful),Rasht(North),and Northwest(Mashhad)between April and September 2020.Demographics,comorbidities and clinical findings including GI symptoms were collected.Statistical descriptive analysis and correlation analyses of symptoms,comorbidities,and mortality were performed.RESULTS The average age of COVID-19 patients was 51.1 years,and 56%were male.Mortality rate was 17%.Cough with 84.6%,shortness of breath with 71.4%,fever with 52.7%,and loss of appetite with 43.9%were the main symptoms.Overall cardiac disease was the most common comorbidity with an average of 28.5%followed by hypertension(28.5%)and diabetes(25.2%).The highest comorbidity in North(Rasht)was diabetes(30%)and in South(Dezful)hypertension(37%).Shiraz leads cardiac disease with 43.4%.The most reported GI symptoms included nausea,diarrhea,vomiting,and abdominal pain,with 42.8%,31.8%,26.8%,and 12%prevalence,respectively.In addition,albumin,alkaline phosphatase,aspartate aminotransferase,and alanine aminotransferase were elevated in 26.3%.CONCLUSION Our results show hypertension and diabetes as the most common comorbidities,but their distribution was different in COVID-19 patients in the four studied regions of Iran.Nausea,diarrhea,and elevated liver enzymes were the most common GI symptoms.There was also a high mortality rate that was associated with high infection rates in Iran at the beginning of the pandemic.