Self-identified Race and COVID-19-Associated Acute Kidney Injury and Inflammation: a Retrospective Cohort Study of Hospitalized Inner-City COVID-19 Patients

Abstract

Background Black individuals have been disproportionately affected by the coronavirus disease 2019 (COVID-19). However, it remains unclear whether there are any biological factors that predispose Black patients to COVID-19-related morbidity and mortality. Objective To compare in-hospital morbidity, mortality, and inflammatory marker levels between Black and White hospitalized COVID-19 patients. Design and Participants This single-center retrospective cohort study analyzed data for Black and White patients aged ≥18 years hospitalized with a positive SARS-CoV-2 PCR test between March 1, 2020, and August 4, 2020. Main Measures The exposure was self-identified race documented in the medical record. The primary outcome of was in-hospital death. Secondary outcomes included intensive care unit admission, hospital morbidities, and inflammatory marker levels. Key Results A total of 1,424 Black and White patients were identified. The mean ± SD age was 56.1 ± 17.4 years, and 663 (44.5%) were female. There were 683 (48.0%) Black and 741 (52.0%) White patients. In the univariate analysis, Black patients had longer hospital stays (8.1 ± 10.2 vs. 6.7 ± 8.3 days, p = 0.011) and tended to have higher rates of in-hospital death (11.0% vs. 7.3%), myocardial infarction (6.9% vs. 4.5%), pulmonary embolism (PE; 5.0% vs. 2.3%), and acute kidney injury (AKI; 39.4% vs. 23.1%) than White patients (p <0.05). However, after adjusting for potential confounders, only PE (adjusted odds ratio [aOR] 2.07, 95% CI, 1.13–3.79) and AKI (aOR 2.16, 95% CI, 1.57–2.97) were statistically significantly associated with Black race. In comparison with White patients, Black patients had statistically significantly higher peak plasma D-dimer (standardized β = 0.10), erythrocyte sedimentation rate (standardized β = 0.13), ferritin (standardized β = 0.09), and lactate dehydrogenase (standardized β = 0.11), after adjusting for potential confounders (p<0.05). Conclusions Black hospitalized COVID-19 patients had increased risks of developing PE and AKI and higher inflammatory marker levels compared with White patients. This observation may be explained by differences in the prevalence and severity of underlying comorbidities and other unmeasured biologic risk factors between Black and White patients. Future research is needed to investigate the mechanism of these observed differences in outcomes of severe COVID-19 infection in Black versus White patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06931-1.

COVID-19 outcomes in patients with Dermatomyositis: A registry-based cohort analysis

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Gender and Ethnic Disparities of Acute Kidney Injury in COVID-19 Infected Patients: A Literature Review

“…Vitamin D modulates the immune system by suppressing the T helper 1 immune profile and upregulating the expression of regulatory T cells, thereby reducing the severity of cytokine storm. Therefore, vitamin D deficiency puts Black patients at a higher risk of cytokine storm and resulting systemic and intrarenal inflammation ( Charoenngam et al., 2021 ).…”

“…Charoenngam et al compared the hospital outcomes of Black and White hospitalized patients with COVID-19 at Boston Medical Center, the largest safety net hospital in New England. After adjusting for age, gender, BMI, potential type 2 diabetes, hypertension, and baseline estimated glomerular filtration rate (eGFR), the odds of AKI in black patients were statistically significantly higher (aOR 2.16, 95% CI, 1.57-2.97) (Charoenngam et al, 2021). In order to determine the risk factors related to the development of AKI in patients with COVID-19, Hirsch et al found that black race was both an independent risk factor and an independent predictor for the occurrence of AKI through multivariate analysis (Hirsch et al, 2020).…”

A systematic review and meta-analysis of racial disparities in deep vein thrombosis and pulmonary embolism events in patients hospitalized with coronavirus disease 2019

“…Table I details the study characteristics. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 These 11 studies included a total of 20,023 patients with a proportion of 27-54.2% of female patients. DVT and PE was a single outcome termed VTE in 5 studies and of those, a single study reported VTE and mortality as a composite primary outcome.…”