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Clinical characteristics and predictors of outcomes of hospitalized patients with COVID-19 in a multi-ethnic London NHS Trust: a retrospective cohort study

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Title: Clinical characteristics and predictors of outcomes of hospitalized patients with COVID-19 in a multi-ethnic London NHS Trust: a retrospective cohort study
Authors: Perez Guzman, PN
Daunt, A
Mukherjee, S
Crook, P
Forlano, R
Kont, M
Lochen, A
Vollmer, M
Middleton, P
Judge, R
Harlow, C
Soubieres, A
Cooke, G
White, PJ
Hallett, T
Aylin, P
Ferguson, N
Hauck, K
Thursz, M
Nayagam, S
Item Type: Journal Article
Abstract: Background: Emerging evidence suggests ethnic minorities are disproportionatelyaffected by COVID-19. Detailed clinical analyses of multi-cultural hospitalized patientcohorts remain largely undescribed.Methods: We performed regression, survival andcumulative competing risk analyses to evaluate factors associated with mortality inpatients admitted for COVID-19 in three large London hospitals between February 25and April 5, censored as of May 1, 2020.Results: Of 614 patients (median age 69years, (IQR 25) and 62% male), 381 (62%) had been discharged alive, 178 (29%)died and 55 (9%) remained hospitalized at censoring. Severe hypoxemia (aOR 4.25,95%CI 2.36-7.64), leukocytosis (aOR 2.35, 95%CI 1.35-4.11), thrombocytopenia (aOR1.01, 95%CI 1.00-1.01, increase per 10x9decrease), severe renal impairment (aOR5.14, 95%CI 2.65-9.97), and low albumin (aOR 1.06, 95%CI 1.02-1.09, increase per gdecrease) were associated with death. Forty percent (244) were from black, Asian andother minority ethnic (BAME) groups, 38% (235) white and for 22% (135) ethnicity wasunknown. BAME patients were younger and had fewer comorbidities. Whilst theunadjusted odds of death did not differ by ethnicity, when adjusting for age, sex andcomorbidities, black patients were at higher odds of death compared to whites (aOR1.69, 95%CI 1.00-2.86). This association was stronger when further adjusting foradmission severity (aOR 1.85 95% CI 1.06-3.24). Conclusions: BAME patients were over-represented in our cohort and, whenaccounting for demographic and clinical profile of admission, black patients were atincreased odds of death. Further research is needed into biologic drivers of differencesin COVID-19 outcomes by ethnicity.
Issue Date: 7-Aug-2020
Date of Acceptance: 24-Jul-2020
URI: http://hdl.handle.net/10044/1/81132
DOI: 10.1093/cid/ciaa1091
ISSN: 1058-4838
Publisher: Oxford University Press (OUP)
Start Page: 1
End Page: 11
Journal / Book Title: Clinical Infectious Diseases
Volume: 2020
Copyright Statement: © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Medical Research Council (MRC)
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
Dr Foster Ltd
Imperial College Healthcare NHS Trust: Research Capability Funding (RCF)
Funder's Grant Number: MR/R015600/1
RP-2016-07-012
NIHR200908
n/a
n/a
RDF04
Keywords: COVID-19
ethnic minority groups
mortality
06 Biological Sciences
11 Medical and Health Sciences
Microbiology
Publication Status: Published
Online Publication Date: 2020-08-07
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Department of Infectious Diseases
Institute of Clinical Sciences
Faculty of Medicine
Imperial College London COVID-19
School of Public Health



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