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Ashktorab H, Pizuorno A, Chirumamilla LG, Adeleye F, Dalivand MM, Sherif ZA, Oskrochi G, Challa SR, Jones-Wonni B, Rankine S, Ekwunazu C, Banson A, Kim R, Gilliard C, Ekpe E, Shayegh N, Nyaunu C, Martins C, Slack A, Okwesili P, Abebe M, Batta Y, Ly D, Valarie O, Smith T, Watson K, Kolawole O, Tahmazian S, Atoba S, Khushbakht M, Riley G, Gavin W, Kara A, Hache-Marliere M, Palaiodimos L, Mani VR, Kalabin A, Gayam VR, Garlapati PR, Miller J, Jackson F, Carethers JM, Rustgi V, Brim H. African Americans Possessed High Prevalence of Comorbidities and Frequent Abdominal Symptoms, and Comprised A Disproportionate Share of Covid-19 Mortality among 9,873 Us- Hospitalized Patients Early in the Pandemic. Arch Intern Med Res 2024; 7:27-41. [PMID: 38694760 PMCID: PMC11062622 DOI: 10.26502/aimr.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Background and aim Identifying clinical characteristics and outcomes of different ethnicities in the US may inform treatment for hospitalized COVID-19 patients. Aim of this study is to identify predictors of mortality among US races/ethnicities. Design Setting and participants We retrospectively analyzed de-identified data from 9,873 COVID-19 patients who were hospitalized at 15 US hospital centers in 11 states (March 2020-November 2020). Main Outcomes and Measures: The primary outcome was to identify predictors of mortality in hospitalized COVID-19 patients. Results Among the 9,873 patients, there were 64.1% African Americans (AA), 19.8% Caucasians, 10.4% Hispanics, and 5.7% Asians, with 50.7% female. Males showed higher in-hospital mortality (20.9% vs. 15.3%, p=0.001). Non- survivors were significantly older (67 vs. 61 years) than survivors. Patients in New York had the highest in-hospital mortality (OR=3.54 (3.03 - 4.14)). AA patients possessed higher prevalence of comorbidities, had longer hospital stay, higher ICU admission rates, increased requirement for mechanical ventilation and higher in-hospital mortality compared to other races/ethnicities. Gastrointestinal symptoms (GI), particularly diarrhea, were more common among minority patients. Among GI symptoms and laboratory findings, abdominal pain (5.3%, p=0.03), elevated AST (n=2653, 50.2%, p=<0.001, OR=2.18), bilirubin (n=577, 12.9%, p=0.01) and low albumin levels (n=361, 19.1%, p=0.03) were associated with mortality. Multivariate analysis (adjusted for age, sex, race, geographic location) indicates that patients with asthma, COPD, cardiac disease, hypertension, diabetes mellitus, immunocompromised status, shortness of breath and cough possess higher odds of in-hospital mortality. Among laboratory parameters, patients with lymphocytopenia (OR2=2.50), lymphocytosis (OR2=1.41), and elevations of serum CRP (OR2=4.19), CPK (OR2=1.43), LDH (OR2=2.10), troponin (OR2=2.91), ferritin (OR2=1.88), AST (OR2=2.18), D-dimer (OR2=2.75) are more prone to death. Patients on glucocorticoids (OR2=1.49) and mechanical ventilation (OR2=9.78) have higher in-hospital mortality. Conclusion These findings suggest that older age, male sex, AA race, and hospitalization in New York were associated with higher in-hospital mortality rates from COVID-19 in early pandemic stages. Other predictors of mortality included the presence of comorbidities, shortness of breath, cough elevated serum inflammatory markers, altered lymphocyte count, elevated AST, and low serum albumin. AA patients comprised a disproportionate share of COVID-19 death in the US during 2020 relative to other races/ethnicities.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Antonio Pizuorno
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | | | - Folake Adeleye
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | | | - Zaki A Sherif
- Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC, USA
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | | | - Boubini Jones-Wonni
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Sheldon Rankine
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Chiamaka Ekwunazu
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Abigail Banson
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Rachel Kim
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Chandler Gilliard
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Elizabeth Ekpe
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Nader Shayegh
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Constance Nyaunu
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Chidi Martins
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Ashley Slack
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Princess Okwesili
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Malachi Abebe
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Yashvardhan Batta
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Do Ly
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Ogwo Valarie
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Tori Smith
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Kyra Watson
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Oluwapelumi Kolawole
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Sarine Tahmazian
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Sofiat Atoba
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Myra Khushbakht
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Gregory Riley
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - Warren Gavin
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, IN, USA
| | - Areeba Kara
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, IN, USA
| | | | | | - Vishnu R Mani
- Department of Trauma, Acute and Critical Care Surgery, Duke University Medical Center, NC, USA
| | - Aleksandr Kalabin
- Department of Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital, NY, USA
| | | | | | - Joseph Miller
- Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Fatimah Jackson
- Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC, USA
| | - John M Carethers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine; Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Vinod Rustgi
- Division of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital - New Brunswick, NJ
| | - Hassan Brim
- Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC, USA
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Batta Y, King C, Cooper F, Johnson J, Haddad N, Boueri MG, DeBerry E, Haddad GE. Direct and indirect cardiovascular and cardiometabolic sequelae of the combined anti-retroviral therapy on people living with HIV. Front Physiol 2023; 14:1118653. [PMID: 37078025 PMCID: PMC10107050 DOI: 10.3389/fphys.2023.1118653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
With reports of its emergence as far back as the early 1900s, human immunodeficiency virus (HIV) has become one of the deadliest and most difficult viruses to treat in the era of modern medicine. Although not always effective, HIV treatment has evolved and improved substantially over the past few decades. Despite the major advancements in the efficacy of HIV therapy, there are mounting concerns about the physiological, cardiovascular, and neurological sequelae of current treatments. The objective of this review is to (Blattner et al., Cancer Res., 1985, 45(9 Suppl), 4598s-601s) highlight the different forms of antiretroviral therapy, how they work, and any effects that they may have on the cardiovascular health of patients living with HIV, and to (Mann et al., J Infect Dis, 1992, 165(2), 245-50) explore the new, more common therapeutic combinations currently available and their effects on cardiovascular and neurological health. We executed a computer-based literature search using databases such as PubMed to look for relevant, original articles that were published after 1998 to current year. Articles that had relevance, in any capacity, to the field of HIV therapy and its intersection with cardiovascular and neurological health were included. Amongst currently used classes of HIV therapies, protease inhibitors (PIs) and combined anti-retroviral therapy (cART) were found to have an overall negative effect on the cardiovascular system related to increased cardiac apoptosis, reduced repair mechanisms, block hyperplasia/hypertrophy, decreased ATP production in the heart tissue, increased total cholesterol, low-density lipoproteins, triglycerides, and gross endothelial dysfunction. The review of Integrase Strand Transfer Inhibitors (INSTI), Nucleoside Reverse Transcriptase Inhibitors (NRTI), and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) revealed mixed results, in which both positive and negative effects on cardiovascular health were observed. In parallel, studies suggest that autonomic dysfunction caused by these drugs is a frequent and significant occurrence that needs to be closely monitored in all HIV + patients. While still a relatively nascent field, more research on the cardiovascular and neurological implications of HIV therapy is crucial to accurately evaluate patient risk.
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Affiliation(s)
- Yashvardhan Batta
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Cody King
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Farion Cooper
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - John Johnson
- Delaware Psychiatric Center, New Castle, DE, United States
| | - Natasha Haddad
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | | | - Ella DeBerry
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Georges E. Haddad
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
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Gharbin J, Winful A, Hassan MA, Bajaj S, Batta Y, Alebna P, Rhodd S, Taha M, Fatima U, Mehrotra P. Differences in the Clinical Outcome of Ischemic and Nonischemic Cardiomyopathy in Heart Failure With Concomitant Opioid Use Disorder. Curr Probl Cardiol 2023; 48:101609. [PMID: 36690309 DOI: 10.1016/j.cpcardiol.2023.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Heart Failure (HF) and Opioid Use Disorder (OUD) independently have significant impact on patients and the United States (US) health system. In the setting of the opioid epidemic, research on the effects of OUD on cardiovascular diseases is rapidly evolving. However, no study exists on differential outcomes of ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) in patients with HF with OUD. We performed a retrospective, observational cohort study using National Inpatient Sample (NIS) 2018-2020 databases. Patients aged 18 years and above with diagnoses of HF with concomitant OUD were included. Patients were further classified into ICM and NICM. Primary outcome of interest was differences in all- cause in-hospital mortality. Secondary outcome was incidence of cardiogenic shock. We identified 99,810 hospitalizations that met inclusion criteria, ICM accounted for 27%. Mean age for ICM was higher compared to NICM (63 years vs 56 years, P < 0.01). Compared to NICM, patients with ICM had higher cardiovascular disease risk factors and comorbidities; type 2 diabetes mellitus (46.3 % vs 30.1%, P < 0.01), atrial fibrillation/flutter (33.5% vs 29.9%, P < 0.01), hyperlipidemia (52.5% vs 28.9%, P < 0.01), and Charlson comorbidity index ≥5 was 46.7% versus 29.7%, P < 0.01. After controlling for covariates and potential confounders, we observed higher odds of all-cause in-hospital mortality in patients with NICM (aOR = 1.36; 95% CI:1.03-1.78, P = 0.02). There was no statistical significant difference in incidence of cardiogenic shock between ICM and NICM (aOR = 0.86;95% CI 0.70-1.07, P = 0.18). In patients with HF with concomitant OUD, we found a 36% increase in odds of all-cause in-hospital mortality in patients with NICM compared to ICM despite being younger in age with less comorbidities. There was no difference in odds of in-hospital cardiogenic shock in this study population. This study contributes to the discussion of OUD and cardiovascular diseases which is rapidly developing and requires further prospective studies.
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Affiliation(s)
- John Gharbin
- Department of Medicine, Howard University Hospital, Washington DC, USA.
| | - Adwoa Winful
- Department of Hospital Medicine, Doctors Hospital of Augusta, Augusta, GA, USA
| | | | - Siddharth Bajaj
- Department of Medicine, Howard University Hospital, Washington DC, USA
| | | | - Pamela Alebna
- Department of Medicine, RWJ Barnabas Health, Jersey City, NJ, USA
| | - Suchellis Rhodd
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Mohammed Taha
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Urooj Fatima
- College of Medicine, Howard University, Washington, DC, USA; Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Prafulla Mehrotra
- College of Medicine, Howard University, Washington, DC, USA; Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
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Batta Y, King C, Johnson J, Haddad N, Boueri M, Haddad G. Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems. Front Physiol 2022; 12:748972. [PMID: 35095546 PMCID: PMC8795698 DOI: 10.3389/fphys.2021.748972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 patients with pre-existing cardiovascular conditions are at greater risk of severe illness due to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to pre-existing hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS-CoV-2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review. In particular, SARS-CoV-2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications. Also, cardiac arrhythmias are another well-known cardiovascular-related complication seen in COVID-19 infections and merit discussion in this review. Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS-CoV-2 patients. Currently, the specific causative mechanism of the increased incidence of MI is unclear. However, studies suggest several links to high angiotensin-converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyper-inflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2-mediated cardio-protection. Furthermore, hypertension and SARS-CoV-2 infection patients’ prognosis has shown mixed results across current studies. For this reason, an in-depth analysis of the interactions between SARS-CoV2 and the ACE2 cardio-protective mechanism is warranted. Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia. Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk. This review aims to discuss the current literature related to potential complications of COVID-19 infection with hypertension and the vasculature, including the cervical one. Finally, age is a significant prognostic indicator among COVID-19 patients. For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID-19, it is essential to explore the mechanisms by which SARS-CoV-2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.
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Affiliation(s)
- Yashvardhan Batta
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Cody King
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - John Johnson
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Natasha Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | | | - Georges Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
- *Correspondence: Georges Haddad,
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