Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumonia
Abstract Background Racial/ethnic minorities are at higher risk for severe COVID-19. This may be related to social determinants that lead to chronic inflammatory states. The aims of the study were to determine if there are racial/ethnic disparities with inflammatory markers and association of methyl...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-022-07237-1 |
| _version_ | 1818356240936337408 |
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| author | Ronaldo C. Go Themba Nyirenda Maryam Bojarian Davood K. Hosseini Kevin Kim Mehek Rahim Elli G. Paleoudis Anna C. Go Zhiyong Han Steven J. Sperber Anjali Gupta |
| author_facet | Ronaldo C. Go Themba Nyirenda Maryam Bojarian Davood K. Hosseini Kevin Kim Mehek Rahim Elli G. Paleoudis Anna C. Go Zhiyong Han Steven J. Sperber Anjali Gupta |
| author_sort | Ronaldo C. Go |
| collection | DOAJ |
| description | Abstract Background Racial/ethnic minorities are at higher risk for severe COVID-19. This may be related to social determinants that lead to chronic inflammatory states. The aims of the study were to determine if there are racial/ethnic disparities with inflammatory markers and association of methylprednisolone to in hospital survival. Methods This was a secondary analysis of a retrospective cohort study of patients ≥ 18 years of age and admitted for severe COVID-19 pneumonia between March and June 2020 in 13 Hospitals in New Jersey, United States. Patients who received other formulation of corticosteroids were not included. Area under the receiver operating characteristics curves were performed to test for discriminatory ability of each inflammatory makers. Univariate and multivariate Cox regression assessed the association of variables to in hospital survival. Results Propensity matched sample (n = 759) between no methylprednisolone (n = 380) and methylprednisolone (n = 379) had 338 Whites, 102 Blacks, 61 Asian/Indians, and 251 non-Black non-White Hispanics. Compared to CRP, area under receiving operating characteristic curve for d-dimer in Hispanics (0.742) was statistically different (DeLong Test P = 0.0041). Multivariate cox regression showed that different variables in Blacks [age ≥ 60 years (HR = 3.71, P = 0.0281), mechanical ventilation (HR = 5.07, P = 0.0281) and creatinine ≥ 1.5 mg/dL (HR = 3.61, P = 0.0007)], Whites [cancer (HR = 1.68, P = 0.0213), qSOFA score of 1 (HR = 1.81, P = 0.0213), qSOFA score of 2 (HR = 5.16, P < 0.0001), qSOFA score of 3 (HR = 11.81, P < 0.0001) and creatinine ≥ 1.5 mg/dL (HR = 2.16, P = 0.0006)], Hispanics [hypertension (HR = 2.52, P = 0.0007), cancer (HR = 2.99, P = 0.0244 and D-dimer ≥ 2 mcg/mL (HR = 2.22, P = 0.0077)], and Asian/Indians [ chronic kidney disease (HR = 6.36, P = 0.0031) and CRP > 20 mg/L (HR = 5.02, P = 0.0032)] were statistically significant for mortality. Low dose and high dose methylprednisolone were significantly associated with prolonged survival in Whites [low dose (HR = 0.37, P < 0.0001) and high dose (HR = 0.48, P < 0.0183)] and Asian/Indians [low dose (HR = 0.13, P = 0.0101) and high dose (HR = 0.15, P = 0.01)]. However, high dose was not associated with improved survival compared to low dose. Methylprednisolone was not associated with prolonged survival in Blacks and Hispanics. Conclusion Racial/Ethnic disparities with inflammatory markers preclude the use of one marker as a predictor of survival. Methylprednisolone is associated with prolonged survival in Asian/Indians and Whites. |
| first_indexed | 2024-12-13T19:54:05Z |
| format | Article |
| id | doaj.art-6878535c72b54592b3db770f8c6fb728 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-13T19:54:05Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-6878535c72b54592b3db770f8c6fb7282022-12-21T23:33:21ZengBMCBMC Infectious Diseases1471-23342022-03-0122111510.1186/s12879-022-07237-1Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumoniaRonaldo C. Go0Themba Nyirenda1Maryam Bojarian2Davood K. Hosseini3Kevin Kim4Mehek Rahim5Elli G. Paleoudis6Anna C. Go7Zhiyong Han8Steven J. Sperber9Anjali Gupta10Hackensack Meridian School of MedicineHackensack Meridian School of MedicineHackensack University Medical CenterHackensack University Medical CenterHackensack University Medical CenterHackensack University Medical CenterHackensack Meridian School of MedicineGullas School of MedicineHackensack Meridian School of MedicineHackensack Meridian School of MedicineHackensack Meridian School of MedicineAbstract Background Racial/ethnic minorities are at higher risk for severe COVID-19. This may be related to social determinants that lead to chronic inflammatory states. The aims of the study were to determine if there are racial/ethnic disparities with inflammatory markers and association of methylprednisolone to in hospital survival. Methods This was a secondary analysis of a retrospective cohort study of patients ≥ 18 years of age and admitted for severe COVID-19 pneumonia between March and June 2020 in 13 Hospitals in New Jersey, United States. Patients who received other formulation of corticosteroids were not included. Area under the receiver operating characteristics curves were performed to test for discriminatory ability of each inflammatory makers. Univariate and multivariate Cox regression assessed the association of variables to in hospital survival. Results Propensity matched sample (n = 759) between no methylprednisolone (n = 380) and methylprednisolone (n = 379) had 338 Whites, 102 Blacks, 61 Asian/Indians, and 251 non-Black non-White Hispanics. Compared to CRP, area under receiving operating characteristic curve for d-dimer in Hispanics (0.742) was statistically different (DeLong Test P = 0.0041). Multivariate cox regression showed that different variables in Blacks [age ≥ 60 years (HR = 3.71, P = 0.0281), mechanical ventilation (HR = 5.07, P = 0.0281) and creatinine ≥ 1.5 mg/dL (HR = 3.61, P = 0.0007)], Whites [cancer (HR = 1.68, P = 0.0213), qSOFA score of 1 (HR = 1.81, P = 0.0213), qSOFA score of 2 (HR = 5.16, P < 0.0001), qSOFA score of 3 (HR = 11.81, P < 0.0001) and creatinine ≥ 1.5 mg/dL (HR = 2.16, P = 0.0006)], Hispanics [hypertension (HR = 2.52, P = 0.0007), cancer (HR = 2.99, P = 0.0244 and D-dimer ≥ 2 mcg/mL (HR = 2.22, P = 0.0077)], and Asian/Indians [ chronic kidney disease (HR = 6.36, P = 0.0031) and CRP > 20 mg/L (HR = 5.02, P = 0.0032)] were statistically significant for mortality. Low dose and high dose methylprednisolone were significantly associated with prolonged survival in Whites [low dose (HR = 0.37, P < 0.0001) and high dose (HR = 0.48, P < 0.0183)] and Asian/Indians [low dose (HR = 0.13, P = 0.0101) and high dose (HR = 0.15, P = 0.01)]. However, high dose was not associated with improved survival compared to low dose. Methylprednisolone was not associated with prolonged survival in Blacks and Hispanics. Conclusion Racial/Ethnic disparities with inflammatory markers preclude the use of one marker as a predictor of survival. Methylprednisolone is associated with prolonged survival in Asian/Indians and Whites.https://doi.org/10.1186/s12879-022-07237-1Racial/ethnic disparitiesComorbiditiesInflammationMethylprednisoloneCOVID-19 |
| spellingShingle | Ronaldo C. Go Themba Nyirenda Maryam Bojarian Davood K. Hosseini Kevin Kim Mehek Rahim Elli G. Paleoudis Anna C. Go Zhiyong Han Steven J. Sperber Anjali Gupta Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumonia BMC Infectious Diseases Racial/ethnic disparities Comorbidities Inflammation Methylprednisolone COVID-19 |
| title | Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumonia |
| title_full | Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumonia |
| title_fullStr | Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumonia |
| title_full_unstemmed | Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumonia |
| title_short | Racial/ethnic disparities on inflammation and response to methylprednisolone in severe COVID-19 pneumonia |
| title_sort | racial ethnic disparities on inflammation and response to methylprednisolone in severe covid 19 pneumonia |
| topic | Racial/ethnic disparities Comorbidities Inflammation Methylprednisolone COVID-19 |
| url | https://doi.org/10.1186/s12879-022-07237-1 |
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