Clinical Characteristics, Respiratory Mechanics, and Outcomes in Critically Ill Individuals With COVID-19 Infection in an Underserved Urban Population

Abstract

BACKGROUND: The COVID-19 outbreak in the United States has disproportionately affected Black individuals, but little is known about the factors that underlie this observation. Herein, we describe these associations with mortality in a largely minority underserved population. METHODS: This single-center retrospective observational study included all adult subjects with laboratory-confirmed SARS-Cov-2 treated in our ICU between March 15 and May 10, 2020. RESULTS: 128 critically ill adult subjects were included in the study (median age 68 y [interquartile range 61–76], 45% female, and 64% Black); 124 (97%) required intubation. Eighty (63%) subjects died during their in-patient stay, which did not differ by race/ethnicity. Compared with other racial/ethnic groups, Blacks had a greater proportion of women (52% vs 30%, P 5.02) and subjects with hypertension (91% vs 78%, P 5.035). Asthma (P 5.03) was associated with lower inpatient death, primarily among Black subjects (P 5.02). Among Black subjects, increased age (odds ratio 1.06 [95% CI 1.05–1.22] per year), positive fluid balance (odds ratio 1.06 [95% CI 1.01– 1.11] per 100 mL), and treatment with tocilizumab (odds ratio 25.0 [95% CI 3.5–180]) were independently associated with in-patient death, while higher platelets (odds ratio 0.65 [95% CI 0.47– 0.89] per 50 3 103/mL) and treatment with intermediate dose anticoagulants (odds ratio 0.08 [95% CI 0.02–0.43]) were protective. Among other race/ethnic groups, higher total bilirubin (odds ratio 1.75 [95% CI 0.94–3.25] per 0.2 mg/dL) and higher maximum lactate (odds ratio 1.43 [95% CI 0.96–2.13] per mmol/L) were marginally associated with increased death, while tocilizumab treatment was marginally protective (odds ratio 0.24 [95% CI 0.05–1.25]). During first 72 h of ventilation, those who died had less increase in PaO2 =FIO2 (P 5.046) and less reduction in PEEP (P 5.01) and FIO2 requirement (P 5.002); these patterns did not differ by race/ethnicity. CONCLUSIONS: Black and other race/ethnicity subjects had similar mortality rates due to COVID-19 but differed in factors that were associated with increased risk of death. In both groups, subjects who died were older, had a positive fluid balance, and less improvement in PaO2 =FIO2, PEEP, and FIO2 requirement on ventilation.