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

Perez-Guzman, Pablo N; Daunt, Anna; Mukherjee, Sujit; Crook, Peter; Forlano, Roberta; Kont, Mara D; Løchen, Alessandra; Vollmer, Michaela; Middleton, Paul; Judge, Rebekah; Harlow, Christopher; Soubieres, Anet; Cooke, Graham; White, Peter J; Hallett, Timothy B; Aylin, Paul; Ferguson, Neil; Hauck, Katharina; Thursz, Mark R; Nayagam, Shevanthi

BACKGROUND: Emerging evidence suggests ethnic minorities are disproportionately affected by COVID-19. Detailed clinical analyses of multi-cultural hospitalized patient cohorts remain largely undescribed. METHODS: We performed regression, survival and cumulative competing risk analyses to evaluate factors associated with mortality in patients admitted for COVID-19 in three large London hospitals between February 25 and April 5, censored as of May 1, 2020. RESULTS: Of 614 patients (median age 69 years, (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 (aOR 1.01, 95%CI 1.00-1.01, increase per 10x(9) decrease), severe renal impairment (aOR 5.14, 95%CI 2.65-9.97), and low albumin (aOR 1.06, 95%CI 1.02-1.09, increase per g decrease) were associated with death. Forty percent (244) were from black, Asian and other minority ethnic (BAME) groups, 38% (235) white and for 22% (135) ethnicity was unknown. BAME patients were younger and had fewer comorbidities. Whilst the unadjusted odds of death did not differ by ethnicity, when adjusting for age, sex and comorbidities, black patients were at higher odds of death compared to whites (aOR 1.69, 95%CI 1.00-2.86). This association was stronger when further adjusting for admission severity (aOR 1.85 95% CI 1.06-3.24). CONCLUSIONS: BAME patients were over-represented in our cohort and, when accounting for demographic and clinical profile of admission, black patients were at increased odds of death. Further research is needed into biologic drivers of differences in COVID-19 outcomes by ethnicity.