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Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19
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JAMA Network Open | December 22, 2021 | Volume: 4 | Issue: 12 | Pages: e2140568
Healthcare disparities among anticoagulation therapies for severe COVID‐19 patients in the multi‐site VIRUS registry
Kirkup, Christian , Puranik, Arjun, Conrad, Ian, Gomaa, Dina , Mosier, Jarrod , Заболотских, И. Б. , Daugherty, Steven K., Bernstein, Michael, Zaren, Howard A. , Bansal, Vikas , Pickering, Brian , Badley, Andrew D. , Camazine, Maraya , Koritala, Thoyaja , O'Horo, John C, Bansal, Vikas , Soundararajan, Venky , Badley, Andrew D , Mosier, Jarrod M , Pawlowski, Colin , O’Horo, John C. , Banner‐Goodspeed, Valerie , Kashyap, Rahul , Venkatakrishnan, A J , Soundararajan, Venky
Journal of Medical Virology | March 5, 2021 | Volume: 93 | Issue: 7 | Pages: 4303-4318
Abstract Here we analyze hospitalized andintensive care unit coronavirus disease 2019 (COVID‐19) patient outcomes from the international VIRUS registry ( https://clinicaltrials.gov/ct2/show/NCT04323787 ). We find that COVID‐19 patients administered unfractionated heparin but not enoxaparin have a higher mortality‐rate (390 of 1012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1939 = 14%), presenting a risk ratio of 2.79 (95% confidence interval [CI]: [2.42, 3.16]; p = 4.45e−52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin versus 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% CI: [1.42, 2.00]; p = 1.5e−8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2644 [25%]), risk ratio 1.26 (95% CI: [1.14, 1.40]; p = 7.5e−5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1047 [30%] for Black/African American vs. 263 of 1047 [25%] for White/Caucasian, p = .02, risk ratio 1.18; 95% CI: [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow‐up prospective research into the observed racial disparity in anticoagulant use and outcomes for severe COVID‐19 patients.