P0720 - Demographic and Digestive Laboratory Characteristics Predict Mortality Among Hospitalized COVID-19 Patients

Manuel Martinez, MD, FACG¹, Shinjini Nandi, PhD², Rozina Haile, MD³, Erik L. Anderson, DO, PhD³, Mairin Joseph-Talreja, MD⁴, Mona T. Trafalgar, BSN, RN³, Jennifer Yudkevitch, MSc⁵, Yin Min Myat, BA⁵, Ravi K. Anand, MD⁶, Katherine Wong, MD⁷, Henry Hefler, MD, MS⁸, Fadi Antaki, MD⁹, Violeta Popov, MD, PhD¹⁰, Molly D. Plummer, MD¹¹, Victoria Jackson, MD¹², Leela Nayak, MD¹³, Peter S. Liang, MD, MPH^14
1VA NY Harbor Health Care System-Brooklyn Campus, Brooklyn, NY; ²Montana State University, Bozeman, MT; ³Brooklyn VA NY Harbor Healthcare System, Brooklyn, NY; ⁴SUNY Downstate Health Sciences University, Houston, TX; ⁵VA New York Harbor Health System, Brooklyn, NY; ⁶Wayne State University, Detroit Medical Center, Detroit, MI; ⁷Wayne State University School of Medicine, Detroit, MI; ⁸Department of Veterans Affairs, New Orleans, LA; ⁹John D. Dingell VA Medical Center, Detroit, MI; ¹⁰NYU Langone School of Medicine, New York, NY; ¹¹Tulane University, New Orleans, LA; ¹²Tulane University School of Medicine, New Orleans, LA; ¹³Southeast Louisiana Veterans Healthcare System, New Orleans, LA; ¹⁴NYU Langone/VA NY Harbor, New York, NY

Introduction: Digestive laboratory abnormalities related to COVID-19 have been previously described, but most reports came from single centers and findings have been conflicting. We conducted a multi-center study using data from three large urban VA centers (New York Harbor VA, New Orleans VA and Detroit VA) to examine the association between demographics and digestive laboratory values with mortality on index hospitalization among individuals diagnosed with COVID-19.

Methods: We manually extracted data on individuals hospitalized for COVID-19 between December 2019 and June 2020 at the three facilities. For this analysis, data on demographics and seven digestive laboratory values (highest AST, ALT, alkaline phosphatase, total bilirubin, and INR during admission, as well as lowest hemoglobin and platelets) were analyzed in relation to index hospitalization mortality. We performed descriptive statistics and conducted a multivariable logistic regression model.

Results: Out of a total of 390 individuals who were hospitalized with COVID-19, 168 (43%) died and 222 survived. The median age of patients who died was higher than those who survived (75 vs. 69 years). The vast majority (94%) of patients were male. Black patients accounted for a higher proportion of those who died than those who survived (61% vs. 55%), whereas the opposite was true for Whites (26% vs. 31%) and Hispanics (9% vs. 12%). In the multivariable model (Table), mortality was associated with older age (OR 1.07, 95% CI 1.03-1.10), higher BMI (OR 1.05, 95% CI 1.01-1.10), higher AST (OR 1.01, 95% CI 1.004-1.02), lower ALT (OR 0.99, 95% CI 0.98-0.996), higher alkaline phosphatase (OR 1.02, 95% CI 1.01-1.02), and lower hemoglobin (OR 0.83, 95% CI 0.72-0.97).

Discussion: In this multicenter VA study of patients hospitalized with COVID-19 during the first half of 2020, overall mortality was 43%. For mortality during index hospitalization, we observed a positive association with age, BMI, AST, and alkaline phosphatase, and an inverse association with ALT and hemoglobin. Every 1 unit increase in hemoglobin was associated with 17% decreased odds of death. These findings suggest that commonly used digestive laboratory tests have prognostic significance for COVID-related survival.

Variable	OR (95% CI )
Age	1.07 (1.03-1.10)
Sex
Male	Reference
Female	0.65 (0.09-4.72)
Race
White	Reference
Black	0.96 (0.47-1.97)
Asian	--a
AI/AN	--a
NH/PI	--a
Unknown	1.75 (0.48-6.39)
Declined to answer	1.24 (0.11-13.73)
Ethnicity
Hispanic	Reference
Not Hispanic	1.08 (0.40-2.95)
Unknown	--a
Declined to answer	1.13 (0.07-19.15)
BMI	1.05 (1.01-1.10)
AST (highest)	1.01 (1.004-1.02)
ALT (highest)	0.99 (0.98-0.996)
Alkaline Phosphatase (highest)	1.02 (1.01-1.02)
Total bilirubin (highest)	1.20 (0.71-2.02)
Hemoglobin (lowest)	0.83 (0.72-0.97)
Platelets (lowest)	1.00 (0.99-1.00)
INR (highest)	0.98 (0.66-1.45)

Table: Table-Predictors of Mortality During Index Hospitalization
AI/AN = Asian Indian/American Indian; NH/PI = Native Hawaiian/Pacific Islander
a=Suppressed, Unstable Estimate


Disclosures:
Manuel Martinez: Medtronic – Consultant.
Shinjini Nandi indicated no relevant financial relationships.
Rozina Haile indicated no relevant financial relationships.
Erik Anderson indicated no relevant financial relationships.
Mairin Joseph-Talreja indicated no relevant financial relationships.
Mona Trafalgar indicated no relevant financial relationships.
Jennifer Yudkevitch indicated no relevant financial relationships.
Yin Min Myat indicated no relevant financial relationships.
Ravi Anand indicated no relevant financial relationships.
Katherine Wong indicated no relevant financial relationships.
Henry Hefler indicated no relevant financial relationships.
Fadi Antaki indicated no relevant financial relationships.
Violeta Popov indicated no relevant financial relationships.
Molly Plummer indicated no relevant financial relationships.
Victoria Jackson indicated no relevant financial relationships.
Leela Nayak indicated no relevant financial relationships.
Peter Liang indicated no relevant financial relationships.


Manuel Martinez, MD, FACG¹, Shinjini Nandi, PhD², Rozina Haile, MD³, Erik L. Anderson, DO, PhD³, Mairin Joseph-Talreja, MD⁴, Mona T. Trafalgar, BSN, RN³, Jennifer Yudkevitch, MSc⁵, Yin Min Myat, BA⁵, Ravi K. Anand, MD⁶, Katherine Wong, MD⁷, Henry Hefler, MD, MS⁸, Fadi Antaki, MD⁹, Violeta Popov, MD, PhD¹⁰, Molly D. Plummer, MD¹¹, Victoria Jackson, MD¹², Leela Nayak, MD¹³, Peter S. Liang, MD, MPH¹⁴. P0720 - Demographic and Digestive Laboratory Characteristics Predict Mortality Among Hospitalized COVID-19 Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.