Becker's Clinical Quality & Infection Control

35 QUALITY IMPROVEMENT & MEASUREMENT Black COVID-19 patients face lower death risk than white patients after hospitalization, study finds By Erica Carbajal W hile Black patients were more likely to test positive for COVID-19 than white patients at NYU Langone Health last spring, they had a lower risk of death and severe illness aer hospitalization, according to a study published Dec. 4 in JAMA Network Open. Researchers evaluated EHR data for 9,722 patients tested for COVID-19 at the New York City-based health system between March 1 and April 8. More than 4,800 test- ed positive for COVID-19, of which 2,623 were hospitalized. Results showed Black patients were less likely to die or be discharged to hospice compared to white patients aer hospitaliza- tion and had a lower risk of critical illness. Results were fully adjusted for age, sex, in- surance status, comorbidities and neighbor- hood socioeconomic data. Aer adjustment, there were no significant differences in death risk between white patients and Hispanic and Asian patients. Asian patients were less likely to test positive for COVID-19, but more likely to be hospitalized compared to white patients. "We do see a bit of a paradox," said Joseph Ravenell, MD, study author and associ- ate professor at NYU Grossman School of Medicine's Department of Population Health. "In keeping with other research, we've found that once Black patients with COVID-19 make it to the hospital — despite coming from lower-income neighborhoods — their odds of dying are similar to or lower than white patients. Meanwhile, we also know that Black and Hispanic people are disproportionately contracting and dying of COVID-19 across the country." e findings indicate other structural factors such as poor housing conditions and unequal healthcare access may contribute to the higher numbers of out-of-hospital deaths in Hispanic and Black communities, and should be considered in future research, the study said. n New C. diff guidelines a boon to predicting patient death risk, study finds By Mackenzie Bean I n 2017, two organizations updated national guidelines for treating and diagnosing Clostridioides difficile infection. New research published in Open Forum Infectious Diseases vali- dates these guideline changes, suggesting they nearly doubled hospitals' ability to predict C. difficile mortality. The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America updated guidelines on assessing kidney damage caused by fluid loss in patients with severe C. difficile infections in 2017. They recommended using a single creatinine measure to determine kidney damage. To assess the benefits of the guideline change, researchers at the University of Houston studied the outcomes of 705 patients with C. difficile infections at several hospitals in the Houston area. Patients were evaluated and diagnosed using either the original or updated recommendations. Using the new single creatinine measurement to assess C. difficile severity was "fourfold more predictive in identifying patients likely to die during their hospitalization," study author Kevin Garey, PharmD, department chair of pharmacy practice and translational research at University of Houston's College of Pharmacy, said in a news release. "When combined with increased white blood cell count, another severity predictor, the newly revised severity predictor was two- fold better at predicting mortality," Dr. Garey said. n Global study confirms men at higher risk for COVID-19 complications, death By Erica Carbajal M en and women have a nearly equivalent risk of COVID-19 infection, but men are about 40 percent more likely to die, according to a large study published in Nature Communications Dec. 9. Researchers observed a "sex bias" in the study of more than 3 million COVID-19 cases through- out the world. A total of 90 reports spanning 46 countries and 44 U.S. states were analyzed. While researchers found similar proportions of COVID-19 infections between men and women, male patients were nearly three times more likely to require intensive care and had a 1.39 odds ratio for death. Previous studies have outlined immune response differences between men and women, indicat- ing a stronger antiviral response and increased immunity toward viral antigens in women, the study said. "Although further studies are needed, these data have implications for the clinical management of COVID-19 and highlight the importance of considering sex as a variable in fundamental and clinical research," researchers said. n

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