AB1327 COVID-19 CUTANEOUS AND SYSTEMIC MANIFESTATIONS AMONG DIFFERENT RACIAL GROUPS: A META-ANALYSIS

Abstract

BackgroundCOVID-19 cutaneous manifestations were first reported in February 2020, after a rash was listed as a sign of the virus.[1]In 2020, an article emphasized the absence of images among skin of color with respect to COVID-19 skin manifestations.[2]Without detection and treatment, individuals with skin of color may experience a disproportionate incidence of morbidity and mortality.[3]Discussion of cutaneous findings in skin of color remains limited to reviews and individual studies, and although there are meta-analyses that assess systemic manifestations among different races, investigation of various symptoms among people with skin of color, and overall comparison of systemic manifestations to cutaneous manifestations remains unreported to our knowledge.[4]ObjectivesThe objective of this meta-analysis was to quantify the frequency of reported cutaneous and systemic manifestations among different races.MethodsA search for studies on dermatologic and systemic manifestations associated with COVID-19 published before February 2022 was run on PubMed and Embase. Two independent reviewers screened abstracts and full manuscripts for eligibility based on the following criteria: studies included children or adult patients diagnosed with COVID-19 or temporal association to COVID-19, studies included assessment of cutaneous and systemic manifestations of individuals, studies identified cutaneous and systemic manifestations among different races, and studies were peer-reviewed case reports, original studies, systematic reviews, meta-analyses, and letters to the editor. Race and the most common systemic and dermatologic manifestations were extracted from included studies. Event rates for each outcome by race were pooled using a single-arm meta-analysis and the random-effects model to account for heterogeneity.ResultsSeventeen studies, involving 2,525 patients, were selected. Pooled estimates for multisystem inflammatory syndrome (MIS) for Black, White, and Asian cases were 28% (95% CI, 18.8-40.7, p=0.001), 40.1% (95% CI, 23.0-60.1, p=0.332), and 20% (95% CI, 13.2-29.2, p=0.000), respectively. The most common manifestations were pyrexia, elevated inflammatory markers, cardiac dysfunction, and gastrointestinal symptoms. The frequency of elevated inflammatory markers within Black cases surpassed White and Asian cases (30.9%, 28.7%, and 19.6%). The percentage of Black cases for cardiac dysfunction exceeded White and Asian cases (38.8%, 25%, and 21.2%,). The frequency of pyrexia reported among Asian and Black cases exceeded White cases (26.7%, 24.3%, and 15.3%). The prevalence of dermatologic manifestations in Black cases was 4.2% (95% CI, 0.8-19.8, p=0.000) compared to White and Asian cases, 70.7% (95% CI, 42.9-88.6, p=0.139) and 11.7% (95% CI, 9.0-15.1, p=0.000).ConclusionThis meta-analysis highlights the discordance in reporting systemic manifestations compared to dermatologic manifestations by race in COVID-19 patients. Further investigation is needed to determine the underlying cause.