Comorbidities for fatal outcome among the COVID-19 patients: A hospital-based case-control study

Abstract

Comorbidities for fatal outcome among the COVID-19 patients: A hospital-based case-control study Dear Editor, Since the discovery of coronavirus disease 2019 (COVID-19), there have been numerous evidences supporting the pathogenic role of chronic comorbidities in the prognosis of infections, including the study by Galloway et al., 1 however, with the extent of the risk remained controversial. 2-6 The existing univariate models do not adequately distinguish between risk due to age and that due to increased presence of co-morbidities in older patients, thus these assessments of real effect from comorbidities are inevitably confounded. Here by performing a retrospective multi-center study, we try to evaluate the adjusted effect of the common preexisting comorbidities on COVID-19 related death, based on which, the therapy effect of three widely used anti-hypertension drugs were assessed. From 18 January to 24 February 2020, 1138 confirmed COVID-19 patients consisting of 920 survivals and 218 deaths from three designated hospitals for COVID-19 treatment in Hubei province were included for analysis (Table S1). The presence of comorbidities was reported in 49.12% (559/1138) of the total patients, with significantly higher frequency in the deceased than in the survivals (77.06% vs. 42.50%, P < 0.001; Table S1). As a whole, hypertension was the most prevalent comorbidity (32.95%), followed by diabetes mellitus (DM, 15.64%) and chronic heart diseases (CHD, 9.31%). The chronic obstructive pulmonary diseases (COPD), malignancy, cerebrovascular diseases (CVD), chronic kidney diseases (CKD), and chronic viral hepatitis (CVH) were less frequent, with prevalence ranging from 2.11% to 6.41%. By multivariate logistic regression model adjusting age, sex, and delay from symptom onset to hospital admission, six comorbidities showed significant associations with the disease outcome, with malignancy exhibiting the highest risk of death, followed by CKD, CVD, hypertension, CHD, and DM (Fig. 1 A and Table S2). An age-stratified analysis revealed the effect of comorbidities on death was reduced as the age increased. Among the patients ≤60 years, CVD had the highest effect on death, followed by hypertension. Among the patients aged 60-70 years, only malignancy and DM were related to fatal outcome. Among the patients aged > 70 years, none of the eight comorbidities demonstrated the significant association with fatal outcome. The sex-stratified analysis disclosed that male patients presenting with any of the three comorbidities (hypertension, DM, or CVD) had an increased risk of developing fatal outcome, in contrast, female patients presenting any of the four comorbidities (CHD, COPD, malignancy, or CKD) had an increased risk of fatal outcome (Table S3).

Calcium channel blocker amlodipine besylate therapy is associated with reduced case fatality rate of COVID-19 patients with hypertension

“…These results together suggest that CCBs, such as amlodipine besylate, may be effective drug options for treating COVID-19 patients who have hypertension as the comorbidity. The benefit of CCBs on COVID-19 patients with hypertension was also observed by other research groups [35][36][37] . Meanwhile, we cannot ignore the limitation of the small sample size, and loss of information regarding biomarkers of cardiac damage, lung echography, and IL6 level in patients in the current study; therefore, further studies including larger sample size are needed to confirm the efficacy of CCBs in treating COVID-19 patients who have hypertension as the comorbidity.…”

COVID-19 and the World with Co-Morbidities of Heart Disease, Hypertension and Diabetes

“…Some patients having SARS-CoV-2 infection exhibited CVD problems 27 and heart diseases as co-morbidities along with COVID-19 which influence prognosis and fatal outcomes during this ongoing pandemic 20 . Individuals who have suffered from heart failure (HF) are at higher risk of getting gripped by infections, which precipitate acute HF and increases mortality rates in such patients.…”

“…However, the COVID-19 is indiscriminately affecting everyone; the co-morbidities are being suspected to pose a higher risk for decreasing the survival rate of the SARS-CoV-2 affected individuals. Various kinds of pee-existing diseases have been identified as co-morbidities in SARS-CoV-2 infection, which increases susceptibility, pose risks of more severity outcomes and deaths in COVID-19 patients by modulating virus-host interactions and host-immune responses, and also have some agedependent effects [16][17][18][19][20] . These include hypertension, diabetes, heart disease, chronic lung, kidney and liver diseases, malignancies, pro-inflammatory and pro-coagulative states, cerebrovascular diseases, smoking and others.…”

“…The two life style associated conditions of overweight and obesity are identified as potential risks factors towards contributing to severe illness associated in COVID-19 patients 18,21 . The most common co-morbidities that have been identified with SARS-CoV-2 infection are heart diseases, hypertension, and diabetes 20,[22][23][24][25] , which are the commonly found clinical conditions worldwide. Presence of diabetes and hypertension were found to be associated with a 2-fold while CVDs were associated with 3-fold increased requirement of intensive care and greater risk of severe disease, suggesting the importance of these co-morbidities as prognostic markers 23 .…”

Therapeutic Intervention of COVID-19 by Natural Products: A Population-Specific Survey Directed Approach

“…COVID-19 and population health are often linked by the comorbidities among certain populations. Studies show that patient populations with comorbidities suffer much worse outcomes than patients with no comorbidities [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Most common comorbidities among COVID-19 patients are hypertension and diabetes [ 72 , 73 , 74 , 75 , 76 , 77 ].…”