Old Age, Number and Specific Comorbidities are Closely Related to Progression and Poor Prognosis in Patients with COVID-19

Abstract

Background— Some patients with comorbidities and rapid disease progression have a poor prognosis.Aim—In this study, we aimed to investigate the distribution characteristics of comorbidities and their relationship with disease progression and outcomes of COVID-19 patients.Methods— A total of 718 COVID-19 patients were divided into five clinical type groups and eight age-interval groups. The distribution characteristics of comorbidities were compared between the different clinical type groups and between the different age-interval groups, and their relationships with disease progression and outcomes of COVID-19 patients were assessed.Results—Approximately 88.62% (637/718) of the COVID-19 patients were twenty to fifty-nine years old. Approximately 65.73% (554/718) had one or more comorbidities, and common comorbidities included non-alcoholic fatty liver disease (NAFLD), hyperlipidaemia, hypertension, diabetes mellitus (DM), chronic hepatitis B (CHB), hyperuricaemia and gout. COVID-19 patients with comorbidities were older, especially those with chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). Hypertension, DM, COPD, chronic kidney disease (CKD) and CVD were mainly found in severe COVID-19 patients, and hypertension, CKD and CVD were primarily associated with those who died. Risk factors included the number of comorbidities and hyperlipidaemia for disease severity, age, the number of comorbidities, hyperlipidaemia, NAFLD and COPD for the virus negative conversion time, and the number of comorbidities and CKD for prognosis. Number of comorbidities played a predictive role in disease progression and outcomes.Conclusions—These findings provide a reference for clinicians to focus on the number and specific comorbidities in COVID-19 patients to predict disease progression and prognosis.Clinical Trial Registry: Chinese Clinical Trial Register ChiCTR2000034563

High Number and Specific Comorbidities Could Impact the Immune Response in COVID-19 Patients

“…Function alteration of specific T lymphocyte subsets (including regulatory T (Treg) cells) results in the hypothesis thatT2D autoimmunity was exacerbated by partial inflammation ( 30 ). Our previous study showed that the lowest lymphocyte counts, especially T and B subsets were found in patients with severe COVID-19 and DM ( 15 – 18 ). Previous study showed that obese diabetic subjects presented much higher levels of polyclonal activation and antibody secretion in B cell, with impaired ability to response to new antigens such as seasonal influenza vaccination.…”

“…Therefore, specific comorbidities associated with immunodeficiencies (including cancer, CHB, CKD, NAFLD, CVD and DM) often coexist with SARS-CoV-2 infection, which leads to host immune responses dysregulation and thus exacerbating already aggravated inflammatory processes. Patients with COVID-19 are more severe organ damage, more susceptible to bacterial infections and a poor prognosis ( 15 – 18 ).…”

“…A total of 783 subjects, including 55 healthy controls who were from the medical examination clinic ( 16 ) and 718 COVID-19 patients who were from the first and second hospital isolation wards ( 15 – 18 ), and these patients were presented at Public Health and Clinical Center of Chengdu from 16 January 2020 to 30 April 2021 ( Figure 1 ). The study was approved by the Ethics Committee of Public Health and Clinical Center of Chengdu (No.…”

“…Function alteration of specific T lymphocyte subsets (including regulatory T (Treg) cells) results in the hypothesis that T2DM autoimmunity was exacerbated by partial inflammation ( 25 – 30 ). Our previous study showed that the lowest lymphocyte counts, especially T and B subsets were found in patients with severe COVID-19 and DM ( 15 – 18 ).…”

“…As an important part of the dysfunction of regulating host immune response, what played an important role in the pathophysiology of COVID-19 ( 8 , 14 – 18 ), SARS ( 19 ), and MERS-CoV ( 20 )was the decline in cellular immune function. Host both innate and adaptive immune responses were altered due to SARS-COV-2 infection ( 21 ).…”