DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214409

COVID-19 disease and comorbidity: an outcome? A study on Indian population in a COVID care hospital

Namrata Makkar, Amit Singla, Ajeet Jain, Lalendra Upreti, B. L. Sherwal

Abstract


Background: The world has been severely affected by the novel coronavirus disease (Covid-19). Continuously rising number of cases has put a significant strain on healthcare resources of all countries of the world. Preliminary studies show that people suffering from comorbid conditions are at a relatively higher risk of severe disease and poor outcome.

Methods: We studied the risk of ICU admission in 152 Covid-19 positive patients with comorbidity compared to those without comorbid conditions. We studied effect of old age (>65 years), male sex, presence of at least one comorbidity, presence of multiple comorbidities, diabetes mellitus, hypertension, CAD, respiratory disease, neurological disease, skin disease, and hypothyroidism on outcome of coronavirus disease with two tailed Student’s t-test, odds ratio, Chi-square test was used to test significance of results at 95% confidence interval 95% (95% CI). Fisher’s test was also used if one expected value (row total × column total/grand total) was less than 5.

Results: In this study, 23 (15.13%) required ICU care. We found higher odds of ICU admission in Covid-19 patients in case of presence of comorbid condition (OR=7.3, 95% CI=2.674, 20.038), diabetes mellitus (OR=2.8, 95% CI=1.035, 8.028), hypertension (OR=1.3, 95% CI=0.396, 4.258), coronary artery disease (OR=2.3, 95% CI=0.430, 12.978) and malignancy (OR=6.5, 95% CI=1.516, 28.54). Case fatality rate (CFR) of those with comorbid conditions was higher (7.55) compared to those without comorbidity (3.03).

Conclusions: This study shows that presence of comorbid conditions in Covid-19 positive patients results in significantly higher risk of ICU admission and poor outcome.


Keywords


Comorbidity, Critical care, Death, Outcome

Full Text:

PDF

References


Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Bio Medica Atenei Parmensis. 2020;91(1):157-60.

WHO Covid-19 Situation Report Number 128. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200527-covid-19-sitrep-128.pdf?sfvrsn=11720c0a_2. Accessed on 10 May 2020.

Sun P, Qie S, Liu Z, Ren J, Xi JJ. Clinical characteristics of 50466 patients with 2019-nCoV infection. medRxiv. 2020.

Zangrillo A, Beretta L, Scandroglio AM, Monti G, Fominskiy E, Colombo S, et al. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Crit Care Resusc. 2020;22(3):200-11.

Hu Y, Sun J, Dai Z, Deng H, Li X, Huang Q, et al. Prevalence and severity of corona virus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Virol. 2020;127:104371.

Jing QL, Li YG, Ma MM, Gu YZ, Li K, Ma Y, et al. Contagiousness and secondary attack rate of 2019 novel coronavirus based on cluster epidemics of COVID-19 in Guangzhou. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(10):1623-6.

Li W, Zhang B, Lu J, Liu S, Chang Z, Cao P, et al. The characteristics of household transmission of COVID-19. Clin Infect Dis. 2020;71(8):1943-6.

Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: a nationwide analysis. Eur Respir J. 2020;2000547.

Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging. 2020;12(7):6049.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.

Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368.

Jain V, Yuan JM. Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection. Medrxiv. 2020.

Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524.

Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical and mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-25.

Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020;127:104378.

Revised National Clinical Management Guideline for COVID19. Ministry of Health and Family welfare. Available from: https://www.mohfw.gov.in/pdf/RevisedNationalClinicalManagementGuidelineforCOVID1931032020.pdf. Accessed on 10 May 2020.

Ventura MT, Casciaro M, Gangemi S, Buquicchio R. Immunosenescence in aging: between immune cells depletion and cytokines up-regulation. Clin Mol Allerg. 2017;15(1):1-8.

Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19. J Infect. 2020;80(6):607-13.

Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-74.

Chan‐Yeung M, Xu R. SARS: epidemiology. Respirology. 2003;8(1):S9-14.

Ahmed AE. The predictors of 3- and 30-day mortality in 660 MERS-CoV patients. BMC Infect Dis. 2017;17(1):1-8.

WHO. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. WHO. World Health Organization. Available from: https://www.who.int/csr/sars/country/table2004_04_21/en/. Accessed on 9 May 2020.

WHO. Middle East respiratory syndrome coronavirus (MERS-CoV). WHO. World Health Organization. Available from: http://www.who.int/emergencies/mers-cov/en/. Accessed on 9 May 2020.