Impact of Comorbidity on Mortality in COVID-19 Patients: A Single- Center Retrospective Study

Impact of Comorbidity on Mortality in COVID-19 Patients: A Single- Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Comorbidity on Mortality in COVID-19 Patients: A Single- Center Retrospective Study Nuha Al-aghbari, Arif Maldar, Mubashir Angolkar, Romana Khurseed This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4161548/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The global spread of COVID-19 has had a profound impact on human health, with millions of people infected and a significant death. Comorbidities play a pivotal role in the prognosis of COVID-19 patients. The aim of this study was to assess the impact of the comorbidity on mortality in COVID-19 patients in a Single-Centre Retrospective Study. The characteristics and results of patients with COVID-19 admitted to KLE's Hospital in Belgaum, Karnataka, India, were examined through retrospective research. 642 participants having COVID-19 diagnoses between October 1, 2020, and September 30, 2021 were enrolled in the research. Data such as, patients' clinical features, vital signs, demographic information and patients' outcomes (survived or deceased) were collected. The findings of this study showed that out of 642 patients, 256 patients had co morbidities, 62.8% of them had poly morbidity and most prevalent underlying medical conditions were hypertension, diabetes, and heart disease which affected 30.7%, 29.1, and 7.9%, respectively. Only diabetes and renal disease reported strong associations (P.value: 0.011, aOR: 1.852 95% CI: 1.148–2.988), (p.value: 0.000, aOR: 6.491 (95% CI: 2.613–16.124), respectively. Furthermore, Comorbidities such kidney disease, and diabetes mellitus can lead to more serious complications and death in COVID-19 patients. Understanding the impact of these comorbidities on COVID-19 mortality is essential for more effective patient care and resource allocation. COVID-19 Comorbidity Mortality India retrospective Introduction CoVID-19, a virus that has taken the world by storm, was deemed a global health emergency by the World Health Organization and in March 2020 by August 2022, it had infected over 600 million people and killed more than 6 million. But humanity has not given up. There have been advances in the development of COVID-19 treatments and vaccines., offering a glimmer of hope in the fight against this deadly virus.( 1 ) COVID-19 is a highly contagious respiratory illness that has quickly spread around the world since it first appeared in China in late 2019.. ( 2 ) The causative agent is a novel coronavirus named SARS-CoV-2 that can cause a range of symptoms, including problems with the upper respiratory tract, such as the nose and throat.( 3 ) It is a new RNA coronavirus that can spread from person to person, both in healthcare settings and in communities.( 4 ) Coronaviruses are a diverse family of viruses that can infect a wide range of hosts, including animals and humans. There are four main types of coronaviruses, but only two of them, alpha and beta coronaviruses, have been shown to cause disease in animals. Beta coronaviruses are also responsible for two major outbreaks in humans in the last two decades: SARS in 2003 and MERS in 2012.( 3 ) It Can present with a variety of signs and symptoms, from simple to complex. Many people with COVID-19 pneumonia need to be hospitalized.( 5 ) Most people with COVID-19 experience a fever, muscle aches, fatigue, and a dry cough. While majority of the patients are expected to have a good outcome. Individuals who are older and have chronic medical problems may have a worse prognosis. Within a week of symptom onset, severely ill patients may develop difficulty breathing and low oxygen levels in the blood. This can quickly progress to acute respiratory distress syndrome (ARDS) or failure of other vital organs. ( 6 ) Some COVID-19 patients require hospitalization, while others need intensive care. Unfortunately, some patients may die from the disease. When COVID-19 cases rise, it is essential to identify people who are most likely to get very sick so that healthcare providers can focus on helping those who are most in need. Healthcare resources can be allocated efficiently and patient outcomes can be improved.( 1 ) Determining what makes COVID-19 more serious is essential for managing resources effectively, especially during a pandemic.( 7 ) Comorbidities, or underlying health conditions, are one of the most concerning clinical factors among patients with COVID-19. People with comorbidities are more likely to have severe outcomes, require more complex care, and incur higher healthcare costs. Researchers must identify optimal local solutions that are aligned with current national guidelines. ( 8 ) People who are older and have other health problems or a compromised immune system are more likely to get sick from COVID-19. During the pandemic, healthcare systems have often been overwhelmed by the growing number of infected cases.( 2 ) COVID-19 can be a ruthless adversary especially for those with underlying health conditions such as HTN, DM, and cardiovascular diseases. These conditions can make the virus more likely to cause severe illness, hospitalization, and even death.( 9 ) Blood pressure that is consistently too high, also known as hypertension, is a very widespread long-term medical condition the world. In 2010, high blood pressure affected over one-third of adults (1.39 billion people) around the world.( 7 ) It can damage the heart and blood vessels, making them more susceptible to the virus. Diabetes can impair the immune system's ability to fight off infection, making it more difficult to fight off infection. Cardiovascular diseases, such as heart disease and stroke, can also impair the body's ability to respond to COVID-19. ( 9 ) Hypertension and COVID-19 severity may be related to the angiotensin-converting enzyme 2 (ACE2) protein. The spike protein of SARS-CoV-2 binds to ACE2, which can lead to a decrease in the amount and activity of ACE2.( 11 ) Diabetes patients are more likely to get sick from COVID-19 and have serious complications. COVID-19 also disrupts health care and lifestyle factors, which can also make DM patients sick. It is important to understand these risks and how to reduce them, both now and in the future. This will help DM patients to make informed decisions about their health either before or after COVID-19 pandemic.( 12 ) COVID-19 appears to be a contributing factor in the cardiovascular complications, like arrhythmias, myocardial injury, venous thromboembolism, and acute coronary syndrome. ( 13 ) While COPD, a chronic lung disease that causes obstructed airflow and inflammation, progresses over time, has not been definitively linked to an increased risk of contracting COVID-19 independent of established risk factors, there is growing concern regarding its potential to exacerbate clinical outcomes in those diagnosed with the virus..( 14 ) Also Thyroid hormones and immune-regulatory molecules play pivotal role in the complex interplay between the viral infection and thyroid gland disorder. Viruses, along with the resulting inflammatory and immunological reactions, can have a significant impact on thyroid function. Because thyroid hormones affect many parts of the body, including the heart and lungs, thyroid function may have a direct impact on the severity and progression of COVID-19.( 15 ) Diabetes and Hypertension are most common chronic diseases worldwide, and they are also known to be one of the factors for more severe COVID-19 infection and death. However, the exact impact of these comorbidities on COVID-19 mortality is still not fully understood.16) there is still a gap in the literature regarding impact of specific comorbidities on COVID-19 mortality.( 17 ) This study aims to address these gaps in the literature by investigating the impact of specific comorbidities on COVID-19 mortality in a single-center retrospective study. The results of this research will give us important insights that can help us make better clinical decisions and develop public health measures to lower the fatality rate of COVID-19 in patients with underlying health conditions. Materials and Method 2.1. Study design, population and setting This retrospective records-based study was carried out at KLE Prabhakar Kore Hospital & MRC in Belgaum, Karnataka, India. It included all Individuals with COVID-19 who were hospitalized during the period between October 1, 2020, and September 30, 2021. COVID-19 positivity was confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR) or rapid antigen test (RAT) of a nose or throat swab sample. Only participants who had complete medical records were included in the study. Patients without complete electronic records were excluded. Consent to participate was not sought because this was a retrospective study. 2.2. Data Collection A pre-designed structured questionnaire was used to collect demographic information (age, gender, duration of stay) and clinical features (signs and symptoms, patient comorbidities, and outcomes [survivors and deceased]) at the hospital level. 2.3. Statistical analysis Data analysis was performed using IBM SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA)., the study reported the categorical variables as frequencies and percentages, and the continuous variables as median and interquartile range (IQR) for non-normally distributed data. They used the chi-square test to compare the categorical variables. was done to see whether there were any differences or association between the independent variables and the outcome for deceased characteristics patients. However, multi logistic regression used to analyze the comorbidities with COVI-19 mortality. At a p-value of 0.05, differences and relationships were considered as statistically significant. Results 3.1. Baseline participant characteristics Table (1) shows that more than two-thirds were male patients made up 69.2% of the COVID-19 patient population and the majority of patients were over 53 years old (51.9%), with median age was 54 years. Most patients were hospitalized for less than a week (50.8%), with a median hospitalization length of 6 days. The three most common clinical symptoms were shortness of breath (dyspnea), fever, and neurological problems, which affected 52.2%, 47.4%, and 29.1% of patients, respectively. Out of 642 patients, 256, had comorbidities and 62.8% of those patients had poly morbidity. The most frequent underlying medical conditions were hypertension, diabetes mellites, and heart disease which affected 30.7%, 29.1, and 7.9%. The average temperature of the patients was 98.4 °F (36.9 °C), with a range of 92.9–101 °F (34.4–38.3 °C). The patient's blood pressure was at its highest point at 250/130 mm Hg. The pulse rate median was 88 beats per minute (BPM), with a range of 36–180 BPM. The respiratory rate median was 24 breaths per minute, with a range of 18–56 breaths per minute. The oxygen saturation of blood median was 95%, with a range of 30–100%. In addition, blood glucose median level was 144.5 mg/dl (8.0 mmol/L), with a range of 36-644 mg/dl. Furthermore, the majority of COVID-19 patients survived (77.1%). 3.2 Demographic and clinical features of deceased COVID-19 Table (2) shows that the majority who died were males (23.4%) with age ≥53 years (29.1%) and stayed in hospital ≤ 6 days (23%). Decease was significantly associated with the age, having a significantly higher prevalence (p = 0.001) in patients aged 53 and over than in those younger than 53. However, there is no statically differences with gender and period of hospitalization. The majority of decease patients were suffering from dyspnea (30.1%), chest pain (24.0%) and fever (23.4%). Decease was significantly associated with the patients who were suffering from dyspnea, (p.value = 0.000) compared to those who survived. Table (3) shows that the study further identified 161 (or 62.9%) COVID-19 patients with two or more underlying health conditions, suggesting that COVID-19 patients with multiple underlying health conditions (32.9%) are more likely to die from the virus than those with a single underlying health condition (25.6%). COVID-19 patients with two or more underlying health conditions were older (average age 62.2 years) and predominantly male (68.3%),were more likely to have dyspnea, fever and neurological disorder. (44.7%, 36.7% and 27.9%), respectively, when compared to patients with no comorbidities Table (4) shows that varying degrees of association between different underlying health conditions and death from COVID-19. While some comorbidities like diabetes and renal disease show strong associations (P.value: 0.011, aOR: 1.852 95% CI: 1.148-2.988), (P.value: 0.000, aOR: 6.491 (95% CI: 2.613-16.124), respectively. Others like hypertension, thyroid disease, cardiac diseases, pulmonary disease, liver diseases, and hematological disorders do not show statistically significant associations in study population. The odds ratio in HTN and pulmonary diseases is greater than 1, which suggests that people with HTN and pulmonary diseases may be slightly more likely to die from COVID-19 than people without. Discussion COVID-19 is an expanding pandemic that has resulted in countless cases and deaths worldwide.(2) A new study on SARS-CoV-2 has found that comorbidities amplify the risk of death in COVID-19 patients.(19) (20) While there has been a great deal of study related to the impact of underlying health conditions on death in COVID-19 patient, there are still some gaps in our understanding about the influence of interactions between multiple comorbidities on mortality among individual with COVID-19. While the majority of COVID-19 patients in this study were male, there was no statistically significant difference in death rates between males and females. Similar findings have been reported in other studies. (4,21,22) However, some studies have found that the predominant number of COVID-19 patients were female and this is maybe because this study used propensity score matching to control for potential confounding variables. This means that the researchers compared men and women who were similar in terms of their age, ethnicity, and other factors that could stimulate COVID-19 infection risk. Other studies may not have used propensity score matching, which could have led to biased results.(23) The age distribution of the patients in this study was consistent with that of a study conducted in China, with the majority of patients being aged 53 or older.(4) Also study conducted in Egypt showed the majority between 60-79 years and has statically significant with presence of comorbidities. (8) On the other hand, other study conducted in China showed that the majority were between 15-49 years. (4) Compared to a study in China where half of the patients stayed in the hospital for 7 to 13 days, (24) most patients in this study were hospitalized for less than 6 days. This maybe due to the healthcare systems or type of the study design. While the commonest symptoms among the patients in this study were dyspnoea, fever, and neurological problems., cough and fever are the most common symptoms of COVID-19 in China, according to a study.(4) (21) also similar findings were found in Egypt. (8) Long-term health conditions such as high blood pressure, diabetes, lung diseases, and heart diseases, as well as the conditions that lead up to them, may be more likely to get COVID-19. Chronic diseases and infectious diseases share several common characteristics, such as a proinflammatory state and a weakened innate immune response.(25) Diabetes is a key element in predicting negative consequences.(18) A systematic analysis of five studies about COVID-19 reported that , A total of 17.1% of the participants had high blood pressure, 16.4% had heart disease, and 9.7% had diabetes. (18) However, the most common prevalent medical conditions in this study were hypertension, diabetes, and heart disease which affected 30.7%, 29.1, and 7.9%. Of the various comorbidities investigated in this study, only DM, and renal disease were found to be statistically significantly associated with death. This association maybe due to the accumulation of activated innate immune cells in metabolic tissues can contribute to the development of diabetes so these cells produce inflammatory mediators, which can disrupt insulin sensitivity and harm beta cells. Metabolic disorders can also impair the function of immune cells, making people more vulnerable to disease complications.(25) (21) Similar findings were found in meta-analysis study that revealed that the diabetic prevalence is lower in individual with COVID-19 who survive the illness than in those who do not. However, the prevalence of diabetes did not differ significantly between ICU and non-ICU patients. Additionally, The study found that people with diabetes were more likely to have severe COVID-19, meaning that patients with diabetes had a greater chance of getting severe COVID-19 illness.(19) In addition reseraches have shown that underlying health conditions, such as heart disease and diabetes, are associated with higher mortality rates from SARS-CoV. In fact, heart disease and diabetes can double the risk of death. (18) On the other hand, this study's results indicate that heart disease is not associated with an increased risk of death. The use of ACE inhibitors and ARBs for the treatment of hypertension can cause cells to produce more ACE2 receptors. As a result, patients with hypertension who are taking ACE inhibitors or ARBs may be more susceptible to infection with COVID-19.This is because the increased expression of ACE2 on the surface of cells can provide more entry points for the virus.(19) Individuals with pre-existing cardiovascular or metabolic disorders may be at an elevated risk of contracting COVID-19, and these conditions can also have a detrimental effect on the progression and outcome of pneumonia.(18) Patients with kidney have an increased risk of death from COVID-19 in the hospital.(24) The virus may enter kidney cells through receptors known as ACE2, which are produced in large amount in the kidney. This can lead to direct damage to kidney cells. Immune complexes, which are formed when antibodies bind to antigens, can be deposited in the kidney. This can cause inflammation and damage to kidney tissue. Cytokines and other mediators produced by the immune system can have indirect effects on the kidney. For example, hypoxia (low oxygen levels), shock, and rhabdomyolysis (muscle breakdown) can all damage the kidney. (24) Because the virus primarily targets the respiratory tract. In people with chronic pulmonary diseases, COVID-19 can lead to increased bronchospasm (narrowing of the airways), lung inflammation, and acute respiratory distress syndrome (ARDS).(26) In this study, patients with kidney diseases had the highest mortality rate (65.2%) among all the comorbid conditions, followed by pulmonary disease (33.3%) and diabetes mellitus (32.6%). These findings agree with previous research. which has shown that people with chronic kidney disease (CKD) are more likely to die from COVID-19.(8) This study found that individuals with poly comorbidities were more likely to have a fatal outcome from COVID-19 than those with a mono comorbidity.. This is consistent with other studies that have shown that patients with multiple comorbidities are more likely to have poorer health outcomes. The findings of this study suggest that the number and type of comorbidities should be considered when predicting the prognosis of patients with COVID-19.(20) People with multiple underlying health conditions, such as diabetes and kidney disease, are more likely to get a severe case of COVID-19 and have complications. Therefore, they should be closely monitored for signs and symptoms of COVID-19 and hospitalized early if infected. Clinicians should also be aware of potential interactions between COVID-19 treatments and medications used to treat comorbidities. Limitation of the study A single tertiary hospital conducted the study. The findings could not be generalized to other areas both inside and outside of India. Since this study was retrospective in nature, we used secondary data to carry it out. Some additional variables such as type of DM and HbA1c level could not be explored since it was based on patient medical information and was retrospective research. Conclusion In conclusion, our study has shed light on the impact of comorbidities, such as hypertension, diabetes mellitus, and renal disease, on COVID-19 mortality. It contributes to our understanding of the interplay between comorbidities and COVID-19 outcomes, providing valuable insights for healthcare professionals and policymakers. By recognizing the influence of specific comorbidities, healthcare systems can better tailor their responses to protect and treat the populations who are disproportionately affected by COVID-19. Recommendation Based on findings and conclusions of this research, it is recommended to: Further research: Additional more research is necessary to elucidate the underlying processes and mechanisms. by which hypertension, kidney disease, and diabetes mellitus increase COVID-19 mortality. This research could lead to the development of more targeted treatment and prevention strategies for these patients. Also design clinical practice guidelines: Clinical practice guidelines should be developed to inform the management of COVID-19 in patients with hypertensive disease, kidney disease, and diabetes. These guidelines should be based on the latest evidence and should be updated regularly as new information emerges. Declarations Approval for the study was obtained from the Human Ethics Committee (I.H. E.C.) of KLE Higher Education and Research Academy, JNMC, Belagavi (Reference number: MDC/DOME/243) with a waiver of consent. Consent to use their data was obtained from the Clinical Services Manager, the Medical Director and Chief Executive Officer of KLE Hospital, and the Medical Records Department (MRD). All personal identifiers were tagged and anonymized to ensure privacy and confidentiality. Conflict of Interest This research was carried out without any commercial or financial relationships that could be interpreted as a possible conflict of interest. Author Contributions All authors made significant contributions to all aspects of the study, from its conception and design to the acquisition and analysis of the data, the interpretation of the results, and the writing of the manuscript. Funding None Acknowledgments The Dr. Prabhakar Kore Hospital & Medical Research Center at KLE is gratefully acknowledged by the authors for its support in patient identification and data extraction. Consent of publication Not applicable References Kim J, Park SH, Kim JM. Effect of Comorbidities on the Infection Rate and Severity of COVID-19: Nationwide Cohort Study With Propensity Score Matching. JMIR Public Health Surveill. 2022 Nov 18;8(11):e35025. Al-Aghbari N, Maldar A, Angolkar M, Khurseed R, Shrestha S, Saikam P. Inflammatory Markers for Prognosis of COVID-19 Mortality in Hospitalized Indian Patients: A Single-Center Retrospective Study. UST J Med Sci [Internet]. 2023 Jun 12 [cited 2023 Oct 11];1(1). 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Available from: http://medrxiv.org/lookup/doi/10.1101/2020.02.18.20023242 Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. International Journal of Infectious Diseases. 2020 May;94:91–5. CDC. Coronavirus (COVID-19): symptoms of coronavirus: Centers for Disease Control and Prevention;2020 [Internet]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/ Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4161548","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284504506,"identity":"1c4876cf-2b8c-4814-a4e7-876d0ccaf9a7","order_by":0,"name":"Nuha Al-aghbari","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYFACHgYGyX82cmAG8Vos2NKMSdRSwXY4sYFoLebsvQc/3OBhTt9w/OzBBx8Y7OR0Gwhosew5lyw5Q4Itd8OZvGTDGQzJxmYHCGgxuJFjIC1hwJO74UCOmTQPw4HEbURoMf79J0Ei3eD8G+K1mElIHDBIADGI1HLmjJmFZEOC4cwbb4wNZxgQ45fjPcY3JBv+y/OdzzF88KHCTo6gFjhQAKs0IFY5CMg3kKJ6FIyCUTAKRhQAADMoQerioPj4AAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Nuha","middleName":"","lastName":"Al-aghbari","suffix":""},{"id":284504507,"identity":"67e1f921-98d8-42bd-946d-c2dde2998bd5","order_by":1,"name":"Arif Maldar","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Arif","middleName":"","lastName":"Maldar","suffix":""},{"id":284504510,"identity":"1935ee57-1b86-42e7-9b61-a39db21aa322","order_by":2,"name":"Mubashir Angolkar","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mubashir","middleName":"","lastName":"Angolkar","suffix":""},{"id":284504511,"identity":"1449c5dc-092e-4564-9623-301c215a6fe8","order_by":3,"name":"Romana Khurseed","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Romana","middleName":"","lastName":"Khurseed","suffix":""}],"badges":[],"createdAt":"2024-03-25 07:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4161548/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4161548/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57011109,"identity":"de6c9725-b6ed-4ad8-a93e-d6d3240e814c","added_by":"auto","created_at":"2024-05-23 11:23:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":284484,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4161548/v1/74fda721-d52a-4bb7-b612-a25ce19ba6d0.pdf"},{"id":53955800,"identity":"641d4d31-6edc-4e73-881e-06c22d473236","added_by":"auto","created_at":"2024-04-02 17:11:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":37687,"visible":true,"origin":"","legend":"","description":"","filename":"Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-4161548/v1/6a6fb51b100f9e9fee0227ce.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Comorbidity on Mortality in COVID-19 Patients: A Single- Center Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCoVID-19, a virus that has taken the world by storm, was deemed a global health emergency by the World Health Organization and in March 2020 by August 2022, it had infected over 600\u0026nbsp;million people and killed more than 6\u0026nbsp;million. But humanity has not given up. There have been advances in the development of COVID-19 treatments and vaccines., offering a glimmer of hope in the fight against this deadly virus.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCOVID-19 is a highly contagious respiratory illness that has quickly spread around the world since it first appeared in China in late 2019.. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The causative agent is a novel coronavirus named SARS-CoV-2 that can cause a range of symptoms, including problems with the upper respiratory tract, such as the nose and throat.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIt is a new RNA coronavirus that can spread from person to person, both in healthcare settings and in communities.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Coronaviruses are a diverse family of viruses that can infect a wide range of hosts, including animals and humans. There are four main types of coronaviruses, but only two of them, alpha and beta coronaviruses, have been shown to cause disease in animals. Beta coronaviruses are also responsible for two major outbreaks in humans in the last two decades: SARS in 2003 and MERS in 2012.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIt Can present with a variety of signs and symptoms, from simple to complex. Many people with COVID-19 pneumonia need to be hospitalized.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Most people with COVID-19 experience a fever, muscle aches, fatigue, and a dry cough. While majority of the patients are expected to have a good outcome. Individuals who are older and have chronic medical problems may have a worse prognosis. Within a week of symptom onset, severely ill patients may develop difficulty breathing and low oxygen levels in the blood. This can quickly progress to acute respiratory distress syndrome (ARDS) or failure of other vital organs. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Some COVID-19 patients require hospitalization, while others need intensive care. Unfortunately, some patients may die from the disease. When COVID-19 cases rise, it is essential to identify people who are most likely to get very sick so that healthcare providers can focus on helping those who are most in need.\u003c/p\u003e \u003cp\u003eHealthcare resources can be allocated efficiently and patient outcomes can be improved.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Determining what makes COVID-19 more serious is essential for managing resources effectively, especially during a pandemic.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Comorbidities, or underlying health conditions, are one of the most concerning clinical factors among patients with COVID-19. People with comorbidities are more likely to have severe outcomes, require more complex care, and incur higher healthcare costs. Researchers must identify optimal local solutions that are aligned with current national guidelines. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePeople who are older and have other health problems or a compromised immune system are more likely to get sick from COVID-19. During the pandemic, healthcare systems have often been overwhelmed by the growing number of infected cases.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) COVID-19 can be a ruthless adversary especially for those with underlying health conditions such as HTN, DM, and cardiovascular diseases. These conditions can make the virus more likely to cause severe illness, hospitalization, and even death.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eBlood pressure that is consistently too high, also known as hypertension, is a very widespread long-term medical condition the world. In 2010, high blood pressure affected over one-third of adults (1.39\u0026nbsp;billion people) around the world.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) It can damage the heart and blood vessels, making them more susceptible to the virus. Diabetes can impair the immune system's ability to fight off infection, making it more difficult to fight off infection. Cardiovascular diseases, such as heart disease and stroke, can also impair the body's ability to respond to COVID-19. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Hypertension and COVID-19 severity may be related to the angiotensin-converting enzyme 2 (ACE2) protein. The spike protein of SARS-CoV-2 binds to ACE2, which can lead to a decrease in the amount and activity of ACE2.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDiabetes patients are more likely to get sick from COVID-19 and have serious complications. COVID-19 also disrupts health care and lifestyle factors, which can also make DM patients sick. It is important to understand these risks and how to reduce them, both now and in the future. This will help DM patients to make informed decisions about their health either before or after COVID-19 pandemic.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCOVID-19 appears to be a contributing factor in the cardiovascular complications, like arrhythmias, myocardial injury, venous thromboembolism, and acute coronary syndrome. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) While COPD, a chronic lung disease that causes obstructed airflow and inflammation, progresses over time, has not been definitively linked to an increased risk of contracting COVID-19 independent of established risk factors, there is growing concern regarding its potential to exacerbate clinical outcomes in those diagnosed with the virus..(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Also Thyroid hormones and immune-regulatory molecules play pivotal role in the complex interplay between the viral infection and thyroid gland disorder. Viruses, along with the resulting inflammatory and immunological reactions, can have a significant impact on thyroid function. Because thyroid hormones affect many parts of the body, including the heart and lungs, thyroid function may have a direct impact on the severity and progression of COVID-19.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDiabetes and Hypertension are most common chronic diseases worldwide, and they are also known to be one of the factors for more severe COVID-19 infection and death. However, the exact impact of these comorbidities on COVID-19 mortality is still not fully understood.16) there is still a gap in the literature regarding impact of specific comorbidities on COVID-19 mortality.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) This study aims to address these gaps in the literature by investigating the impact of specific comorbidities on COVID-19 mortality in a single-center retrospective study. The results of this research will give us important insights that can help us make better clinical decisions and develop public health measures to lower the fatality rate of COVID-19 in patients with underlying health conditions.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study design, population and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective records-based study was carried out at KLE Prabhakar Kore Hospital \u0026amp; MRC in Belgaum, Karnataka, India.\u0026nbsp;It\u0026nbsp;included all Individuals with COVID-19 who were hospitalized during the period between\u003c/p\u003e\n\u003cp\u003eOctober 1, 2020, and September 30, 2021. COVID-19 positivity was confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR) or rapid antigen test (RAT) of a nose or throat swab sample. Only participants who had complete medical records were included in the study. Patients without complete electronic records were excluded. Consent to participate was not sought because this was a retrospective study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003epre-designed structured questionnaire was used to collect demographic\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003einformation (age, gender, duration of stay) and clinical features (signs and\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003esymptoms, patient comorbidities, and outcomes [survivors and\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003edeceased]) at the hospital level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using IBM SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA)., the study reported the categorical variables as frequencies and percentages, and the continuous variables as median and interquartile range (IQR) for non-normally distributed data. They used the chi-square test to compare the categorical variables. was done to see whether there were any differences or association between the independent variables and the outcome for deceased characteristics patients. However, multi logistic regression used to analyze the comorbidities with COVI-19 mortality. At a p-value of 0.05, differences and relationships were considered as statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e3.1. Baseline participant characteristics\u003c/p\u003e\n\u003cp\u003eTable (1) shows that more than two-thirds were male patients made up 69.2% of the COVID-19 patient population and the majority of patients were over 53 years old (51.9%), with median age was 54 years. Most patients were hospitalized for less than a week (50.8%), with a median hospitalization length of 6 days. The three most common clinical symptoms were shortness of breath (dyspnea), fever, and neurological problems, which affected 52.2%, 47.4%, and 29.1% of patients, respectively. Out of 642 patients, 256, had comorbidities and 62.8% of those patients had poly morbidity. \u0026nbsp;The most frequent underlying medical conditions were hypertension, diabetes mellites, and heart disease which affected 30.7%, 29.1, and 7.9%. The average temperature of the patients was 98.4 \u0026deg;F (36.9 \u0026deg;C), with a range of 92.9\u0026ndash;101 \u0026deg;F (34.4\u0026ndash;38.3 \u0026deg;C). The patient\u0026apos;s blood pressure was at its highest point at 250/130 mm Hg.\u0026nbsp;The pulse rate median was 88 beats per minute (BPM), with a range of 36\u0026ndash;180 BPM. The respiratory rate median was 24 breaths per minute, with a range of 18\u0026ndash;56 breaths per minute. The oxygen saturation of blood median was 95%, with a range of 30\u0026ndash;100%. In addition, blood glucose median level was 144.5 mg/dl (8.0 mmol/L), with a range of 36-644 mg/dl. Furthermore, the majority of COVID-19 patients survived (77.1%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2 Demographic and clinical features of deceased COVID-19\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable (2) shows that the majority who died were males (23.4%) with age \u0026ge;53 years (29.1%) and stayed in hospital \u0026le; 6 days (23%). Decease was significantly associated with the age, having a significantly higher prevalence (p = 0.001) in patients aged 53 and over than in those younger than 53. However, there is no statically differences with gender and period of hospitalization. The majority of decease patients were suffering from dyspnea (30.1%), chest pain (24.0%) and fever (23.4%). Decease was significantly associated with the patients who were suffering from dyspnea, (p.value = 0.000) compared to those who survived.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable (3) shows that the study further identified 161 (or 62.9%) COVID-19 patients with two or more underlying health conditions, suggesting that COVID-19 patients with multiple underlying health conditions (32.9%) are more likely to die from the virus than those with a single underlying health condition (25.6%).\u003c/p\u003e\n\u003cp\u003eCOVID-19 patients with two or more underlying health conditions were older (average age 62.2 years) and predominantly male (68.3%),were more likely to have dyspnea, fever and neurological disorder. (44.7%, 36.7% and 27.9%), respectively, when compared to patients with no comorbidities\u003c/p\u003e\n\u003cp\u003eTable (4) shows that varying degrees of association between different underlying health conditions and death from COVID-19. While some comorbidities like diabetes and renal disease show strong associations (P.value: 0.011, aOR: 1.852 95% CI: 1.148-2.988), (P.value: 0.000, aOR: 6.491 (95% CI: 2.613-16.124), respectively. Others like hypertension, thyroid disease, cardiac diseases, pulmonary disease, liver diseases, and hematological disorders do not show statistically significant associations in study population. The odds ratio in HTN and pulmonary diseases is greater than 1, which suggests that people with HTN and pulmonary diseases may be slightly more likely to die from COVID-19 than people without.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCOVID-19 is an expanding pandemic that has resulted in countless cases and deaths worldwide.(2)\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eA new study on SARS-CoV-2 has found that comorbidities amplify the risk of death in COVID-19 patients.(19)\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(20)\u0026nbsp;While there has been a great deal of study related to the impact of underlying health conditions on death in COVID-19 patient, there are still some gaps in our understanding about the influence of interactions between multiple comorbidities on mortality among individual \u0026nbsp;with COVID-19.\u003c/p\u003e\n\u003cp\u003eWhile the majority of COVID-19 patients in this study were male, there was no statistically significant difference in death rates between males and females. Similar findings have been reported in other studies.\u0026nbsp;(4,21,22)\u0026nbsp;However, some studies have found that the predominant number of COVID-19 patients were female and this is maybe because this study used propensity score matching to control for potential confounding variables. This means that the researchers compared men and women who were similar in terms of their age, ethnicity, and other factors that could stimulate COVID-19 infection risk. Other studies may not have used propensity score matching, which could have led to biased results.(23)\u003c/p\u003e\n\u003cp\u003eThe age distribution of the patients in this study was consistent with that of a study conducted in China, with the majority of patients being aged 53 or older.(4)\u0026nbsp;Also study conducted in Egypt showed the majority between 60-79 years and has statically significant with presence of comorbidities.\u0026nbsp;(8)\u0026nbsp;On the other hand, other study conducted in China showed that the majority were between 15-49 years.\u0026nbsp;(4)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Compared to a study in China where half of the patients stayed in the hospital for 7 to 13 days,\u0026nbsp;(24)\u0026nbsp;most patients in this study were hospitalized for less than 6 days. This maybe due to the healthcare systems or type of the study design.\u003c/p\u003e\n\u003cp\u003eWhile the commonest symptoms among the patients in this study \u0026nbsp;were dyspnoea, fever, and neurological problems., cough and fever are the most common symptoms of COVID-19 in China, according to a study.(4)\u0026nbsp;(21)\u0026nbsp;also similar findings were found in Egypt.\u0026nbsp;(8)\u003c/p\u003e\n\u003cp\u003eLong-term health conditions such as high blood pressure, diabetes, lung diseases, and heart diseases, as well as the conditions that lead up to them, may be more likely to get COVID-19.\u0026nbsp;Chronic diseases and infectious diseases share several common characteristics, such as a proinflammatory state and a weakened innate immune response.(25)\u0026nbsp;Diabetes is a key element in predicting negative consequences.(18)\u0026nbsp;A systematic analysis of five studies about COVID-19 reported that , A total of 17.1% of the participants had high blood pressure, 16.4% had heart disease, and 9.7% had diabetes.\u0026nbsp;(18)\u0026nbsp;However, the most common prevalent medical conditions in this study were hypertension, diabetes, and heart disease which affected 30.7%, 29.1, and 7.9%. Of the various comorbidities investigated in this study, only DM, and renal disease were found to be statistically significantly associated with death. This association maybe due to the accumulation of activated innate immune cells in metabolic tissues can contribute to the development of diabetes so these cells produce inflammatory mediators, which can disrupt insulin sensitivity and harm beta cells. Metabolic disorders can also impair the function of immune cells, making people more vulnerable to disease complications.(25)\u0026nbsp;(21)\u0026nbsp;Similar findings were found in meta-analysis study that revealed that the diabetic prevalence is lower in \u0026nbsp;individual with COVID-19 who survive the illness than in those who do not. However, the prevalence of diabetes did not differ significantly between ICU and non-ICU patients. Additionally, The study found that people with diabetes were more likely to have severe COVID-19, meaning that patients with diabetes had a greater chance of getting severe COVID-19 illness.(19)\u0026nbsp;In addition reseraches have shown that underlying health conditions, such as heart disease and diabetes, are associated with higher mortality rates from\u0026nbsp;SARS-CoV. In fact, heart disease and diabetes can double the risk of death.\u0026nbsp;(18)\u0026nbsp;On the other hand, this study\u0026apos;s results indicate that heart disease is not associated with an increased risk of death.\u003c/p\u003e\n\u003cp\u003eThe use of ACE inhibitors and ARBs for the treatment of hypertension can cause cells to produce more ACE2 receptors. As a result, patients with hypertension who are taking ACE inhibitors or ARBs may be more susceptible to infection with COVID-19.This is because the increased expression of ACE2 on the surface of cells can provide more entry points for the virus.(19)\u003c/p\u003e\n\u003cp\u003eIndividuals with pre-existing cardiovascular or metabolic disorders may be at an elevated risk of contracting COVID-19, and these conditions can also have a detrimental effect on the progression and outcome of pneumonia.(18)\u003c/p\u003e\n\u003cp\u003ePatients with kidney\u0026nbsp;have an increased risk of death from COVID-19 in the hospital.(24)\u0026nbsp;The virus may enter kidney cells through receptors known as ACE2, which are produced in large amount in the kidney. This can lead to direct damage to kidney cells. Immune complexes, which are formed when antibodies bind to antigens, can be deposited in the kidney. This can cause inflammation and damage to kidney tissue. Cytokines and other mediators produced by the immune system can have indirect effects on the kidney. For example, hypoxia (low oxygen levels), shock, and rhabdomyolysis (muscle breakdown) can all damage the kidney.\u0026nbsp;(24)\u003c/p\u003e\n\u003cp\u003eBecause the virus primarily targets the respiratory tract. In people with chronic pulmonary diseases, COVID-19 can lead to increased bronchospasm (narrowing of the airways), lung inflammation, and acute respiratory distress syndrome (ARDS).(26)\u003c/p\u003e\n\u003cp\u003eIn this study, patients with kidney diseases had the highest mortality rate (65.2%) among all the comorbid conditions, followed by pulmonary disease (33.3%) and diabetes mellitus \u0026nbsp;(32.6%). These findings agree with previous research.\u003c/p\u003e\n\u003cp\u003ewhich has shown that people with chronic kidney disease (CKD) are more likely to die from COVID-19.(8)\u003c/p\u003e\n\u003cp\u003eThis study found that individuals with poly comorbidities were more likely to have a fatal outcome from COVID-19 than those with a mono comorbidity.. This is consistent with other studies that have shown that patients with multiple comorbidities are more likely to have poorer health outcomes. The findings of this study suggest that the\u0026nbsp;number and type of comorbidities should be considered when predicting the prognosis of patients with COVID-19.(20)\u0026nbsp;People with multiple underlying health conditions, such as diabetes and kidney disease, are more likely to get a severe case of COVID-19 and have complications. Therefore, they should be closely monitored for signs and symptoms of COVID-19 and hospitalized early if infected. Clinicians should also be aware of potential interactions between COVID-19 treatments and medications used to treat comorbidities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA single tertiary hospital conducted the study. The findings could not be generalized to other areas both inside and outside of India. Since this study was retrospective in nature, we used secondary data to carry it out. Some additional variables such as type of DM and HbA1c level could not be explored since it was based on patient medical information and was retrospective research. \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study has shed light on the impact of comorbidities, such as hypertension, diabetes mellitus, and renal disease, on COVID-19 mortality. It contributes to our understanding of the interplay between comorbidities and COVID-19 outcomes, providing valuable insights for healthcare professionals and policymakers. By recognizing the influence of specific comorbidities, healthcare systems can better tailor their responses to protect and treat the \u0026nbsp;populations who are disproportionately affected by COVID-19.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on findings and conclusions of this research, it is recommended to:\u0026nbsp;\u003cbr\u003e\u0026nbsp;Further research: Additional more research is necessary to elucidate the underlying processes and mechanisms. by which hypertension, kidney disease, and diabetes mellitus increase COVID-19 mortality. This research could lead to the development of more targeted treatment and prevention strategies for these patients. Also design clinical practice guidelines: Clinical practice guidelines should be developed to inform the management of COVID-19 in \u0026nbsp;patients with hypertensive disease, kidney disease, and diabetes. These guidelines should be based on the latest evidence and should be updated regularly as new information emerges.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eApproval for the study was obtained from the Human Ethics Committee (I.H. E.C.) of KLE Higher Education and Research Academy, JNMC, Belagavi (Reference number: MDC/DOME/243) with a waiver of consent. Consent to use their data was obtained from the Clinical Services Manager, the Medical Director and Chief Executive Officer of KLE Hospital, and the Medical Records Department (MRD). All personal identifiers were tagged and anonymized to ensure privacy and confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was carried out without any commercial or financial relationships that could be interpreted as a possible conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made significant contributions to all aspects of the study,\u0026nbsp;from its conception and design to the acquisition and analysis of the data,\u0026nbsp;the interpretation of the results,\u0026nbsp;and the writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Dr. Prabhakar Kore Hospital \u0026amp; Medical Research Center at KLE is gratefully acknowledged by the authors for its support in patient identification and data extraction. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKim J, Park SH, Kim JM. Effect of Comorbidities on the Infection Rate and Severity of COVID-19: Nationwide Cohort Study With Propensity Score Matching. JMIR Public Health Surveill. 2022 Nov 18;8(11):e35025. \u003c/li\u003e\n\u003cli\u003eAl-Aghbari N, Maldar A, Angolkar M, Khurseed R, Shrestha S, Saikam P. Inflammatory Markers for Prognosis of COVID-19 Mortality in Hospitalized Indian Patients: A Single-Center Retrospective Study. UST J Med Sci [Internet]. 2023 Jun 12 [cited 2023 Oct 11];1(1). Available from: https://journals.ust.edu.ye/USTJMS/article/view/15\u003c/li\u003e\n\u003cli\u003eChatterjee S, Nalla LV, Sharma M, Sharma N, Singh AA, Malim FM, et al. Association of COVID-19 with Comorbidities: An Update. ACS Pharmacol Transl Sci. 2023 Mar 10;6(3):334\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eGuan W jie, Ni Z yi, Hu Y, Liang W hua, Ou C quan, He J xing, et al. Clinical characteristics of 2019 novel coronavirus infection in China [Internet]. Respiratory Medicine; 2020 Feb [cited 2023 Oct 5]. Available from: http://medrxiv.org/lookup/doi/10.1101/2020.02.06.20020974\u003c/li\u003e\n\u003cli\u003eZhou 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. The Lancet. 2020 Mar;395(10229):1054\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eWu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020 Jul 1;180(7):934\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003ePranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020 Apr;21(2):147032032092689. \u003c/li\u003e\n\u003cli\u003eKhedr EM, Daef E, Mohamed-Hussein A, Mostafa EF, Zein M, Hassany SM, et al. Impact of comorbidities on COVID-19 outcome [Internet]. Respiratory Medicine; 2020 Nov [cited 2023 Oct 5]. Available from: http://medrxiv.org/lookup/doi/10.1101/2020.11.28.20240267\u003c/li\u003e\n\u003cli\u003eNagy \u0026Eacute;, Cseh V, Barcs I, Ludwig E. The Impact of Comorbidities and Obesity on the Severity and Outcome of COVID-19 in Hospitalized Patients\u0026mdash;A Retrospective Study in a Hungarian Hospital. IJERPH. 2023 Jan 12;20(2):1372. \u003c/li\u003e\n\u003cli\u003eHtun YM, Win TT, Aung A, Latt TZ, Phyo YN, Tun TM, et al. Initial presenting symptoms, comorbidities and severity of COVID-19 patients during the second wave of epidemic in Myanmar. Trop Med Health. 2021 Dec;49(1):62. \u003c/li\u003e\n\u003cli\u003eLim JH, Jung HY, Choi JY, Park SH, Kim CD, Kim YL, et al. Hypertension and Electrolyte Disorders in Patients with COVID-19. Electrolyte Blood Press. 2020;18(2):23. \u003c/li\u003e\n\u003cli\u003eHartmann-Boyce J, Morris E, Goyder C, Kinton J, Perring J, Nunan D, et al. Diabetes and COVID-19: Risks, Management, and Learnings From Other National Disasters. Diabetes Care. 2020 Aug 1;43(8):1695\u0026ndash;703. \u003c/li\u003e\n\u003cli\u003eNishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020 Sep;17(9):543\u0026ndash;58. \u003c/li\u003e\n\u003cli\u003eGerayeli FV, Milne S, Cheung C, Li X, Yang CWT, Tam A, et al. COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine. 2021 Mar;33:100789. \u003c/li\u003e\n\u003cli\u003eNaguib R. Potential relationships between COVID-19 and the thyroid gland: an update. J Int Med Res. 2022 Feb;50(2):030006052210828. \u003c/li\u003e\n\u003cli\u003eZaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review. Diabetes \u0026amp; Metabolic Syndrome: Clinical Research \u0026amp; Reviews. 2020 Sep;14(5):1133\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eGe E, Li Y, Wu S, Candido E, Wei X. Association of pre-existing comorbidities with mortality and disease severity among 167,500 individuals with COVID-19 in Canada: A population-based cohort study. Augusto O, editor. PLoS ONE. 2021 Oct 5;16(10):e0258154. \u003c/li\u003e\n\u003cli\u003eLi B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020 May;109(5):531\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eParveen R, Sehar N, Bajpai R, Agarwal NB. Association of diabetes and hypertension with disease severity in covid-19 patients: A systematic literature review and exploratory meta-analysis. Diabetes Research and Clinical Practice. 2020 Aug;166:108295. \u003c/li\u003e\n\u003cli\u003eGuan W jie, Liang W hua, Zhao Y, Liang H rui, Chen Z sheng, Li Y min, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020 May;55(5):2000547. \u003c/li\u003e\n\u003cli\u003eHuang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 Feb;395(10223):497\u0026ndash;506. \u003c/li\u003e\n\u003cli\u003eAl-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020 Jul 23;136(4):489\u0026ndash;500. \u003c/li\u003e\n\u003cli\u003eKim J, Park SH, Kim JM. Association of comorbidities with COVID-19 infection rate and severity: nationwide cohort study with propensity score matching [Internet]. Infectious Diseases (except HIV/AIDS); 2021 Sep [cited 2023 Oct 5]. Available from: http://medrxiv.org/lookup/doi/10.1101/2021.09.22.21263946\u003c/li\u003e\n\u003cli\u003eCheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney impairment is associated with in-hospital death of COVID-19 patients [Internet]. Nephrology; 2020 Feb [cited 2023 Oct 11]. Available from: http://medrxiv.org/lookup/doi/10.1101/2020.02.18.20023242\u003c/li\u003e\n\u003cli\u003eYang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. International Journal of Infectious Diseases. 2020 May;94:91\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eCDC. Coronavirus (COVID-19): symptoms of coronavirus: Centers for Disease Control and Prevention;2020 [Internet]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Comorbidity, Mortality, India, retrospective","lastPublishedDoi":"10.21203/rs.3.rs-4161548/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4161548/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe global spread of COVID-19 has had a profound impact on human health, with millions of people infected and a significant death. Comorbidities play a pivotal role in the prognosis of COVID-19 patients. The aim of this study was to assess the impact of the comorbidity on mortality in COVID-19 patients in a Single-Centre Retrospective Study. The characteristics and results of patients with COVID-19 admitted to KLE's Hospital in Belgaum, Karnataka, India, were examined through retrospective research. 642 participants having COVID-19 diagnoses between October 1, 2020, and September 30, 2021 were enrolled in the research. Data such as, patients' clinical features, vital signs, demographic information and patients' outcomes (survived or deceased) were collected. The findings of this study showed that out of 642 patients, 256 patients had co morbidities, 62.8% of them had poly morbidity and most prevalent underlying medical conditions were hypertension, diabetes, and heart disease which affected 30.7%, 29.1, and 7.9%, respectively. Only diabetes and renal disease reported strong associations (P.value: 0.011, aOR: 1.852 95% CI: 1.148\u0026ndash;2.988), (p.value: 0.000, aOR: 6.491 (95% CI: 2.613\u0026ndash;16.124), respectively. Furthermore, Comorbidities such kidney disease, and diabetes mellitus can lead to more serious complications and death in COVID-19 patients. Understanding the impact of these comorbidities on COVID-19 mortality is essential for more effective patient care and resource allocation.\u003c/p\u003e","manuscriptTitle":"Impact of Comorbidity on Mortality in COVID-19 Patients: A Single- Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-02 17:10:51","doi":"10.21203/rs.3.rs-4161548/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27310821-ac18-4f75-9904-a35e2f9a304e","owner":[],"postedDate":"April 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-23T11:23:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-02 17:10:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4161548","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4161548","identity":"rs-4161548","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}