Comorbidities Affect the Recovery Rate of Covid-19 Patients - A Retrospective Study in Lahore, Pakistan

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Maria Arshad Hadiqa Jaleel Saleem Perwaiz Iqbal Manahil Asif Madiha Ali Manal Mubarak Samar Asim Farkhanda Ghafoor

Abstract

Many studies have identified various risk factors associated with Covid-19, for example, individuals with comorbidities are at an increased risk of contracting the disease and developing severe symptoms than those without comorbidities, however, these findings are inconsistent. This study identifies various risk predictors of Covid-19 patients with and without comorbidities. Data of Covid-19 patients was retrieved from Patient Digital Library of Shalamar Hospital, Lahore and encompassed patients’ gender, age, symptoms and severity besides other vitals. Data of total 1,639 patients who were admitted at Pulmonology Unit of Shalamar Hospital was examined. Out of this, 180 Covid-19 patients were recruited for final analyses as they were fully in accordance with the eligibility criteria framed for this study. Of these, 137 were suffering from comorbidities and the analysis revealed that these comorbidities had significant effect on the end result of the Covid-19 illness (P=0.002) i.e. the mortality rate among the patients with comorbidities was found to be 33.6% (n=46) and that of patients with no comorbidities was 9.3% (n=4). Likewise, the recovery rate of patients without comorbidities was significantly high (90.7%, n=39). However, interestingly, presence or absence of comorbidities had no significant impact on severity of the disease. Moreover, O2 saturation < 90% is predicted as a risk factor of severity whereas age > 59, presence of comorbidities and severe symptoms are found to be the risk predictors for the outcome of the disease being recovered or expired.

Keywords: Comorbidities, Covid-19, Risk Factors, Recovery rate

Article Details

How to Cite
ARSHAD, Maria et al. Comorbidities Affect the Recovery Rate of Covid-19 Patients - A Retrospective Study in Lahore, Pakistan. Medical Research Archives, [S.l.], v. 10, n. 9, sep. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3060>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v10i9.3060.
Section
Research Articles

References

1. Sanyaolu A, Okorie C, Marinkovic A, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med. 2020;2(8):1069-1076.
2. Aghili SMM, Ebrahimpur M, Arjmand B, et al. Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis. Int J Obes. 2021;45(5):998-1016.
3. WHO. WHO Coronavirus (COVID-19) Dashboard. 2022; https://covid19.who.int/. Accessed August 05, 2022.
4. WHO. WHO Covid-19 dashboard Pakistan. https://covid19.who.int/region/emro/country/pk Accessed August 5, 2022.
5. Zhou F, Yu T, Du R, 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):1054-1062.
6. Ejaz H, Alsrhani A, Zafar A, et al. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020;13(12):1833-1839.
7. Yin T, Li Y, Ying Y, Luo ZJ. Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors. BMC Infect Dis. 2021;21(1):1-13.
8. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513.
9. Zhang J, Dong X, Cao Y, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-1741.
10. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069.
11. Jin J-M, Bai P, He W, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health. 2020:152.
12. Ishigami J, Grams ME, Chang AR, Carrero JJ, Coresh J, Matsushita KJ. CKD and risk for hospitalization with infection: the atherosclerosis risk in communities (ARIC) study. Am J Kidney Dis. 2017;69(6):752-761.
13. James MT, Quan H, Tonelli M, et al. CKD and risk of hospitalization and death with pneumonia. Am. J. Kidney Dis. 2009;54(1):24-32.
14. Zhou YJ, Zheng KI, Wang XB, et al. Metabolic-associated fatty liver disease is associated with severity of COVID-19. Liver Int. 2020;40(9):2160-2163.
15. Henry BM, Lippi GJ. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020;52(6):1193-1194.
16. Lee H, Choi H, Yang B, et al. Interstitial lung disease increases susceptibility to and severity of COVID-19. Eur. Respir. J. 2021;58(6).
17. Song J, Zeng M, Wang H, et al. Distinct effects of asthma and COPD comorbidity on disease expression and outcome in patients with COVID-19. Allergy. 2021;76(2):483-496.
18. Caballero A, Ceriello A, Misra A, et al. COVID-19 in people living with diabetes: an international consensus. J Diabetes Complications. 2020;34(9):107671.
19. Gagliardi MC, Tieri P, Ortona E, Ruggieri AJ. ACE2 expression and sex disparity in COVID-19. Cell Death Discov. 2020;6(1):1-2.
20. Elgendy IY, Pepine CJ. Why are women better protected from COVID-19: clues for men? Sex and COVID-19. Int J Cardiol. 2020;315:105-106.
21. Agrawal H, Das N, Nathani S, et al. An assessment on impact of COVID-19 infection in a gender specific manner. Stem Cell Rev Rep. 2021;17(1):94-112.
22. Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim BJI. Association of sex, age, and comorbidities with mortality in COVID-19 patients: a systematic review and meta-analysis. Intervirology. 2021;64(1):36-47.
23. Klein SL, Huber S. Sex differences in susceptibility to viral infection. In: Sex hormones and immunity to infection. Springer; 2010.
24. Ruggieri A, Anticoli S, D’Ambrosio A, Giordani L, Viora MJ. The influence of sex and gender on immunity, infection and vaccination. Ann Ist Super Sanità. 2016;52(2):198-204.
25. Klein SL, Flanagan KL. Sex differences in immune responses. Nat. Rev. Immunol. 2016;16(10):626-638.
26. Hou H, Wang T, Zhang B, et al. Detection of IgM and IgG antibodies in patients with coronavirus disease 2019. Clin Transl Immunology. 2020;9(5):e1136.
27. Ambrosino I, Barbagelata E, Ortona E, et al. Gender differences in patients with COVID-19: a narrative review. Monaldi Arch Chest Dis. 2020;90(2).
28. Organization WH. Clinical management of COVID-19: interim guidance, 27 May 2020. World Health Organization. 2020.
29. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242.
30. Baradaran A, Ebrahimzadeh MH, Baradaran A, Kachooei AR. Prevalence of comorbidities in COVID-19 patients: a systematic review and meta-analysis. Arch Bone Jt Surg. 2020;8(Suppl 1):247.
31. Bajgain KT, Badal S, Bajgain BB, Santana MJ. Prevalence of comorbidities among individuals with COVID-19: A rapid review of current literature. Am. J. Infect. Control. 2021;49(2):238-246.
32. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis. Arch Acad Emerg Med. 2020;8(1).
33. Aghili R, Honardoost M, Khamseh ME. COVID-19: Case fatality and ACE2 inhibitors treatment concerns in patients with comorbidities. Med J Islam Repub Iran. 2020;34:147.
34. Honardoost M, Janani L, Aghili R, Emami Z, Khamseh ME. The association between presence of comorbidities and COVID-19 severity: a systematic review and meta-analysis. Cerebrovasc Dis. 2021;50(2):132-140.
35. Guan W-j, Liang W-h, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5).
36. 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.
37. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-2059.
38. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95.
39. Atkins JL, Masoli JA, Delgado J, et al. Preexisting comorbidities predicting COVID-19 and mortality in the UK biobank community cohort. J. Gerontol. 2020;75(11):2224-2230.
40. Zhou Y, Yang Q, Chi J, et al. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis. Int J Infect Dis. 2020;99:47-56.
41. Garg S, Kim L, Whitaker M, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019—COVID-NET, 14 States, March 1–30, 2020. CDC. 2020;69(15):458.
42. Caress JB, Castoro RJ, Simmons Z, et al. COVID‐19–associated Guillain‐Barré syndrome: The early pandemic experience. Muscle Nerve. 2020;62(4):485-491.
43. Rajdev K, Victor N, Buckholtz ES, et al. A case of Guillain-Barré syndrome associated with COVID-19. J. Investig. Med. High Impact Case Rep. 2020;8:2324709620961198.
44. Verma V, Talwar D, Kumar S, Acharya S, Verma A. Oral candidiasis as rare complication of COVID-19: A case series. Med Sci. 2021;25:1397-1401.
45. De La Flor Merino JC, Mola Reyes L, Linares Gravalos T, Roel Conde A, Rodeles del Pozo M. An unusual case of severe acute hyponatremia in patient with COVID-19 infection. Nefrologia. 2020;40(3):356-358.
46. Noori M, Nejadghaderi SA, Sullman MJ, Carson‐Chahhoud K, Kolahi AA, Safiri S. Epidemiology, prognosis and management of potassium disorders in Covid-19. Rev Med Virol. 2022;32(1):e2262.
47. Hariyanto TI, Kurniawan A. Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis. Sleep Med. 2021;82:47-53.
48. Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World J. Psychiatry. 2021;20(1):124-130.
49. Cordtz R, Lindhardsen J, Soussi BG, et al. Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark. Rheumatology. 2021;60(SI):SI59-SI67.
50. Yang X, Yang Q, Wang Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020;18(6):1469-1472.
51. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta. 2020;506:145-148.
52. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481.
53. Faghih Dinevari M, Somi MH, Sadeghi Majd E, Abbasalizad Farhangi M, Nikniaz Z. Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran. BMC Infect. Dis. 2021;21(1):1-7.
54. Bellmann-Weiler R, Lanser L, Barket R, et al. Prevalence and predictive value of anemia and dysregulated iron homeostasis in patients with COVID-19 infection. J Clin Med. 2020;9(8):2429.
55. Tao Z, Xu J, Chen W, et al. Anemia is associated with severe illness in COVID-19: a retrospective cohort study. J Med Virol. 2021;93(3):1478-1488.
56. Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. 2020;323(15):1488-1494.
57. CDC. COVID-19 Information for Specific Groups of People. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html. Accessed August 5, 2022.
58. Covid C, Team R, COVID C, et al. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. Morb Mortal Wkly Rep. 2020;69(12):343.
59. CDC. Symptoms of COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed August 5, 2022.
60. Zhu L, She Z-G, Cheng X, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31(6):1068-1077. e1063.
61. Guan W-j, Liang W-h, He J-x, Zhong N-s. Cardiovascular comorbidity and its impact on patients with COVID-19. Eur. Respir. J. 2020;55(6).
62. Kashani KB. Hypoxia in COVID-19: sign of severity or cause for poor outcomes. Paper presented at: Mayo Clin Proc. 2020.
63. Mejía F, Medina C, Cornejo E, et al. Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PLoS One. 2020;15(12):e0244171.
64. Xie J, Covassin N, Fan Z, et al. Association between hypoxemia and mortality in patients with COVID-19. Paper presented at: Mayo Clin Proc. 2020.
65. Eltzschig HK, Carmeliet P. Hypoxia and inflammation. N Engl J Med. 2011;364(7):656-665.
66. Wu J, Liu J, Zhao X, et al. Clinical characteristics of imported cases of coronavirus disease 2019 (COVID-19) in Jiangsu Province: a multicenter descriptive study. Clin Infect Dis. 2020;71(15):706-712.
67. Wan S, Xiang Y, Fang W, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol. 2020;92(7):797-806.
68. Wenham C, Smith J, Morgan. COVID-19: the gendered impacts of the outbreak. Lancet. 2020;395(10227):846-848.
69. Li Lq, Huang T, Wang Yq, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577-583.
70. Jaillon S, Berthenet K, Garlanda C. Sexual dimorphism in innate immunity. Clinic Rev Allerg Immunol. 2019;56(3):308-321.
71. Mohammad I, Starskaia I, Nagy T, et al. Estrogen receptor α contributes to T cell–mediated autoimmune inflammation by promoting T cell activation and proliferation. Sci Signal. 2018;11(526):eaap9415.
72. Ghosh S, Klein RS. Sex drives dimorphic immune responses to viral infections. J Immunol. 2017;198(5):1782-1790.
73. Riccardo F, Ajelli M, Andrianou XD, et al. Epidemiological characteristics of COVID-19 cases and estimates of the reproductive numbers 1 month into the epidemic, Italy, 28 January to 31 March 2020. Euro Surveill. 2020;25(49):2000790.
74. Barek MA, Aziz MA, Islam MS. Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID-19 cases: a meta-analysis with 55 studies and 10014 cases. Heliyon. 2020;6(12):e05684.
75. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25.
76. Landi F, Barillaro C, Bellieni A, et al. The new challenge of geriatrics: saving frail older people from the SARS-COV-2 pandemic infection. J Nutr Health Aging. 2020;24(5):466-470.
77. Duan J, Wang X, Chi J, et al. Correlation between the variables collected at admission and progression to severe cases during hospitalization among patients with COVID-19 in Chongqing. J Med Virol. 2020;92(11):2616-2622.
78. Gallo Marin B, Aghagoli G, Lavine K, et al. Predictors of COVID-19 severity: a literature review. Rev Med Virol. 2021;31(1):1-10.
79. Cecconi M, Piovani D, Brunetta E, et al. Early predictors of clinical deterioration in a cohort of 239 patients hospitalized for Covid-19 infection in Lombardy, Italy. J Clin Med. 2020;9(5):1548.
80. Ciceri F, Castagna A, Rovere-Querini P, et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin. Immunol. 2020;217:108509.
81. Galloway JB, Norton S, Barker RD, et al. A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: an observational cohort study. J. Infect. 2020;81(2):282-288.
82. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-118.
83. Jordan RE, Adab P, Cheng K. Covid-19: risk factors for severe disease and death. In. Vol 368: BMJ. 2020.

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