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.