bims-covirf Biomed News
on COVID19 risk factors
Issue of 2021‒03‒14
seven papers selected by
Catherine Rycroft

  1. Scand J Immunol. 2021 Mar 12. e13039
      COVID-19 is highly transmissible; however, its severity varies from one individual to another. Variability among different isolates of the virus and among its receptor (ACE2) may contribute to this severity but comorbidity plays a major role on disease prognosis. Many comorbidities have been reported to be associated with severe COVID-19 patients. We have collected data from retrospective studies which include clinical and epidemiological features of patients and categorize them into severe/mild, ICU/non-ICU, and survivors/dead patients. In this review, we give an update about SARS-CoV-2 structure with emphasis on the possible reasons for the severity of the virus in patients. We also collected information and patients' data to highlight the relation between COVID-19 patients and comorbidities.
    Keywords:  COVID-19; SARS-CoV-2; Severity; comorbidities; risk factors
  2. Lancet Reg Health West Pac. 2021 Apr;9 100108
      Background: Data on COVID-19-related mortality and associated factors from low-resource settings are scarce. This study examined clinical characteristics and factors associated with in-hospital mortality of COVID-19 patients in Jakarta, Indonesia, from March 2 to July 31, 2020.Methods: This retrospective cohort included all hospitalised patients with PCR-confirmed COVID-19 in 55 hospitals. We extracted demographic and clinical data, including hospital outcomes (discharge or death). We used logistic regression to examine factors associated with mortality.
    Findings: Of 4265 patients with a definitive outcome by July 31, 3768 (88%) were discharged and 497 (12%) died. The median age was 46 years (IQR 32-57), 5% were children, and 31% had >1 comorbidity. Age-specific mortalities were 11% (7/61) for <5 years; 4% (1/23) for 5-9; 2% (3/133) for 10-19; 2% (8/638) for 20-29; 3% (26/755) for 30-39; 7% (61/819) for 40-49; 17% (155/941) for 50-59; 22% (132/611) for 60-69; and 34% (96/284) for ≥70. Risk of death was associated with higher age, male sex; pre-existing hypertension, diabetes, or chronic kidney disease; clinical diagnosis of pneumonia; multiple (>3) symptoms; immediate ICU admission, or intubation. Across all ages, risk of death was higher for patients with >1 comorbidity compared to those without; notably the risk was six-fold increased among patients <50 years (adjusted odds ratio 5.87, 95%CI 3.28-10.52; 27% vs 3% mortality).
    Interpretation: Overall in-hospital mortality was lower than reported in high-income countries, probably due to younger age distribution and fewer comorbidities. Deaths occurred across all ages, with >10% mortality among children <5 years and adults >50 years.
    Keywords:  COVID-19; Indonesia; Mortality; SARS-CoV-2; children; coronavirus
  3. Ann Transl Med. 2021 Feb;9(4): 280
      Background: This study aims to determine the clinical characteristics and prognosis of COVID-19 patients with comorbidities and to identify survival factors.Methods: A retrospective study was conducted in Wuhan, China, between February 8, 2020, and March 9, 2020. Based on underlying diseases, patients were assigned to either the comorbidity group or the non-comorbidity group. The clinical characteristics and outcomes of COVID-19 were analyzed and a Kaplan-Meier survival analysis was used to evaluate the prognosis predictive value of each comorbidity.
    Results: During the study period, 278 COVID-19 patients were enrolled, 175 (62.95%) were assigned to the comorbidity group, and 103 (37.05%) to the non-comorbidity group. Of the patients in the comorbidity group, 34.86% were classified as critical. Further, patients in the comorbidity group had lower lymphocyte cell counts, and higher concentrations of D-dimer, high sensitivity C-reactive protein, interleukin 6, and serum ferritin as well as higher critical illness severity scores than patients in the non-comorbidity group (P<0.05). Patients in the comorbidity group also had higher mortality, acute respiratory distress syndrome, and ventilation treatment rates than patients in the non-comorbidity group (P<0.05). The length of hospital stay was longer in the comorbidity group than in the non-comorbidity group (P<0.05). The most common underlying diseases included hypertension (40.65%), diabetes mellitus (20.5%), and cardiovascular disease (19.42%). Patients with comorbidities were more likely to develop cardiovascular sequelae associated with COVID-19, shock, acute kidney injury, and multiple organ dysfunction syndrome (30.86% vs. 12.62%, P=0.001; 18.86% vs. 8.74%, P=0.023; 24.57% vs. 11.65%, P=0.009; 33.71% vs. 14.56%, P=0.000, respectively). In the Kaplan-Meier survival analysis, older patients (¡Ý65 years) (log-rank test: χ2=4.202, P=0.040) and patients with chronic obstructive pulmonary disease (COPD) (log-rank test: χ2=4.839, P=0.028) or diabetes mellitus (log-rank test: χ2=4.377, P=0.036) had shorter survival than those without comorbidities.
    Conclusions: Patients with comorbidities were more severely affected and had a higher mortality rate. Age, COPD and diabetes mellitus were the main factors affecting the survival of patients.
    Keywords:  ARDS; COVID-19; comorbidity; hospital mortality
  4. Biomed Res Int. 2021 ;2021 6695707
      Background: The UAE reported its first cluster of COVID 2019 in a group of returned travellers from Wuhan in January 2020. Various comorbidities are associated with worse disease prognosis. Understanding the impact of ethnicity on the disease outcome is an important public health issue but data from our region is lacking.Aim: We aim to identify comorbidities among patients hospitalized for COVID-19 that are associated with inhospital death. Also, to assess if ethnicity is correlated with increased risk of death. Patients and Method. The study is a single-centre, observational study in Shaikh Shakhbout Medical City, Abu Dhabi. Patients admitted with COVID-19, between 1st of March and the end of May, were enrolled. Records were studied for demography, comorbidity, and ethnicity. Ethnicity was divided into Arabs (Gulf, North Africa, and the Levant), South Asia (India, Pakistan, Bangladesh, Nepal, and Afghanistan), Africans, the Philippines, and others. The study was approved by the Department of Health of Abu Dhabi.
    Results: 1075 patients (972 males) were enrolled. There were 24 nationalities under 5 ethnicity groups. Mean (average) age was 51 years (20-81). 101 (9.4%) died with deceased patients being significantly older. Death risk was not significantly influenced by sex. Duration of hospitalization among survivors was 6.2 days (0.2-40.4) with older patients and men staying longer (P < 0.01). Comorbidities of diabetes, hypertension, cardiovascular disease, chronic renal disease, liver disease, and malignancy were associated with higher risk of mortality univariate, but only liver disease reached statistical significance after adjustment for age. The highest percentage of death was seen in Arab Levant (21.2) followed by the Asian Afghan (18.8); however, differences among ethnicities did not reach statistical significance (P = 0.086).
    Conclusion: COVID-19 outcome was worse in older people and those with comorbidities. Men and older patients required longer hospitalization. Ethnicity is not seen to impact the risk of mortality.
  5. J Health Care Poor Underserved. 2021;32(1):32(1): 245-257
      OBJECTIVES: To determine the association between the Center for Disease Control and Prevention's (CDC) Social Vulnerability Index (SVI) with the risk of COVID-19-related mortality.METHODS: We merged by county CDC's SVI and the New York Times data on coronavirus cases. We estimated the association between the SVI and risk of death from COVID-19 per 100,000 people in counties with confirmed cases (n=2,755 U.S. counties) using multivariable Poisson regression.
    RESULTS: The adjusted risk of COVID-19-related death followed a non-linear pattern, with the lowest risk among SVIs from 0.05 to 0.55 (roughly 3.1 to 3.5/100,000 people) and highest risk corresponding to SVI=0.95 (6.5/100,000). Compared with a SVI=0.35, SVIs of 0.85 and 0.95 were associated with 2.3 (2.1, 2.5) and 3.4 (3.1, 3.7) excess deaths per 100,000, respectively.
    CONCLUSIONS: High social vulnerability is associated with increased risk of COVID-19-related mortality among U.S. counties with confirmed cases.
  6. Obesity (Silver Spring). 2021 Mar 11.
      OBJECTIVE: To assess whether diabetes mellitus (DM) or obesity are independent risk factors for severe COVID-19 outcomes and explore if the risk conferred by one condition is modified by the other.METHODS: This retrospective cohort study of inpatient adults with COVID-19 used multivariable Cox regression to determine the independent effects of DM and obesity on the composite outcome of intubation, intensive care unit admission, or in-hospital mortality. Effect modification between DM and obesity was assessed with a statistical interaction term and exploration of stratum-specific effects.
    RESULTS: Among 3533 patients, 1134 (32%) had DM, 1256 (36%) had obesity, and 430 (12%) had both. Diabetes and obesity were independently associated with the composite outcome (HR 1.14 [95% CI 1.01, 1.30] and HR 1.22 [1.05, 1.43], respectively). A statistical trend for potential interaction between DM and obesity was observed (p=0.20). Stratified analyses showed potential increased risk with obesity compared to normal body mass index among DM (HR 1.34 [1.04, 1.74]) and non-DM patients (HR 1.18 [0.96, 1.43]).
    CONCLUSION: Diabetes and obesity are independent risk factors associated with COVID-19 severity. Stratified analyses suggest obesity may confer greater risk to patients with DM compared to patients without DM, and this relationship requires further exploration.
    Keywords:  #BGT and GA contributed equally; BMI; SARS-CoV-2; body mass index; mortality; weight
  7. Rheumatol Int. 2021 Mar 09.
      Patients with rheumatic diseases are often more susceptible to different bacteria and viruses because of immune impairment, but it is not clear whether there is a higher risk of infection and a more serious course of disease for novel coronavirus (SARS-CoV-2). We performed this systematic review and meta analysis to assess the risk and clinical outcomes of COVID-19 in patients with rheumatic diseases compared with the general population. We searched PubMed, EMBASE, Scopus and Web of Science databases from January 1, 2020 to October 20, 2020 to determine epidemiological information related to patients with rheumatic diseases and COVID-19, including clear risk estimate or data that could be converted and extracted. We included 26 observational studies, totaling about 2000 patients with rheumatic diseases of whom were infected with COVID-19. Meta-analysis showed that the risk of COVID-19 infection in rheumatic patients was significantly higher than that in the general population (OR = 1.53, 95% CI 1.24-1.88, P = 0.000). In terms of hospitalization and severe clinical outcomes associated with COVID-19, we found that rheumatic patients showed similar results to the reference population (hospitalization OR = 1.36, 95% CI 0.81-2.29, P = 0.247; admitted to ICU OR = 1.94, 95% CI 0.88-4.27, P = 0.098; death OR = 1.29, 95% CI 0.84-1.97, P = 0.248). The presence of comorbidities, hypertension, lung diseases were significantly associated with the increased risk of COVID-19-related hospitalization in rheumatic patients and anti-TNF drugs were associated with lower hospitalization risk. Older age was related to severe COVID-19. Our meta-analysis indicated that rheumatic patients were at a higher risk of COVID-19 infection but might not lead to a more serious disease process.
    Keywords:  COVID-19; Meta analysis; Rheumatic diseases; Risk; Systematic review