Clinical Prognosis and Risk Factors of Death for Covid-19 Patients Complicated with Coronary Heart Disease/Diabetes/Hypertension-A Retrospective, Real-World Study

Abstract

Objectives: To explore the clinical prognosis and the risk factors of death of COVID-19 patients complicated with one of the three major comorbidities (coronary heart disease, diabetes, or hypertension) based on real-world data.

Methods: This single-center retrospective real-world study investigated all in-hospital patients who were transferred to the Coronavirus Special Ward of the Elderly Center of Zhongshan Hospital from March to June 2022 with a positive COVID-19 virus nucleic acid test and with at least one of the three comorbidities (coronary heart disease, diabetes or hypertension). Clinical data and laboratory test results of eligible patients were collected. A multivariate logistic regression analysis was performed to explore the risk associated with the prognosis.

Results: For the 1,281 PCR positive patients at the admission included in the analysis, the mean age was 70.5±13.7 years and 658 (51.4%) were males. There were 1,092 (85.2%) patients with hypertension, 477(37.2%) patients with diabetes, and 124 (9.7%) patients with coronary heart disease. The length of hospital stay (LOS) was 9.2±5.1 days. Among all admitted patients,1112 (91.5%) were fully recovered, 77 (6.9%) were improved, and 29 (2.6%) died. Over the hospitalization, 172 (13.4%) PCR positive patients experienced rebound COVID following initial recovery with negative PCR test. A multivariate logistic regression analysis showed that vaccination had no protective effects in this study population; Paxlovid was associated with a lower risk of death(OR =0 .98, 95% CI: 0.95-1.00). Whereas, presence of solid malignancies and nerve system disease were significantly associated with increased risk of death (OR=1.04, 95% CI:1.02-1.05; OR=1.10, 95% CI:1.05-1.14; OR=1.08, 95% CI:1.03-1.13; respectively). 

Conclusion: Vast majority of the hospitalized COVID patients were fully recovered. Paxlovid was associated with a lower risk of death; Whereas, presence of solid malignancies and nerve system disease, and some treatments were all significantly associated with an increased risk of death.

Note:
Funding Information: This work was supported by National Natural Science Foundation of China (82170110), Shanghai Pujiang Program (20PJ1402400), Science and Technology Commission of Shanghai Municipality (20DZ2254400, 20DZ2261200), Shanghai Municipal Science and Technology Major Project (ZD2021CY001) and Shanghai Municipal Key Clinical Specialty (shslczdzk02201).

Declaration of Interests: Huifen Weng, Lijing, Xingwei Lu were employed by Shanghai Centennial Scientific Co., Ltd. Shanghai, China. Wei Yang were employed by Shanghai Suvalue Healthcare Scientific Co., Ltd. Shanghai, China. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical Approval Statement: The study protocol was approved by the Ethics Committee of Zhongshan Hospital (IRB No. B2022-183(2)) and was registered with the Chinese Clinical Trials Registry.

Keywords: Covid-19, chronic respiratory disease, Clinical prognosis, risk factors, coronary heart disease, diabete, hypertension