key: cord-0965888-qez8cq00
authors: Posso, Margarita; Comas, Mercè; Román, Marta; Domingo, Laia; Louro, Javier; González, Cristina; Sala, María; Anglès, Albert; Cirera, Isabel; Cots, Francesc; Frías, Víctor-Manuel; Gea, Joaquim; Güerri-Fernández, Robert; Masclans, Joan Ramon; Noguès, Xavier; Vázquez, Olga; Villar-García, Judith; Horcajada, Juan Pablo; Pascual, Julio; Castells, Xavier
title: Comorbidities and mortality in patients with COVID-19 aged 60 years and older in a university hospital in Spain
date: 2020-07-16
journal: Arch Bronconeumol
DOI: 10.1016/j.arbres.2020.06.012
sha: b25aed29cc1888f232bd0fb1692ab8e84cb81917
doc_id: 965888
cord_uid: qez8cq00

nan

We performed a retrospective evaluation of prospectively collected data from the PSMAR clinical records. This study was approved by the Ethics Committee of PSMAR in 2020. We included patients ≥60 years who had been hospitalized and discharged (alive or dead) from COVID-19 between 23 rd February and 12 th May of 2020 in the PSMAR. The PSMAR batches four health centres serving a population of approximately 350,000 inhabitants. Included patients had a diagnosis of COVID-19 from the Minimum Basic Data Set that collects the diagnosis leading to admission, and up to 10 comorbidities per patient. Diagnoses are coded according to the International Classification of Diseases 10th edition. We confirmed that patients had a positive result on polymerase chain reaction testing of a nasopharyngeal sample and/or a clinically/radiologically diagnosis of COVID-19. Patients were not followed after discharge but COVID-19 related early readmissions were considered as part of the COVID-19 course. Patients discharged alive directly from the emergency room were excluded.

We evaluated gender, age (60-74, 75-84, or >=85 years), and the presence of the following comorbidities at the time of hospital admission: hypertension, heart failure, obesity, diabetes, chronic respiratory disease (chronic obstructive pulmonary disease or asthma), malignancy, chronic kidney disease (including kidney transplantation), and chronic liver disease. Mortality was recorded at hospital discharge.

After describing the clinical characteristics, we evaluated differences in the categories stratifying for those patients who died and those who did not using the Mann Whitney's-U test or Chi-Square test. We used independent logistic regression models to estimate crude and adjusted odds ratios (aOR) of dying and its 95% confidence interval (95%CI) for each comorbidity adjusting by age and gender. All statistical tests were two-sided. P values less than 0.05 were considered statistically significant.

We included 834 COVID-19 patients aged 60 years and older. 53.5% were women, with an average age of 78.2 (SD=9.8) years, and hospital mortality of 23.5%. The prevalence of patients with at least one comorbidity was 81.9%. Hypertension was the most frequent (64.6%), followed by chronic kidney disease (29.3%), diabetes (28.1%), chronic respiratory disease (17.1%), heart failure (11.9%), obesity (6.6%), malignancy (5.4%), and chronic liver disease (2.3%). dying than those without, although these results were not statistically significant. The presence of hypertension and chronic respiratory disease was not associated with hospital mortality (Figure) .

In our population of COVID-19 hospitalized patients aged 60 years and older, the presence of pre-existing comorbidities such as heart failure and chronic kidney disease was associated with an increased risk of hospital mortality. We also confirmed that COVID-19-related mortality increased with age. Conversely, we were not able to confirm the association of malignancy, chronic liver disease, obesity, or diabetes with in-hospital mortality but a potential increase in risk was observed. Unexpectedly, the odds ratios for dying of patients with hypertension or chronic respiratory disease were lower than one.

In agreement with previous international studies 6,7 , we found that patients with heart failure and chronic kidney disease were more likely to die for COVID-19 than patients without these conditions. It has been suggested that both the direct SARS-CoV-2 infection and the immunologic human response could destabilize pre-existing myocardial and kidney illnesses.

Complications, such as acute cardiac 8 or kidney 9 injuries may, therefore, most frequently occur in patients with these underlying comorbidities leading to an increased risk of death.

The main limitations of this study derive from the modest number of included patients and the information available from the clinical records. Also, we could not address the effect of inpatient treatment or procedures performed during hospitalization. Finally, our analyses were not extended beyond discharge but mortality after this is likely to be small.

In conclusion, in a population of COVID-19 patients aged 60 years and older, the presence of comorbidities such as heart failure and chronic kidney disease is associated with an increased risk of hospital mortality. The mechanisms that underlie the development of severe COVID-19 in patients with pre-existing comorbidities are still poorly understood and warrant further investigation.

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