Prevalence of co-morbidities in hospitalized patients with COVID-19 in a COVID dedicated hospital

INTRODUCTION

A novel corona virus causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection become a public health emergency of international concern.¹ The infection has increased and caused pandemic.²

It can spread through respiratory tract and causes respiratory tract infections. It develops symptoms like cough, fever, breathlessness, myalgia etc.^3-5 Severe pneumonia may develop requiring intensive care. It is associated with morbidity and mortality. Death is due to respiratory failure.^6,7

Underlying co-morbidities may worsen the clinical outcome. So, more attention is to be given to COVID patients with co-morbidities.⁸

Few studies have been conducted on the prevalence of predominant chronic diseases with COVID-19. Taking into consideration the above factors, a study has been undertaken to assess the prevalence of co-morbidities in a COVID dedicated hospital.

Objective

To find the prevalence of co-morbidities in hospitalized patients with COVID-19 in a COVID dedicated hospital.

METHODS

Study design

It was a centre based retrospective study was carried out at a COVID Dedicated Hospital, Mumbai.

Selection of study group

All admitted patients of COVID-19 in a COVID dedicated hospital, Mumbai were selected in 4 and half months (19^th March 2020 to 31^st July 2020) by universal sampling technique.

Inclusion criteria

Patients above 20 years were included.

Exclusion criteria

Patients below 20 years were excluded.

Ethics committee approval taken from an institutional ethics committee.

Statistical analysis

Analysis was done in MS excel with proportions and percentages.

RESULTS

All 6072 patients who were above 20 years were included in the study. Mean age was 48 years and 67.7% were male. The prevalence of various co-morbidities were as follows.

Hypertension was the most prevalent co-morbidity. 25% cases were hypertensive.

Second common co-morbidity was diabetes mellitus. 22.3% cases were diabetic.

The prevalence of chronic kidney disease was 5.2%.

4.2% COVID cases were having Ischemic heart disease.

Table 5 shows 3.2% COVID cases were having hypothyroidism.

1.7% COVID cases were having chronic obstructive pulmonary disease.

0.9% COVID cases were having cerebrovascular disease as shown in Table 7.

0.3% COVID cases were having one or the other malignancy (Table 8).

DISCUSSION

SARS-CoV2 is a newly detected strain causing challenge to countries all over the world. Its long incubation period (3 to 14 days), its contagiousness, estimating positive cases in community, insufficient protective resources are the key problems.^9,10 As SARS-CoV2 is a novel virus, pre-existing immunity does not exist for this infection. No specific treatment exists for the disease. Vaccine does not exist till date. These all factors make the disease more complicated specifically for vulnerable population like elderly individuals, patients with one or more co-morbidities.

In our study, the prevalence of hypertension was 25% in COVID cases. Similarly the prevalence of hypertension was 9.5%, 12%, 15% in studies carried out by Kui et al, Xu et al, Huang et al.^11-13 It is higher i.e. 31.2% and 30% in studies carried out by Wang et al, Zhang et al.^14,15 The difference may be due to different age groups of study population.

The prevalence diabetes mellitus was 22.3% in our study. The prevalence of diabetes mellitus was 10.2%, 10.1%, 12.1%, 10.2% in studies carried out by Kui et al, Wang et al, Zhang et al, Liang et al.^11,14-16 It was higher i.e. 19.5% in study carried out by Huang et al.¹³ It was lower i.e. 7.37% in study carried out by Guan et al.¹⁷

In our study the prevalence of chronic kidney disease (CKD) was 5.2%. It was 3%, 2.8%, 0.01%, 1.41%, 1.2% in studies conducted by Chen et al, Wang et al, Guan et al, Zhang et al, Wu et al.^{12,14,15,17,19} It was higher i.e. 47% in study carried out by Guarner et al and 7.3% in study conducted by Huang et al.^13,18 Chronic kidney disease is an immune compromised state making patients with CKD more prone to COVID-19 disease.

The prevalence of ischemic heart disease (IHD) was 4.2% in this study. It was 5.8%, 23% and 25% in study conducted by Guan et al, Huang et al and Wang et al.^13,14,17

The prevalence of hypothyroidism was 3.1% in this study. It was 6.8% in study conducted by Van Gerwen et al.²¹

The prevalence of chronic obstructive pulmonary disease (COPD) was 1.7% in this study. It was 2.9%, 1.6%, 1.4%, 1.5%, 2.4%,1.1% in the study done by Wang et al, Xu et al, Zhang et al, Kui et al, Huang et al, Guan et al respectively.^11-15,17 Unregulated ACE₂ and dipeptidyl peptidase IV (DPP₄), a specific receptor of this virus has a higher rate of expression in COPD patients.²⁰

The prevalence of malignancy was 0.3 % in the study. It was 1%, 1.5%, 2.4% and 1.2% in studies carried by Chen et al, Kui et al, Huang et al, Wu et al respectively.^2,11,13,19 It was higher i.e. 7.2% in study conducted by Wang et al.¹⁴

Thus, it provides a tool for planning preventive and supportive services to patients. It is very important for healthcare policy makers to form strict guidelines to prevent novel corona virus infection transmission mainly in vulnerable people with hypertension, diabetes mellitus, CKD, IHD, COPD, CVD and malignancy like social distancing, washing hands, wearing mask etc.

The knowledge and understanding of prevalence of co-morbidities with COVID-19 help clinicians for timely interventions for management of COVID-19 disease and control of these co-morbidities.

CONCLUSION

It has been concluded that various co-morbidities are present in patients with COVID-19 which may worsen the clinical outcome. So, more attention is to be given to COVID patients with co-morbidities.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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