Insights into comorbidities, complications, and severity scores in hospitally admitted coronavirus disease 2019 patients: can the outcome be predicted?

Background
Pre-existing clinical conditions, such as cardiovascular diseases, diabetes, cancer, and others, have been described to possibly modulate the immune responses and host–viral interactions, and increase patients’ risk for severe forms of coronavirus disease 2019 (COVID-19) and poor outcomes.


Objective
This study aimed to investigate the relationship between comorbidities, complications, and outcomes among COVID-19 patients.


Patients and methods

A prospective cohort study (
n
=218) was carried out at the isolation unit of Assiut University Hospitals. Infection by severe acute respiratory syndrome coronavirus 2 was confirmed by real-time reverse transcription PCR. Demographic characteristics, clinical symptoms, pre-existing comorbidities, laboratory data, and arterial blood gas analysis were all documented and analyzed. Imaging modalities, Sequential Organ Failure Assessment (SOFA) score, Pneumonia Severity Index, and CURB-65 score were applied. Complications and patients’ outcomes were recorded.



Results

Hypertension, diabetes mellitus, and ischemic heart disease were significantly higher among nonsurvivors. Significant predictors associated with mortality were: pre-existing comorbid disease (
P
=0.034), low mean blood pressure; low levels of PaO
2
and PaO2/FiO
2
at admission (
P
=0.004,
P
=0.034,
P
˂0.001, respectively); occurrence of complications (
P
=0.004); increased level of serum ferritin (
P
=0.045). The diagnostic accuracy for prediction of mortality for SOFA score, Pneumonia Severity Index, CURB-65, neutrophil lymphocyte ratio, serum ferritin, D-dimer, and PaO
2
/FiO
2
was 79, 75.5, 71, 78, 68, 60.5, and 73.5%, respectively at cut off points more than 8, more than 99, more than 2, more than 10, more than 870, more than 1, less than 138, respectively.



Conclusion
The existence of certain comorbidities and complications significantly influences the outcomes of COVID-19 patients. Notably, low mean blood pressure, low PaO2, and low PaO2/FiO2 at admission, duration of ICU stay, occurrence of complications, serum ferritin, and SOFA score were all factors related to mortality. This study highlights the importance of individualized patient care and the need for early recognition of severity and mortality predictors to improve patients’ outcome.