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COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan’s population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19.
COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups.
A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender.
This study identified fever (1592/1812, 87.9%), cough (1433/1812, 79.1%), and shortness of breath (998/1812, 55.1%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4% (n=443) required ICU admission and 21.5% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality.
Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes.
COVID-19 is a worldwide pandemic that has proliferated across the globe since its spread from Wuhan, China, in December 2019 [
As of December 11, 2020, the total number of COVID-19 cases worldwide was 71,070,927, with 49,384,495 recoveries; 1,594,772 deaths; and 20,091,660 active cases awaiting outcomes [
There is a lack of standardized treatment regimens because of varying symptoms associated with COVID-19 infections. The treatment so far has been symptomatic or supportive therapy instead of fixed regimens. A retrospective cohort study on hospitalized patients in China revealed that more men (median age 56 years) than women required intensive care unit (ICU) facilities and had a 28% mortality rate [
We analyzed the characteristics and outcomes of patients; these were correlated with the number and types of comorbidities as indicators of COVID-19 severity and prognostic values in pandemic viral infectious diseases, such as COVID-19. More studies are required to assess the clinical manifestations associated with COVID-19 infections, as well as the time and duration of each symptom after viral invasion, in order to provide concrete data about the course of action needed to counter or avoid symptoms by taking necessary prophylactic steps, especially among high-risk patients.
This retrospective study was conducted using clinical data acquired from 1812 patients with confirmed COVID-19 who were admitted to four major tertiary care hospitals in Islamabad-Rawalpindi from February to August 2020. The Islamabad-based hospitals were Pakistan Air Force Hospital and Pakistan Institute of Medical Sciences Hospital; the Rawalpindi-based hospitals were Holy Family Hospital and Benazir Bhutto Shaheed Hospital. The study was approved by the ethics review board of Rawalpindi Medical University before data collection, and the data were collected with approval from the National Institute of Health, Pakistan, by HA and SA. In addition to this, the data were systematically organized and recorded using a standardized data collection form specifically designed for the study.
Diagnosis of COVID-19 was confirmed using a polymerase chain reaction (PCR) test on nasal and oropharyngeal swab samples taken at the time of admission to the hospital. A detailed medical history was collected for each patient, including age, gender, exposure history, and clinical manifestations of COVID-19, including fever, cough, and respiratory symptoms. A total of 12 comorbidities were each marked as absent or present and these were categorized into four groups: (1) absence of comorbidities, (2) presence of one comorbidity, (3) presence of two comorbidities, and (4) presence of more than two comorbidities. Communicable comorbidities included hepatitis C (Hep C) and tuberculosis (TB). Noncommunicable disease comorbidities included hypertension (HT), diabetes mellitus (DM), cardiovascular diseases (CVDs), asthma, chronic kidney disease (CKD), nervous system disorders (NSDs), chronic obstructive pulmonary disorder (COPD), cancer, allergies, and anemia. A number of other chronic and acute conditions, such as rheumatoid arthritis, typhoid, stomach ulcers, hypothyroidism, and musculoskeletal injuries, were also reported and were grouped together as a 13th category termed “others.”
The study was performed in line with the Declaration of Helsinki. Patients with COVID-19 who had immunological diseases or missing data were excluded from the analysis to avoid any confounding factors affecting the inflammatory markers assessed in this study.
COVID-19 severity was classified into two groups based on symptoms of patients within the first week of COVID-19 infection: (1) mild to moderate, including patients with fever, cough, and oxygen saturation of 90% or greater on room air along with other symptoms consistent with COVID-19, and (2) severe to critical, including patients with dyspnea (ie, oxygen saturation of less than 90% on room air), pneumonia, and varying degrees of respiratory distress (ie, respiratory rate >30 breaths/min), along with other symptoms. Clinical outcomes studied were COVID-19 severity, requirement of ICU admission, requirement of ventilator, and mortality. This classification was based on WHO guidelines regarding the clinical management of patients with COVID-19 [
Chest radiographs and computed tomography scans, including presence or absence of ground-glass or crazy-paving appearance, were noted. Moreover, hematological and biochemical parameters, including blood complete picture, serum ferritin, liver function test, creatinine, and a few others, were also recorded to assist in categorizing the patients. PCR test results of the patients and clinical outcomes, such as admission to ICU, requirement for noninvasive or invasive ventilation provided at the hospital at some stage of disease progression, and mortality, were also recorded.
Statistical analysis was conducted using SPSS Statistics for Windows (version 24; IBM Corp). Categorical variables were described using frequencies and percentages. We used
This retrospective study included a total of 1812 patients; 69.2% (n=1253) of the patients were male. Patients included in the study ranged in age from 1 to 79 years, with a mean age of 47.32 years. The percentage of patients in the severe to critical group increased with age: 9.8% (31/315) were less than 30 years of age, 59.8% (177/296) were 60 to 69 years of age, and 74.5% (155/208) were 70 years of age or older. Nevertheless, of the 1812 patients with COVID-19 who were admitted to the one of the four hospitals, upon admission, 1153 (63.6%) fell into the category of mild to moderate COVID-19 infection, whereas 659 (36.4%) patients fell into the severe to critical category. Of these 659 patients, some went on to require admission to ICU (n=443) or ventilator support (n=390) during their stay at the hospital, some recovered and were discharged, and some passed away (n=469). Interestingly, we observed equivalent prevalence of male and female patients in the mild to moderate and the severe to critical categories of patients with COVID-19.
In addition to this, regarding the frequency of comorbidities among 1812 patients, 884 patients (48.8%) had none, 364 patients (20.1%) had one, 335 patients (18.5%) had two, and 229 patients (12.6%) had more than two. The most prevalent comorbidity was HT (n=625, 34.5%), followed by DM (n=532, 29.4%), CVDs (n=243, 13.4%), asthma (n=93, 5.1%), CKD (n=93, 5.1%), Hep C (n=84, 4.6%), TB (n=35, 1.9%), NSDs (n=30, 1.7%), COPD (n=18, 1.0%), cancer (n=13, 0.7%), allergies (n=13, 0.7%), and anemia (n=12, 0.7%) (
Moreover, the prevalence of comorbidity stayed higher than 60% for all types in the severe to critical COVID-19 infection category. The prevalence was significant for all types of comorbidities included in this study, except for allergies. Surprisingly, only 111 patients out of 884 (12.6%) with no comorbidities were admitted to hospital or moved into the severe to critical category; this increased to 48.4% (176/364) for patients with a single comorbidity, 60.9% (204/335) for patients with two comorbidities, and 72.5% (166/229) for patients with more than two comorbidities; these results were significant.
Basic demographic characteristics and COVID-19 severity in hospitalized patients.
Variables | Total cases (N=1812), n (%)a | COVID-19 severity, n (%)b | ||||
|
Mild to moderate | Severe to critical |
|
|||
Cases (N=1812) | 1812 (100) | 1153 (63.6) | 659 (36.4) | N/Ac | ||
|
||||||
|
<30 | 315 (17.4) | 284 (30.2) | 31 (9.8) | <.001d | |
|
30-49 | 653 (36.0) | 510 (78.1) | 143 (21.9) |
|
|
|
50-59 | 340 (18.8) | 187 (55.0) | 153 (45.0) |
|
|
|
60-69 | 296 (16.3) | 119 (40.2) | 177 (59.8) |
|
|
|
≥70 | 208 (11.5) | 53 (25.5) | 155 (74.5) |
|
|
|
||||||
|
Male | 1253 (69.2) | 801 (63.9) | 452 (36.0) | .70 | |
|
Female | 559 (30.8) | 352 (63.0) | 207 (37.0) |
|
|
|
||||||
|
None | 884 (48.8) | 773 (87.4) | 111 (12.6) | <.001 | |
|
1 | 364 (20.1) | 186 (51.1) | 176 (48.4) |
|
|
|
2 | 335 (18.5) | 131 (39.1) | 204 (60.9) |
|
|
|
>2 | 229 (12.6) | 63 (27.5) | 166 (72.5) |
|
|
|
||||||
|
Hypertension | 625 (34.5) | 248 (39.7) | 377 (60.3) | <.001 | |
|
Diabetes mellitus | 532 (29.4) | 201 (37.8) | 331 (62.2) | <.001 | |
|
Cardiovascular diseases | 243 (13.4) | 80 (32.9) | 163 (67.1) | <.001 | |
|
Asthma | 93 (5.1 ) | 29 (31.2) | 64 (68.8) | <.001 | |
|
Chronic kidney disease | 93 (5.1) | 32 (34.4) | 61 (65.6) | <.001 | |
|
Hepatitis C | 84 (4.6) | 33 (39.3) | 51 (60.7) | <.001 | |
|
Tuberculosis | 35 (1.9) | 11 (31.4) | 24 (68.6) | <.001 | |
|
Nervous system disorders | 30 (1.7) | 7 (23.3) | 23 (76.7) | <.001 | |
|
Chronic obstructive pulmonary disorder | 18 (1.0) | 2 (11.1) | 16 (88.9) | <.001 | |
|
Cancer | 13 (0.7) | 4 (30.8) | 9 (69.2) | .01 | |
|
Allergies | 13 (0.7) | 5 (38.5) | 8 (61.5) | .06 | |
|
Anemia | 12 (0.7) | 2 (16.7) | 10 (83.3) | .001 | |
|
Others | 84 (4.6 ) | 22 (26.2) | 62 (73.8) | <.001 |
aPercentages in this column are based on the total number of patients (N=1812).
bPercentages in these columns are based on the number of patients reported in the respective rows in the “Total cases” column.
cN/A: not applicable; a
dThe
The frequency of clinical manifestations in the form of fever, cough, dyspnea, anosmia, ageusia, sore throat, and others are shown in
Indicators of severity varied among 1812 patients included in this study. A total of 443 (24.4%) patients required ICU admission, and 390 (21.5%) required ventilator aid at some point of disease progression during their stay at the hospital. Nevertheless, 469 (25.9%) patients died with or without ICU admission or ventilator aid.
A significant increase in ICU admissions, ventilator aid events, and mortality was observed with an increase in age and number of comorbidities. No significant differences in ICU admission, ventilator aid events, and mortality were observed between males and females. A significant increase in ICU admissions, ventilator aid events, and mortality was observed with the presence of any type of studied comorbidity, except for allergies.
Patients with no known comorbidities had minimal requirements for ICU admission (47/884, 5.3%), ventilator aid events (34/884, 3.8%), and mortality (50/884, 5.7%); these proportions were approximately 10 times higher with patients who had two or more comorbidities. Delving into each type of comorbidity revealed that approximately half of the patients with any type of comorbidity required ICU admission with or without ventilator aid, and a significant number of them expired.
Prevalence of reported signs and symptoms in patients with COVID-19 at the time of hospital admission.
Signs and symptoms | Patients experiencing these signs and symptoms (N=1812), n (%) |
Chest pain | 45 (2.5) |
Headache | 81 (4.5) |
Nausea or vomiting | 115 (6.3) |
Diarrhea | 130 (7.2) |
Flu | 150 (8.3) |
Body aches, fatigue, or malaise | 490 (27.0) |
Sore throat | 499 (27.5) |
Anosmia or ageusia | 809 (44.6) |
Dyspnea | 998 (55.1) |
Cough | 1433 (79.1) |
Fever | 1592 (87.9) |
Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, ICU admission, ventilator aid, and mortality. Factors such as age, gender, and number and types of comorbidities were included, except for anemia, which was excluded due to small sample size.
Our results indicate that old age was a significant indicator of COVID-19 severity, ICU admission, ventilator aid, and mortality. Although our data reported a greater number of male patients, male gender had no significant relationship with COVID-19 severity, ICU admission, ventilator aid, and mortality.
In addition, the results of this study revealed that an increase in the number of comorbidities was a significant predictor of COVID-19 severity, ICU admission, ventilator aid, and mortality. HT, DM, COPD, CKD, and asthma were significant predictors COVID-19 severity, ICU admission, ventilator aid, and mortality. NSDs, on the other hand, were a significant predictor of COVID-19 severity, ICU admission, and mortality, but not ventilator aid. TB was a significant predictor of COVID-19 severity and ICU admission, but not ventilator aid and mortality. In addition, Hep C and cancer were both significant predictors of ventilator aid and mortality, whereas CVDs were only a significant predictor of mortality. Presence of allergies was not a significant predictor of any of the study outcomes.
Clinical outcomes of patients with COVID-19.
Variables | Total cases (N=1812), n (%)a | ICUb admission, n (%)c | Ventilator aid, n (%)c | Mortality, n (%)c | |||||||||||
Cases (N=1812) | 1812 (100) | 443 (24.4) | N/Ad | 390 (21.5) | N/A | 469 (25.9) | N/A | ||||||||
|
|||||||||||||||
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<30 | 315 (17.4) | 22 (7.0) | <.001 | 17 (5.4) | <.001 | 19 (6.0) | <.001 | |||||||
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30-49 | 653 (36.0) | 84 (12.9) | <.001 | 75 (11.5) | <.001 | 88 (13.5) | <.001 | |||||||
|
50-59 | 340 (18.8) | 101 (29.7) | <.001 | 90 (26.5) | <.001 | 100 (29.4) | <.001 | |||||||
|
60-69 | 296 (16.3) | 126 (42.6) | <.001 | 109 (36.8) | <.001 | 135 (45.6) | <.001 | |||||||
|
≥70 | 208 (11.5) | 110 (52.9) | <.001 | 99 (47.6) | <.001 | 127 (61.1) | <.001 | |||||||
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Male | 1253 (69.2) | 297 (23.7) | .27e | 263 (21.0) | .41 | 313 (25.0) | .19 | |||||||
|
Female | 559 (30.8) | 146 (26.1) |
|
127 (22.7) |
|
156 (27.9) |
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|||||||||||||||
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None | 884 (48.8) | 47 (5.3) | <.001 | 34 (3.8) | <.001 | 50 (5.7) | <.001 | |||||||
|
1 | 364 (20.1) | 124 (34.4) | <.001 | 110 (30.2) | <.001 | 126 (34.6) | <.001 | |||||||
|
2 | 335 (18.5) | 141 (42.1) | <.001 | 128 (38.2) | <.001 | 147 (43.9) | <.001 | |||||||
|
>2 | 229 (12.6) | 131 (57.2) | <.001 | 118 (51.5) | <.001 | 146 (63.8) | <.001 | |||||||
|
|||||||||||||||
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Hypertension | 625 (34.5) | 274 (43.8) | <.001 | 245 (39.2) | <.001 | 294 (47.0) | <.001 | |||||||
|
Diabetes mellitus | 532 (29.4) | 235 (44.2) | <.001 | 207 (38.9) | <.001 | 245 (46.1) | <.001 | |||||||
|
Cardiovascular diseases | 243 (13.4) | 123 (50.6) | <.001 | 112 (46.1) | <.001 | 135 (55.6) | <.001 | |||||||
|
Asthma | 93 (5.1 ) | 51 (54.4) | <.001 | 45 (48.4) | <.001 | 53 (57.0) | <.001 | |||||||
|
Chronic kidney disease | 93 (5.1) | 50 (53.8) | <.001 | 47 (50.5) | <.001 | 56 (60.2) | <.001 | |||||||
|
Hepatitis C | 84 (4.6) | 37 (44.0) | <.001 | 32 (38.1) | <.001 | 44 (52.4) | <.001 | |||||||
|
Tuberculosis | 35 (1.9) | 21 (60.0) | <.001 | 17 (48.6) | <.001 | 18 (51.4) | <.001 | |||||||
|
Nervous system disorders | 30 (1.7) | 19 (63.3) | <.001 | 16 (53.3) | <.001 | 21 (70.0) | <.001 | |||||||
|
Chronic obstructive pulmonary disorder | 18 (1.0) | 15 (83.3) | <.001 | 16 (88.9) | <.001 | 16 (88.9) | <.001 | |||||||
|
Cancer | 13 (0.7) | 7 (53.8) | .01 | 7 (53.8) | .004 | 9 (69.2) | <.001 | |||||||
|
Allergies | 13 (0.7) | 6 (46.2) | .07 | 6 (46.2) | .03 | 6 (46.2) | .09 | |||||||
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Anemia | 12 (0.7) | 10 (83.3) | <.001 | 10 (83.3) | <.001 | 10 (83.3) | <.001 | |||||||
|
Others | 84 (4.6 ) | 51 (60.7) | <.001 | 48 (67.1) | <.001 | 54 (64.3) | <.001 |
aPercentages in this column are based on the total number of patients (N=1812).
bICU: intensive care unit.
cPercentages in this column are based on the number of patients reported in the respective rows in the “Total cases” column.
dN/A: not applicable; a
eThe
Multivariate analysis of factors associated with COVID-19 severity and clinical outcomes of patients with COVID-19.
Covariates | COVID-19 severity | ICUa admission | Ventilator aid | COVID-19 mortality | ||||||||||||||
ORb (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |||||||||||||||
|
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30-49 | 1.9 (1.2-2.9) | .004 | 1.4 (0.8-2.4) | .19 | 1.6 (0.9-2.9) | .09 | 1.8 (1.0-3.1) | .04 | |||||||||
|
50-59 | 3.5 (2.2-5.6) | <.001 | 2.6 (1.5-4.5) | <.001 | 2.9 (1.7-5.3) | <.001 | 3.1 (1.8-5.6) | <.001 | |||||||||
|
60-69 | 5.1 (3.2-8.3) | <.001 | 3.8 (2.2-6.6) | <.001 | 3.9 (2.1-7.0) | <.001 | 5.4 (3.0-9.7) | <.001 | |||||||||
|
≥70 | 11.0 (6.4-18.7) | <.001 | 5.9 (3.3-10.4) | <.001 | 6.3 (3.4-11.6) | <.001 | 10.7 (5.9-19.5) | <.001 | |||||||||
Gender (male vs female) | 0.9 (0.7-1.2) | .68 | 1.1 (0.8-1.4) | .55 | 1.1 (0.8-1.4) | .71 | 1.2 (0.9-1.5) | .30 | ||||||||||
|
||||||||||||||||||
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1 | 4.6 (3.4-6.2) | <.001 | 6.9 (4.7-10.1) | <.001 | 8.2 (5.3-12.6) | <.001 | 6.2 (4.3-9.0) | <.001 | |||||||||
|
2 | 6.8 (4.9-9.5) | <.001 | 8.8 (5.9-13.1) | <.001 | 10.8 (7.0-16.7) | <.001 | 8.2 (5.6-12.0) | <.001 | |||||||||
|
>2 | 10.8 (7.2-16.0) | <.001 | 14.9 (9.7-23.0) | <.001 | 17.4 (10.8-27.8) | <.001 | 16.9 (11.0-26.1) | <.001 | |||||||||
|
||||||||||||||||||
|
Diabetes mellitus | 2.3 (1.7-3.0) | <.001 | 1.8 (1.4-2.4) | <.001 | 1.7 (1.3-2.2) | <.001 | 1.6 (1.2-2.2) | <.001 | |||||||||
|
Hypertension | 1.9 (1.5-2.5) | <.001 | 2.0 (1.5-2.7) | <.001 | 2.0 (1.5-2.7) | <.001 | 2.0 (1.5-2.7) | <.001 | |||||||||
|
Cardiovascular diseases | 1.4 (1.0-2.0) | .08 | 1.4 (1.0-1.9) | .08 | 1.4 (1.0-2.0) | .054 | 1.5 (1.1-2.2) | .02 | |||||||||
|
Chronic kidney disease | 2.1 (1.3-3.5) | .005 | 2.5 (1.5-4.1) | <.001 | 2.7 (1.6-4.4) | <.001 | 3.3 (2.0-5.4) | <.001 | |||||||||
|
Asthma | 2.4 (1.4-4.0) | .001 | 2.4 (1.5-4.0) | <.001 | 2.1 (1.3-3.5) | .003 | 2.4 (1.5-4.0) | <.001 | |||||||||
|
Tuberculosis | 2.6 (1.1-6.2) | .03 | 3.3 (1.4-7.5) | .005 | 2.1 (0.9-4.6) | .08 | 1.6 (0.7-3.8) | .27 | |||||||||
|
Cancer | 3.0 (0.7-12.8) | .13 | 2.7 (0.7-10.1) | .15 | 3.3 (0.9-12.4) | <.001 | 6.3 (1.5-26.2) | .01 | |||||||||
|
Nervous system disorders | 6.7 (2.6-17.6) | <.001 | 6.2 (2.7-14.7) | <.001 | 4.5 (2.0-10.4) | .82 | 8.5 (3.4-21.1) | <.001 | |||||||||
|
Allergies | 1.0 (0.2-4.3) | .96 | 0.9 (0.2-3.4) | .84 | 1.2 (0.3-4.5) | .54 | 0.7 (0.2-2.7) | .58 | |||||||||
|
Hepatitis C | 1.4 (0.8-2.4) | .18 | 1.3 (0.8-2.1) | .39 | 1.2 (0.7-2.0) | <.001 | 1.8 (1.1-3.0) | .03 | |||||||||
|
Chronic kidney disease | 8.2 (1.7-40.3) | .01 | 10.2 (2.6-40.3) | .001 | 21.7 (4.5-104.8) | <.001 | 17.5 (3.6-86.2) | <.001 | |||||||||
|
Others | 2.8 (1.6-5.1) | <.001 | 2.9 (1.7-4.9) | <.001 | 3.0 (1.8-5.1) | <.001 | 3.2 (1.9-5.5) | <.001 |
aICU: intensive care unit.
bOR: odds ratio.
COVID-19 was declared a pandemic at the start of 2020 after emerging in December 2019 in Wuhan, China [
In our study, the most prevalent presenting symptoms at the time of hospital admission were fever, cough, and shortness of breath. Anosmia, ageusia, sore throat, body aches, fatigue, and malaise were relatively less common presenting symptoms, whereas diarrhea, nausea, and vomiting were the least prevalent presenting symptoms reported by patients at the time of admission. One or more comorbidities, especially HT and DM, were more prevalent among older adults according to our results. Mild to moderate COVID-19 symptoms were highly prevalent in younger groups. These findings were in accordance with those of other studies around the world [
Two of the most significant findings of this study were related to the age and comorbidity of the patients, which can be explained as age-dependent weakened functionality of cell-mediated immunity with a decline in humoral immune support [
Moreover, following cell entry of SARS-CoV-2, a cascade of events leading to replication of viral nucleic acid and release of mature virus particles from the cell ensues, resulting in stimulation of the host’s humoral and cellular immunity. Uncontrolled, systemic release of proinflammatory cytokines and chemokines as a part of the host immune response to SARS-CoV-2 infection results in a highly toxic “cytokine storm,” or cytokine release syndrome, which is another hallmark of COVID-19 [
Similarly, several other meta-analyses reported that HT, DM, CVDs, and CKD were independent risk factors in patients with COVID-19 and indicators of poor prognosis [
Multivariate analysis of results revealed that increased age of patients and the number of comorbidities were significantly associated with increased odds of COVID-19 severity, ICU admission, ventilator aid, and mortality. This establishes the fact that older patients with underlying conditions are not only at a higher risk of developing infection, but may also be at risk of severe progression that requires ventilator aid, which may result in death. No significant differences were found between males and females with respect to the odds of COVID-19 severity, ICU admission, ventilator aid, and mortality. Although HT and DM were the most prevalent among all comorbidities studied, with proportions of 34.5% and 29.4%, respectively, the mortality rates for all comorbidities were significantly higher, and were higher still among patients with two or more comorbidities, with an odds ratio (OR) of 16.9. Nevertheless, all comorbidities examined in this study had relatively higher ORs with respect to ICU admission, ventilator aid, and mortality, emphasizing the importance of considering these factors during COVID-19 treatment protocols.
In short, the COVID-19–associated downregulation of ACE-2, leading to an imbalance of RAAS, combined with an age-dependent impaired immune response and chronic inflammation in older patients, may lead to adverse clinical outcomes. Moreover, the likelihood of the presence of one or multiple chronic underlying comorbidities also increases with age, which may further contribute to a poor prognosis for older patients with COVID-19. Our findings are in line with several studies that have established old age to be a significant predictor of COVID-19 severity, ICU admission, ventilator aid, and mortality [
The ever-evolving nature of viruses makes them a difficult target for drug design and targeted therapies. In such confusing times, large studies monitoring several factors that might be associated in disease progression and severity are important for clarifying the picture and helping in the development of effective and targeted drugs and vaccines. Moreover, such studies help in the identification of high-risk groups that might have a more severe disease progression and may need a different treatment regime than others. In the current situation, most of the major government directives and guidelines are designed to help curtail the number of COVID-19 cases. These measures are focused on the following: (1) preventive strategies to control the rate of infection, where people are encouraged to take suitable preventative measures, such as improvement of hand hygiene, use of facial masks, and social distancing, and (2) management strategies, where patients who test positive with COVID-19 and report mild to moderate symptoms are directed to follow isolation protocols at home, are directed to monitor their progress by themselves while staying in contact with health care workers remotely via telephone, and are encouraged to report to hospitals only if severe symptoms manifest [
angiotensin-converting enzyme 2
chronic kidney disease
chronic obstructive pulmonary disorder
cardiovascular disease
diabetes mellitus
hepatitis C
hypertension
intensive care unit
nervous system disorder
odds ratio
polymerase chain reaction
renin-angiotensin-aldosterone system
real-time reverse transcription–polymerase chain reaction
tuberculosis
World Health Organization
None declared.