DISCUSSION
Our findings showed that myocardial infarction (OR 3.57 ;95% CI
1.49-8.56; p: 0.004), diabetes mellitus (OR 2.41; 95% CI 1.17-4.97; p:
0.017), and renal disease (OR 5.18 ; 95% confidence CI 2.07-12.97; p
<0.001) are significant prognostic factors for short-term
mortality in COVID-19 patients. Multiple comorbidities are associated
with the severity of COVID-19 disease progression. These findings
support a prior systematic review that demonstrated that patients with
COVID-19 disease who also have comorbidities such as hypertension or
diabetes mellitus are more likely to acquire a more severe course and
progression of the disease. Older patients, particularly those 65 years
and older who have comorbidities and are infected, have a higher
likelihood of ICU admission and mortality from
COVID-19.9 Age-related immune cell defects associated
with a more vigorous inflammatory response have been proposed as a
possible explanation for the elderly’s increased
mortality.10
Numerous poor outcomes associated with COVID-19 have been linked to
cardiovascular disease. This, however, may be a direct outcome of
cardiovascular disease or may be a result of other comorbidities
occurring concurrently with the cardiovascular
disease.11 The pathophysiology behind the connection
between cardiovascular disease and COVID-19 is unclear, although they
may involve infection-related demand ischemia that progresses to
myocardial injury or dysfunction or a viral-induced inflammatory storm
that results in shock and subsequent ischemic injury. Additionally, a
recent case report discovered evidence of myocardial infection caused
directly by the virus.12
Type 2 diabetes patients were also more likely to have a more severe
COVID-19 infection. The results of a prior cohort study of 7337 patients
with COVID-19 who had type 2 diabetes and those who did not demonstrate
that individuals with type 2 diabetes required more interventions during
their hospital stay compared to those who did not.11Patients with poor blood glucose control showed a significantly higher
overall death rate than those with proper glucose
control.13 Numerous mechanisms have been proposed to
link diabetes and COVID-19, including a weakened immune system, a
pre-existing proinflammatory state, direct pancreatic injury, and
dysregulation of angiotensin-converting enzyme 2 (ACE2)
signaling.14,15
A previous study indicated that COVID-19 patients with renal disease had
a higher mortality rate, with stage 2 and stage 3 AKI patients having a
3.5- and 4.7-fold greater mortality, respectively than those with normal
kidney function.16 COVID-19’s specific
pathophysiologic link with kidney disease is uncertain. However, ACE2
appears to have a role. ACE2 has been identified as the receptor for
SARS-CoV-1 and was recently confirmed as a cell entry receptor for
SARS-CoV-2.17,18 ACE2s are expressed in a wide variety
of organs, most notably the gastrointestinal tract and kidney. ACE2
expression is about 100 times more in the kidneys than in the lungs in
human tissue RNA sequencing; consequently, kidneys with substantial ACE2
expression may be the primary target of SARS-CoV-2
infection.19 Past studies examining the renal
histopathologic findings in COVID-19 support the hypothesis of SARS-CoV
infection occurring directly in the kidney.20,21
COPD was not found to be a significant predictive factor in our study.
This is in contrast to earlier studies. Among other comorbidities,
chronic obstructive pulmonary disease (COPD) has been linked to a poor
prognosis. A meta-analysis of multiple studies conducted in China
indicated that patients with pre-existing COPD identified with COVID-19
had a fourfold increase in death. The smoking status of patients and the
severity of COVID-19 were not considered in this investigation. Only one
previous study discovered a link between smoking and a severe course of
COVID-19.22
When age and sex were adjusted for, a higher Charlson Comorbidity Index
score was associated with an increased risk of severe COVID-19 and
short-term mortality. This study adds to prior research indicating that
individual comorbidities are independent risk factors for poor COVID-19
outcomes.23,24 Our findings may help guide epidemic
modeling, public health, and clinical decisions about the COVID-19
pandemic’s management. As a result, individuals with comorbidities
should take all necessary precautions to avoid contracting SARS CoV-2,
as they typically have a poor prognosis.
Numerous limitations apply to this study. First, it was based on the
results of a retrospective analysis of medical records, which may have
been lacking in information about symptoms and prior conditions. Second,
this study focused only on a short-term prognosis. Additional research
is needed to establish the effect of comorbidities on COVID-19 outcomes
and determine whether other validated comorbidity indexes can accurately
predict poor COVID-19 outcomes.