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.