Background: Some patients with comorbidities and rapid disease progression have a poor prognosis.Aim: We aimed to investigate the characteristics of comorbidities and their relationship with disease progression and outcomes of COVID-19 patients.Methods: A total of 718 COVID-19 patients were divided into five clinical type groups and eight age-interval groups. The characteristics of comorbidities were compared between the different clinical type groups and between the different age-interval groups, and their relationships with disease progression and outcomes of COVID-19 patients were assessed.Results: Approximately 91.23% (655/718) of COVID-19 patients were younger than 60 years old. Approximately 64.76% (465/718) had one or more comorbidities, and common comorbidities included non-alcoholic fatty liver disease (NAFLD), hyperlipidaemia, hypertension, diabetes mellitus (DM), chronic hepatitis B (CHB), hyperuricaemia, and gout. COVID-19 patients with comorbidities were older, especially those with chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). Hypertension, DM, COPD, chronic kidney disease (CKD) and CVD were mainly found in severe COVID-19 patients. According to spearman correlation analysis the number of comorbidities was correlated positively with disease severity, the number of comorbidities and NAFLD were correlated positively with virus negative conversion time, hypertension, CKD and CVD were primarily associated with those who died, and the above-mentioned correlation existed independently of age. Risk factors included age, the number of comorbidities and hyperlipidaemia for disease severity, the number of comorbidities, hyperlipidaemia, NAFLD and COPD for the virus negative conversion time, and the number of comorbidities and CKD for prognosis. Number of comorbidities and age played a predictive role in disease progression and outcomes.Conclusion: Not only high number and specific comorbidities but also age are closely related to progression and poor prognosis in patients with COVID-19. These findings provide a reference for clinicians to focus on not only the number and specific comorbidities but also age in COVID-19 patients to predict disease progression and prognosis.Clinical Trial Registry: Chinese Clinical Trial Register ChiCTR2000034563.
Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients Dear editor , Follow-up studies in COVID-19 survivors have found persistent symptoms (fatigue, dyspnea, muscle pain et, al.), impaired pulmonary function, abnormal chest CT images in COVID-19 survivors even after 110 days and 6 month of follow-up. 1 , 2 Several studies also have reported that cardiac involvement, including myocardial edema, fibrosis, and cardiac dysfunction, detected by using multi-parameter cardiac magnetic resonance (CMR) techniques were identified in recovered COVID-19 patients during early convalescence. [3][4][5][6][7][8] However, whether COVID-19 has a continuous influence on the cardiovascular system in late convalescence is unknown. Therefore, we used traditional CMR sequences to evaluate cardiac abnormalities in late convalescence comprehensively, including cardiac function, myocardial deformation, and myocardial tissue characteristics, and explore its related risk factors.34 recovered COVID-19 patients at Chengdu Public Health Clinical Medical Centre were prospectively enrolled and followed-up from Jan 1 to Oct 20, 2020. Diagnosis and discharging of COVID-19 patients were based on guidelines of the Chinese Center for Disease Control and Prevention. 9 Six months after discharging from hospital, gadolinium enhanced CMR scan (1.5T, Signa HDxt; GE Medical systems, USA) was performed and 20 healthy controls were enrolled too. All the patients and healthy controls signed informed consent and the institutional ethics board of our institutes approved this study (No. 2020.43). Electrocardiography, echocardiography, laboratory test, and clinical characters at admission were collected. Cardiac abnormalities were defined as a combination of elevated myocardial enzyme and injury marker, abnormal echocardiographic and electrocardiographic results. Patients was divided into two subgroups, subgroup with/without cardiac abnormalities at admission.Biventricular function, myocardial deformation, myocardial edema and fibrosis were evaluated with postprocessing software Cvi42 (Circle Cardiovascular Imaging, Calgary, Canada). Cardiac dysfunction was a combination of left ventricular ejection fraction (LVEF) less than 50%, right ventricular ejection fraction (RVEF) less than 45%, and LV deformation dysfunction. CMR abnormalities was a combination of myocardial edema, fibrosis, and cardiac dysfunction.At admission, 23 (67.65%) patients had cardiac abnormalities, 7 (20.59%) patients had elevated myocardial enzyme, 2 (5.88%) patients had elevated myocardial injury maker, 3 (8.82%) and 20 (58.82%) patients reported abnormal echocardiographic and electrocardiographic results. None of these 34 patients reported cardiovascular-related symptoms or signs during follow-up.
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