Association of chronic diseases with mortality among hospitalized patients with COVID-19 treated with convalescent plasma: Evidence from a single center – Iraq

Abstract

Objective/Background: While there is no universal agreement on the benefits of convalescent plasma (CP) in the treatment of COVID-19 infection, very little is known about whether CP affects the association between chronic diseases and mortality. It is known that chronic diseases are associated with worse outcomes, but it is not clear whether the transfusion of CP impacts this association. This study aims to evaluate this impact considering that few studies have discussed the treatment of COVID-19 patients with CP. Methods: A cross-sectional study was conducted among COVID-19 patients treated with CP at the main hospital for treatment and isolation of COVID-19 in Anbar/Iraq during the period of May to August 2020. A questionnaire on socio-demographic characteristics, smoking, and contact with COVID-19 was conducted. The presence of comorbidity, especially hypertension, heart failure, coronary artery disease, diabetes mellitus, chronic pulmonary diseases, asthma, and the hospital outcome (discharged home alive or cure/death) were included. The Chi-square test (or Fisher's exact test) was used to measure the association between comorbidity with the outcome. Logistic regression was used to assess the main predictors for cure (discharged home alive) and death outcome. Results: The mean age of the subjects was (53.05 ± 15.16), with a higher death rate among the older age group, especially those over 60-year with non-survivors at age of 65 or more. There was a statistically significant association between the presence of comorbidity and the mortality rate (P < 0.001). Subjects with chronic disease had a 5 times higher risk for death due to COVID-19 in comparison to those without the chronic disease (OR = 5.8, C.I. = 2.01-16.96, P = 0.001), hypertension showed the highest predictor (C.I = 1.43- 22.29, p = 0.013). Smoking and gender were not associated with mortality. Conclusion: The present study found a high mortality rate among COVID-19 patients treated with CP, specially for those with age over 60, or with comorbidities.

A systematic review and meta-analysis on the prevalence and impact of coronary artery disease in hospitalized COVID-19 patients

“…Using leave-one-out analysis, three studies were identified as influential studies with an effect of 3.9% [ 41 ], 5.6% [ 47 ], and 3.6% [ 68 ] above the overall estimate of CAD prevalence. The pooled prevalence got adjusted to 13.2% [95% CI: 11.9–14.6] with an I 2 of 97.8% [95% CI: 97.5–98.0] after removing these 3 influential studies and studies with a high risk of bias [ 47 , 79 , 93 ]( Appendix C _ fig. C.2 and C.3 ).…”

“…C4 ). Further analysis was performed, removing the high risk of bias study [ 93 ]. The adjusted OR was 2.63 [95% CI: 2.29–3.02] with an I 2 of 45.0% [95% CI: 10.2–66.3] ( Appendix C _ fig.…”

“…Numerous studies have reported that COVID-19 patients with CAD are at a higher risk of mortality [ [97] , [98] , [99] , [100] ]. A high increment in the prevalence of mortality was observed across included studies, with a prevalence rate ranging between 9% [ 33 ] and 100% [ 93 ]. A possible explanation can be drawn from the fact that the S1 sub-unit of the spike protein of severe acute respiratory syndrome (SARS-CoV-2) binds to the host cells through an angiotensin-converting enzyme (ACE2) which triggers coagulation pathways, vasoconstriction, myocarditis and fibrosis [ 101 ].…”

“…Based on the geographical distribution, the subgroup meta-analysis showed the highest pooled estimate of mortality with CAD in Asian studies compared to those conducted in Europe and the US. However, a lower pooled estimate of mortality was observed in Asian studies after removing the study with a high risk of bias [ 93 ](OR = 2.99 [1.5524; 5.7895], I 2 21.9%). As a result, taking into account the pooled estimate of mortality after removing the influential study could yield a reliable estimate.…”

Secondary bacterial infection in Adult Patients with COVID-19 in Iraq

“…Twenty-five to thirty percent of intensive care unit (ICU) patients contract a lower respiratory tract (LRT) infection caused by resistant bacteria, resulting in high rates of mortality (22-71%), morbidity, and death (8). There was a higher incidence of deaths attributable to COVID 19 among patients who had two or more chronic diseases compared to those who had no such diseases (9). Due to the effect of antibiotic use, the pattern of antibiotic resistance varies from one region to the next (10).…”