Comorbidity status of deceased COVID-19 in-patients in Italy

Abstract

Background Most COVID-19-related deaths have occurred in older persons with comorbidities. Specific patterns of comorbidities related to COVID-19 deaths have not been investigated. Methods A random sample of 6085 individuals in Italy who died in-hospital with confirmed COVID-19 between February and December 2020 were included. Observed to expected (O/E) ratios of disease pairs were computed and logistic regression models were used to determine the association between disease pairs with O/E values ≥ 1.5. Results Six pairs of diseases exhibited O/E values ≥ 1.5 and statistically significant higher odds of co-occurrence in the crude and adjusted analyses: (1) ischemic heart disease and atrial fibrillation, (2) atrial fibrillation and heart failure, (3) atrial fibrillation and stroke, (4) heart failure and COPD, (5) stroke and dementia, and (6) type 2 diabetes and obesity. Conclusion In those deceased in-hospital due to COVID-19 in Italy, disease combinations defined by multiple cardio-respiratory, metabolic, and neuropsychiatric diseases occur more frequently than expected. This finding indicates a need to investigate the possible role of these clinical profiles in the chain of events that lead to death in individuals who have contracted SARS-CoV-2.

Outcome of SARS CoV-2 inpatients treated with convalescent plasma: One-year of data from the Veneto region (Italy) Registry

“…Of the 1,517 patients treated with CCP, 209 deceased (14%). Besides higher age, presence of comorbidities including arterial hypertension, cardiovascular disease, chronic kidney disease, dyslipidemia, obesity and cancer resulted to be predictive of poor outcome, thus confirming the results of previous studies [23] , [24] , [25] .…”

Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection

“…However, our findings are in keeping with the large data analysis conducted by the Italian Superior Institute of Health (ISS) (10). That analysis found that cardiovascular disease, metabolic conditions, COPD, stroke and dementia were the most frequent diseases associated with COVID-19-related mortality in older patients.…”

“…Recently, in a large Italian case series, Vetrano et al (10) showed that specific comorbidities, including cardiovascular diseases, metabolic conditions and dementia, co-occurred in older patients who died from COVID-19. These clusters of comorbidities may be a clinical indication of worse COVID-19 prognosis.…”

“…In the Neurocognitive cluster, dementia and stroke emerged as a particular disease clustering with the highest mortality. Dementia often develops as the result of stroke, and both conditions share common cardiovascular risk factors (10). In addition, both dementia and stroke are known risk factors for advanced clinical frailty in very old individuals, reflecting the massive burden of diseases related to severe COVID-19 complications and mortality (15).…”

“…In addition, both dementia and stroke are known risk factors for advanced clinical frailty in very old individuals, reflecting the massive burden of diseases related to severe COVID-19 complications and mortality (15). Similarly, the presence of cardiovascular diseases may be responsible for an impaired hemodynamic response to COVID-19 infection with the development of acute organ decompensation, poorer cardiovascular fitness, and higher rate of hospitalization and unfavorable clinical outcomes, including mortality (10)(11)(12)(13)(14)(15)(16).…”