Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study

Abstract

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a life-threatening respiratory disease with a high case fatality rate; however, its risk factors remain unclear. We aimed to explore the influence of demographic factors, clinical manifestations and underlying comorbidities on mortality in MERS-CoV patients. Retrospective chart reviews were performed to identify all laboratory-confirmed cases of MERS-COV infection in Saudi Arabia that were reported to the Ministry of Health of Saudi Arabia between 23 April 2014 and 7 June 2016. Statistical analyses were conducted to assess the effect of sex, age, clinical presentation and comorbidities on mortality from MERS-CoV. A total of 281 confirmed MERS-CoV cases were identified: 167 (59.4%) patients were male and 55 (20%) died. Mortality predominantly occurred among Saudi nationals and older patients and was significantly associated with respiratory failure and shortness of breath. Of the 281 confirmed cases, 160 (56.9%) involved comorbidities, wherein diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, end-stage renal disease and chronic kidney disease were significantly associated with mortality from MERS-CoV and two or three comorbidities significantly affected the fatality rates from MERS-CoV. The findings of this study show that old age and the existence of underlying comorbidities significantly increase mortality from MERS-CoV.

Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection

“…Clinical and epidemiological analyses have identified preexisting comorbidities, including diabetes, as important risk factors for the development of severe or lethal disease following MERS-CoV infection (7,(12)(13)(14)(15)(16)(17)(18)(19)(20)22). To understand how diabetes is contributing to MERS-CoV pathogenesis, we developed a small animal model that is both susceptible to MERS-CoV infection and has T2D induced by an HFD (Figure 1).…”

“…Diabetes is a significant risk factor for the development of severe or lethal disease following MERS-CoV infection in humans (16)(17)(18)(19)(20)22). We sought to determine how diabetes predisposes humans to increased morbidity and mortality after MERS-CoV infection by creating a T2D small animal model that is permissive to MERS-CoV infection.…”

“…Although there is little known about the mechanisms of pathogenesis of MERS-CoV in humans, several epidemiological studies have looked at a variety of aspects of MERS-CoV infection, including transmission, indicators of clinical outcome, and risk factors that contribute to the development of severe or lethal disease (7,(12)(13)(14)(15)(16)(17)(18)(19)(20). Risk factors that are associated with the development of more severe disease or death following MERS-CoV infection include male sex, older age, and comorbid illnesses (7,(12)(13)(14)(15).…”

“…Risk factors that are associated with the development of more severe disease or death following MERS-CoV infection include male sex, older age, and comorbid illnesses (7,(12)(13)(14)(15). In particular, diabetes, kidney disease, heart disease, underlying respiratory disease, and hypertension have all been shown to predispose a patient to more severe or lethal disease after MERS-CoV infection (16)(17)(18)(19)(20), Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 in Saudi Arabia and has caused over 2400 cases and more than 800 deaths. Epidemiological studies identified diabetes as the primary comorbidity associated with severe or lethal MERS-CoV infection.…”

“…Although there is a large amount of heterogeneity in the level of risk associated with the various comorbidities because of study designs and target populations, the reports demonstrate that diabetes is a significant risk factor for the development of severe or lethal disease from MERS-CoV infection. The odds ratio of developing severe or lethal disease following MERS-CoV infection when one has comorbid diabetes ranges from 2.47 to 7.24, depending on the study design and population (16)(17)(18)(19)(20)22). Interestingly, diabetes has also been shown to be a risk factor for other lower respiratory tract infections, including Mycobacterium tuberculosis (M. tuberculosis), Burkholderia pseudomallei (B. pseudomallei), and influenza virus (24).…”