Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comorbidities and Mortality Risk in COVID-19 Infected Patients: A Cross-Sectional Study in North-Eastern Iran
COVID-19 Enfekte Hastalarda Eşzamanlı Hastalık ve Ölüm Riski: Kuzeydoğu İran'da Kesitsel Bir Çalışma
Mohammadtaghi SHAKERIa, Parham AHMADIb, Ghazaleh GHORBANNEZHADb, Amirreza NASIRZADEHc, Samaneh ABOLBASHARId, Seyed Masoud SADATIe, Maryam SALARIa
aDepartment of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
bStudent Research Committee, Faculty of Medicine Mashhad University of Medical Sciences, Mashhad, Iran
cStudent Research Committee, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, Iran
dAntimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
eCenter of Statistic and Information Technology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Turkiye Klinikleri J Med Sci. 2023;43(1):29-39
doi: 10.5336/medsci.2022-91119
Article Language: EN
Full Text
ABSTRACT
Objective: The coronavirus disease-2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2, started in Wuhan, China, and was recognized as a pandemic by the World Health Organization. In Iran, the first confirmed COVID-19 case was officially reported on February 19. The aim of this study was to investigate the epidemiological and clinical characteristics, and comorbid conditions, and determine risk factors for the mortality of COVID-19 patients as well as provide a comparison of the epidemiological features between the 3 waves of COVID-19 in the North-East of Iran from January 21, 2020, to March 20, 2021. Material and Methods: The current retrospective epidemiological population-based study was conducted on COVID-19 patients who were admitted to the hospitals affiliated to the Mashhad University of Medical Sciences in Razavi-Khorasan province, Iran. The data were extracted from the Medical Care Monitoring System of the Mashhad University of Medical Sciences. Results: In total, 43.6% of subjects had at least one coexisting underlying medical condition. The most common comorbidities were hypertension, diabetes, and cardiovascular diseases with the prevalence of 19.7, 15.1, and 13.3%; respectively. The overall case fatality rate was 15.0%, following a median of 4 days [interquartile range (IQR) 1-10] of hospitalization. The mean±SD and the median (IQR) of age in expired subjects were 67.40±18.27 and 70 (59-81) years; respectively. Conclusion: Our results demonstrated that age >60, male sex, loss of consciousness, respiratory distress, having at least one comorbidity, and diabetes were mortality risk factors among COVID-19 patients.

Keywords: COVID-19; comorbidity; mortality; Iran
ÖZET
Amaç: Koronavirüs hastalığı-2019 (COVID-19)'a, yeni şiddetli akut solunum sendromu koronavirüs 2 sebep olmuş, Wuhan, Çin'de başlamış ve Dünya Sağlık Örgütü tarafından pandemi olarak tanınmıştır. İran'da, onaylanmış ilk COVID-19 vakası resmi olarak 19 Şubat'ta bildirilmiştir. Bu çalışmanın amacı; COVID-19'un epidemiyolojik ve klinik özelliklerini, eşzamanlı hastalık koşullarını ve COVID-19 hastalarının ölüm risk faktörlerini belirlemenin yanı sıra Kuzeydoğu İran'da 21 Ocak 2020'den 20 Mart 2021'e kadar olan 3 COVID-19 dalgasının epidemiyolojik özelliklerini karşılaştırmaktır. Gereç ve Yöntemler: Mevcut retrosprektif epidemiyolojik popülasyon bazlı çalışma, İran, Khorasan İli'nde Mashhad Üniversitesi Tıbbi Bilimle'e bağlı hastanelere başvuran COVID-19 hastaları üzerinden yürütülmüştür. Veriler, Mashhad Üniversitesi Tıbbi Bilimler, Tıbbi Bakım İzleme Sistemi'nden alınmıştır. Bulgular: Toplamda, hastaların %43,6'sının aynı zamanda altta yatan en az bir tıbbi durumu mevcuttu. En yaygın eşzamanlı hastalıklar, hipertansiyon, diyabet ve kardiyovasküler hastalıklar olup yaygınlık oranları sırasıyla %19,7, 15,1 ve 13,3'tü. Ortalama 4 günlük [çeyrekler arası aralık (ÇAA) 1-10] hastaneye yatışın ardından toplam vaka ölüm oranı %15,0'dı. Ölen hastaların yaş ortalaması±SS 67,40±18,27 ve medyanı (ÇAA) 70 (59-81) idi. Sonuç: Sonuçlarımız, COVID-19 hastalarının ölüm risk faktörleri arasında yaşın 60'tan ileri olması, cinsiyetin erkek olması, bilinç kaybı, solunum problemleri, en az bir eşzamanlı hastalık ve diyabet olduğunu göstermiştir.

Anahtar Kelimeler: COVID-19; eşzamanlı hastalık; ölüm; İran
REFERENCES:
  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. [Crossref]  [PubMed]  [PMC] 
  2. Cucinotta D, Vanelli M. WHO Declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-60. [PubMed]  [PMC] 
  3. Sharma A, Ahmad Farouk I, Lal SK. COVID-19: a review on the novel coronavirus disease evolution, transmission, detection, control and prevention. Viruses. 2021;13(2):202. [Crossref]  [PubMed]  [PMC] 
  4. Rahman S, Montero MTV, Rowe K, Kirton R, Kunik F Jr. Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence. Expert Rev Clin Pharmacol. 2021;14(5):601-21. [Crossref]  [PubMed]  [PMC] 
  5. Zhang L, Shen FM, Chen F, Lin Z. Origin and evolution of the 2019 novel coronavirus. Clin Infect Dis. 2020;71(15):882-3. [Crossref]  [PubMed]  [PMC] 
  6. World Health Organization. COVID-19 weekly epidemiological update, edition 80, 22 February 2022. Available from: [Link] 
  7. Moftakhar L, Seif M. The exponentially increasing rate of patients infected with COVID-19 in Iran. Arch Iran Med. 2020;23(4):235-8. [Crossref]  [PubMed] 
  8. Chilamakuri R, Agarwal S. COVID-19: characteristics and therapeutics. Cells. 2021;10(2):206. [Crossref]  [PubMed]  [PMC] 
  9. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al; COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. [Crossref]  [PubMed]  [PMC] 
  10. Azarbakhsh H, Jokari K, Moftakhar L, Ghelichi Ghojogh M, Karimyan A, Salmanzadeh S, et al. Epidemiological characteristics of patients with COVID-19 in Southwest of Iran from February 19 to June 20, 2020. Med J Islam Repub Iran. 2021;35:116. [Crossref]  [PubMed]  [PMC] 
  11. Ferreira FB, Barbosa Costa G, Sevá ADP, Albuquerque GR, Mariano APM, Sampaio Lopes AT, et al. Characteristics and factors associated with SARS-CoV-2 infections in individuals That Attended Referral Hospitals from Southern Region of Bahia State, Brazil: A Surveillance Network Retrospective Study. Viruses. 2021;13(12):2462. [Crossref]  [PubMed]  [PMC] 
  12. Peckham H, de Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Wedderburn LR, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020;11(1):6317. [Crossref]  [PubMed]  [PMC] 
  13. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. [Crossref]  [PubMed] 
  14. Lechien JR, Chiesa-Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al; COVID-19 Task Force of YO-IFOS. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med. 2020;288(3):335-44. [Crossref]  [PubMed]  [PMC] 
  15. Giesen C, Diez-Izquierdo L, Saa-Requejo CM, Lopez-Carrillo I, Lopez-Vilela CA, Seco-Martinez A, et al; COVID Epidemiological Surveillance and Control Study Group. Epidemiological characteristics of the COVID-19 outbreak in a secondary hospital in Spain. Am J Infect Control. 2021;49(2):143-50. [Crossref]  [PubMed]  [PMC] 
  16. Jutzeler CR, Bourguignon L, Weis CV, Tong B, Wong C, Rieck B, et al. Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;37:101825. [Crossref]  [PubMed]  [PMC] 
  17. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020;277(8):2251-61. [Crossref]  [PubMed]  [PMC] 
  18. Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for Antimicrobial Therapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci. 2020;35(10):e112. [Crossref]  [PubMed]  [PMC] 
  19. Esfahanian F, SeyedAlinaghi S, Janfaza N, Tantuoyir MM. Predictors of hospital mortality among patients with COVID-19 in Tehran, Iran. SAGE Open Med. 2021;9:20503121211051573. [Crossref]  [PubMed]  [PMC] 
  20. Li J, Huang DQ, Zou B, Yang H, Hui WZ, Rui F, et al. Epidemiology of COVID-19: a systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol. 2021;93(3):1449-58. [Crossref]  [PubMed]  [PMC] 
  21. Mao L, Wang M, Chen S, He Q, Chang J, Hong C, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. MedRxiv. 2020. [Crossref] 
  22. Bagheri SH, Asghari A, Farhadi M, Shamshiri AR, Kabir A, Kamrava SK, et al. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med J Islam Repub Iran. 2020;34:62. [Crossref]  [PubMed]  [PMC] 
  23. Trevisan C, Noale M, Prinelli F, Maggi S, Sojic A, Di Bari M, et al; EPICOVID19 Working Group. Age-related changes in clinical presentation of Covid-19: the EPICOVID19 web-based survey. Eur J Intern Med. 2021;86:41-7. [Crossref]  [PubMed]  [PMC] 
  24. Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577-83. [Crossref]  [PubMed]  [PMC] 
  25. Shah P, Owens J, Franklin J, Mehta A, Heymann W, Sewell W, et al. Demographics, comorbidities and outcomes in hospitalized Covid-19 patients in rural southwest Georgia. Ann Med. 2020;52(7):354-60. [Crossref]  [PubMed]  [PMC] 
  26. Karami M, Mirzaei M, Shahbazi F, Keramat F, Jalili E, Bashirian S, et al. Predictors of death in patients with COVID-19: A cross-sectional study in West of Iran. Med J Islam Repub Iran. 2021;35:103. [Crossref]  [PubMed]  [PMC] 
  27. Bidari A, Hassanzadeh M, Naderkhani M, Gholizadeh Mesgarha M, Pour Mohammad A, Azadeh A, et al. Predictors of critical COVID-19 in an Iranian population: age and disabilities play a special role. Med J Islam Repub Iran. 2021;35:94. [Crossref]  [PubMed]  [PMC] 
  28. Ryan C, Minc A, Caceres J, Balsalobre A, Dixit A, Ng BK, et al. Predicting severe outcomes in Covid-19 related illness using only patient demographics, comorbidities and symptoms. Am J Emerg Med. 2021;45:378-84. [Crossref]  [PubMed]  [PMC] 
  29. de Souza FSH, Hojo-Souza NS, Batista BDO, da Silva CM, Guidoni DL. On the analysis of mortality risk factors for hospitalized COVID-19 patients: a data-driven study using the major Brazilian database. PLoS One. 2021;16(3):e0248580. [Crossref]  [PubMed]  [PMC] 
  30. Alali AS, Alshehri AO, Assiri A, Khan S, Alkathiri MA, Almohammed OA, et al. Demographics, comorbidities, and outcomes among young and middle-aged COVID-19 patients in Saudi Arabia. Saudi Pharm J. 2021;29(8):833-42. [Crossref]  [PubMed]  [PMC] 
  31. Gold MS, Sehayek D, Gabrielli S, Zhang X, McCusker C, Ben-Shoshan M. COVID-19 and comorbidities: a systematic review and meta-analysis. Postgrad Med. 2020;132(8):749-55. [Crossref]  [PubMed] 
  32. Moftakhar L, Moftakhar P, Piraee E, Ghaem H, Valipour A, Azarbakhsh H. Epidemiological characteristics and outcomes of COVID-19 in diabetic versus non-diabetic patients. Int J Diabetes Dev Ctries. 2021;41(3):383-8. [Crossref]  [PubMed]  [PMC] 
  33. Di Castelnuovo A, Bonaccio M, Costanzo S, Gialluisi A, Antinori A, Berselli N, et al; COvid-19 RISk and Treatments (CORIST) collaboration. Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study. Nutr Metab Cardiovasc Dis. 2020;30(11):1899-913. [PubMed]  [PMC] 
  34. Moran AE, Roth GA, Narula J, Mensah GA. 1990-2010 global cardiovascular disease atlas. Glob Heart. 2014;9(1):3-16. [Crossref]  [PubMed] 
  35. Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of sex, age, and comorbidities with mortality in COVID-19 patients: a systematic review and meta-analysis. Intervirology. 2020;1-12. [Crossref]  [PubMed]  [PMC] 

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