Analysis of the Influence of Comorbid States on COVID-19 Severity and In-Hospital Mortality for Further Application in an Outpatient Setting
Introduction. The COVID-19 pandemic brought many challenges to the healthcare systems of all countries. Primary care physicians were on the front-lines, handling outpatient care, performing triage, consulting patients on potential risks, symptoms of concern and treatments options. And although emerg...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Publishing House "Kyrylytsya"
2024-06-01
|
| Series: | Львівський клінічний вісник |
| Subjects: | |
| Online Access: | https://lcb-journal.com/index.php/journal/article/view/91 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Introduction. The COVID-19 pandemic brought many challenges to the healthcare systems of all countries. Primary care physicians were on the front-lines, handling outpatient care, performing triage, consulting patients on potential risks, symptoms of concern and treatments options. And although emergency and intensive care units have been using severity scales like the quick COVID-19 severity index, Brescia-COVID Respiratory Severity Scale to rapid asses patient severity and adjust care accordingly, these metrics only apply for an inpatient setting and don’t provide much use for outpatient care and management. By isolating main risk factors for developing severe COVID-19, a tool like this can be created for quick evaluation in an outpatient setting.
The aim of the study. To analyze available research data regarding the most common comorbid conditions of patients with a confirmed COVID-19 infection during in-hospital treatment and their role in disease severity and mortality, and to evaluate the possibility of developing a similar score system for outpatient use.
Materials and methods. Articles on COVID-19 patient care, disease progression, comorbidities and outcomes were gathered from the PubMed using a combination of keywords: COVID-19 (main search keyword), obesity, cardiovascular disease (CVD), hypertension, diabetes, liver disease (LD), asthma, chronic obstructive pulmonary disease (COPD), severity, outcomes. From the register under investigation were excluded articles based on the criteria as follows: patient groups consisting of children under the age of 18 and pregnant women, the lack of cal- culated odds ratios (OR) and patient groups with high risk underlying conditions without multivariable analysis to exclude interference in the results. The data were analyzed based on two main outcomes for each comorbidity - severe disease (including inpatient ICU transfer) and in hospital mortality.
Results. In total 77 articles were chosen based on the defined criteria. Data about OR for patients with relevant risk factors compared to patients without ones, for severe disease course (including in-hospital ICU admission) and mortality were analyzed for each criterion. For obesity the OR for severe disease spanned from 1.1 to 3.51, for CVD - 1.02 to 6, for diabetes - 0.91 to 9.38, for LD - 1.146 to 2.18, for asthma - 0.66 to 2.3, for patients older than 61 - 0.90 to 6.93, for COPD - 0.32 to 5.80, for hypertension - 0.73 to 5.04. The OR for in-hospital mortality were as follows: obesity - 0.84 to 7.18, CVD - 0.92 to 5.917, diabetes - 0.56 to 5.96, LD - 0.33 to 5.67, asthma - 0.83 to 3.21, patients older than 61 - 1.05 to 13.5, COPD - 0.83 to 13.01, hypertension - 0.73 to 4.54. Upon further analysis the median OR value of severe disease for obesity was 1.76, for CVD - 1.7, for diabetes - 1.9, for LD - 1.84, for asthma - 1.18, for age higher than 61 - 3.57, for COPD - 1.56, for hypertension - 1.56. The median OR value of in-hospital mortality for obesity was 1.37, for CVD - 1.67, for diabetes - 1.61, for LD - 2.63, for asthma - 1.04, for age higher than 61 - 3.58, for COPD - 1.61, for hypertension - 1.44.
Conclusions. Comorbid conditions have significant influence on the course of COVID-19 in patients and should be taken into consideration during initial evaluation of the patient`s status. In particular, age and liver function play a key role during decision making, planning treatment and diagnosis. Development and implementation of a tool akin to inpatient scores into the healthcare system will help alleviate the strain on the healthcare system both during and after the pandemic. |
|---|---|
| ISSN: | 2306-4269 2520-2898 |