Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis

  1. Wei-jie Guan
  2. Wen-hua Liang
  3. Yi Zhao
  4. Heng-rui Liang
  5. Zi-sheng Chen
  6. Yi-min Li
  7. Xiao-qing Liu
  8. Ru-chong Chen
  9. Chun-li Tang
  10. Tao Wang
  11. Chun-quan Ou
  12. Li Li
  13. Ping-yan Chen
  14. Ling Sang
  15. Wei Wang
  16. Jian-fu Li
  17. Cai-chen Li
  18. Li-min Ou
  19. Bo Cheng
  20. Shan Xiong
  21. Zheng-yi Ni
  22. Jie Xiang
  23. Yu Hu
  24. Lei Liu
  25. Hong Shan
  26. Chun-liang Lei
  27. Yi-xiang Peng
  28. Li Wei
  29. Yong Liu
  30. Ya-hua Hu
  31. Peng Peng
  32. Jian-ming Wang
  33. Ji-yang Liu
  34. Zhong Chen
  35. Gang Li
  36. Zhi-jian Zheng
  37. Shao-qin Qiu
  38. Jie Luo
  39. Chang-jiang Ye
  40. Shao-yong Zhu
  41. Lin-ling Cheng
  42. Feng Ye
  43. Shi-yue Li
  44. Jin-ping Zheng
  45. Nuo-fu Zhang
  46. Nan-shan Zhong
  47. Jian-xing He
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Abstract

Objective

To evaluate the spectrum of comorbidities and its impact on the clinical outcome in patients with coronavirus disease 2019 (COVID-19).

Design

Retrospective case studies

Setting

575 hospitals in 31 province/autonomous regions/provincial municipalities across China

Participants

1,590 laboratory-confirmed hospitalized patients. Data were collected from November 21st, 2019 to January 31st, 2020.

Main outcomes and measures

Epidemiological and clinical variables (in particular, comorbidities) were extracted from medical charts. The disease severity was categorized based on the American Thoracic Society guidelines for community-acquired pneumonia. The primary endpoint was the composite endpoints, which consisted of the admission to intensive care unit (ICU), or invasive ventilation, or death. The risk of reaching to the composite endpoints was compared among patients with COVID-19 according to the presence and number of comorbidities.

Results

Of the 1,590 cases, the mean age was 48.9 years. 686 patients (42.7%) were females. 647 (40.7%) patients were managed inside Hubei province, and 1,334 (83.9%) patients had a contact history of Wuhan city. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached to the composite endpoints. 399 (25.1%) reported having at least one comorbidity. 269 (16.9%), 59 (3.7%), 30 (1.9%), 130 (8.2%), 28 (1.8%), 24 (1.5%), 21 (1.3%), 18 (1.1%) and 3 (0.2%) patients reported having hypertension, cardiovascular diseases, cerebrovascular diseases, diabetes, hepatitis B infections, chronic obstructive pulmonary disease, chronic kidney diseases, malignancy and immunodeficiency, respectively. 130 (8.2%) patients reported having two or more comorbidities. Patients with two or more comorbidities had significantly escalated risks of reaching to the composite endpoint compared with those who had a single comorbidity, and even more so as compared with those without (all P<0.05). After adjusting for age and smoking status, patients with COPD (HR 2.681, 95%CI 1.424-5.048), diabetes (HR 1.59, 95%CI 1.03-2.45), hypertension (HR 1.58, 95%CI 1.07-2.32) and malignancy (HR 3.50, 95%CI 1.60-7.64) were more likely to reach to the composite endpoints than those without. As compared with patients without comorbidity, the HR (95%CI) was 1.79 (95%CI 1.16-2.77) among patients with at least one comorbidity and 2.59 (95%CI 1.61-4.17) among patients with two or more comorbidities.

Conclusion

Comorbidities are present in around one fourth of patients with COVID-19 in China, and predispose to poorer clinical outcomes.

Highlights

What is already known on this topic

  • <label>-</label>

    Since November 2019, the rapid outbreak of coronavirus disease 2019 (COVID-19) has recently become a public health emergency of international concern. There have been 79,331 laboratory-confirmed cases and 2,595 deaths globally as of February 25th, 2020

  • <label>-</label>

    Previous studies have demonstrated the association between comorbidities and other severe acute respiratory diseases including SARS and MERS.

  • <label>-</label>

    No study with a nationwide representative cohort has demonstrated the spectrum of comorbidities and the impact of comorbidities on the clinical outcomes in patients with COVID-19.

What this study adds

  • <label>-</label>

    In this nationwide study with 1,590 patients with COVID-19, comorbidities were identified in 399 patients. Comorbidities of COVID-19 mainly included hypertension, cardiovascular diseases, cerebrovascular diseases, diabetes, hepatitis B infections, chronic obstructive pulmonary disease, chronic kidney diseases, malignancy and immunodeficiency.

  • <label>-</label>

    The presence of as well as the number of comorbidities predicted the poor clinical outcomes (admission to intensive care unit, invasive ventilation, or death) of COVID-19.

  • <label>-</label>

    Comorbidities should be taken into account when estimating the clinical outcomes of patients with COVID-19 on hospital admission.

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