Indian Journal of Respiratory Care

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VOLUME 12 , ISSUE 1 ( January-March, 2023 ) > List of Articles

Original Article

Predictors of Severe and Critical COVID-19 in Hospitalized Hypertensive Patients

Skakun Oleksiy Zenoviiovych

Keywords : Coronavirus disease 2019, Hospitalized, Hypertension, Predictors, Risk factors

Citation Information : Zenoviiovych SO. Predictors of Severe and Critical COVID-19 in Hospitalized Hypertensive Patients. Indian J Respir Care 2023; 12 (1):77-82.

DOI: 10.5005/jp-journals-11010-1014

License: CC BY-NC-SA 4.0

Published Online: 14-03-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: The severe condition develops in every fifth patient with coronavirus disease 2019 (COVID-19). This study is aimed to assess the factors predicting severe and critical conditions in hypertensive patients with COVID-19-associated pneumonia. Materials and methods: A total of 106 unvaccinated hypertensive patients hospitalized for COVID-19-associated pneumonia were enrolled in the study. Results: Median body mass index (BMI) was higher in patients with severe/critical condition [30.4 (26.4–34.1) kg/m2] than in patients with moderate condition [25.3 (23.5–29.1) kg/m2] (p < 0.001). Diabetes mellitus was more prevalent in patients with severe/critical condition (40.7 vs 21.3%, p = 0.04). Erythrocyte sedimentation rate (ESR) was higher in patients with severe/critical condition [28.0 (14.0–34.5) vs 37.5 (24.0–46.5) mm/hour] (0.004). Patients who developed severe/critical condition were scored higher according to the community-acquired pneumonia symptom (CAP-Sym) questionnaire [30.0 (20.0–37.0) points] than patients who developed the moderate condition [22.0 (16.0–33.0) points] (p = 0.03). Also, ferritin level was higher in patients who developed severe/critical condition [430.5 (177.0–733.0) ng/mL] than in patients who developed the moderate condition [315.5 (169.0–396.0) ng/mL] (p = 0.03). BMI of ≥30 kg/m2 increased the odds of severe/critical condition development [odds ratio (OR) = 3.83 (1.61–9.09), p = 0.002] and was the only independent predictor for the severe/critical condition according to the multivariate logistic regression analysis. Conclusion: Increased BMI, diabetes mellitus, high ESR, and ferritin level at admission predict severe/critical disease in unvaccinated hypertensive patients hospitalized for COVID-19. However, only BMI of ≥30 kg/m2 is an independent risk factor for severe/critical disease according to multivariate logistic regression analysis. CAP-Sym questionnaire may be used for the prediction of severe/critical COVID-19.


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  1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223): 497–506. DOI: 10.1016/S0140-6736(20)30183-5
  2. Center for Systems Science and Engineering. John Hopkins University COVID-19 Dashboard by the Center for Systems Science and. Engineering (CSSE). Available at: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6.
  3. Hernandez Acosta RA, Esquer Garrigos Z, Marcelin JR, et al. COVID-19 pathogenesis and clinical manifestations. Infect Dis Clin North Am 2022;36(2):231–249. DOI: 10.1016/j.idc.2022.01.003
  4. Hu Y, Sun J, Dai Z, et al. Prevalence and severity of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Virol 2020;127:104371. DOI: 10.1016/j.jcv.2020.104371
  5. Assal HH, Abdel-hamid HM, Magdy S, et al. Predictors of severity and mortality in COVID-19 patients. Egypt J Bronchol 2022;16(1):18. DOI:10.1186/s43168-022-00122-0
  6. Sen KK, Dubey R, Mohanty SS, et al. Spectrum of barotraumatic events in COVID-19 patients on high-resolution computed tomography. Indian J Respir Care 2022;11(1):67–70. DOI: 10.4103/ijrc.ijrc_115_21
  7. Joshee S, Vatti N, Chang C. Long-term effects of COVID-19. Mayo Clin Proc 2022;97(3):579–599. DOI: 10.1016/j.mayocp.2021.12.017
  8. Pijls BG, Jolani S, Atherley A, et al. Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies. BMJ Open 2021;11(1):e044640. DOI: 10.1136/bmjopen-2020-044640
  9. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55(5):2000547. DOI: 10.1183/13993003.00547-2020
  10. Del Sole F, Farcomeni A, Loffredo L, et al. Features of severe COVID-19: a systematic review and meta-analysis. Eur J Clin Invest 2020;50(10):e13378. DOI: 10.1111/eci.13378
  11. Bozkurt FT, Tercan M, Patmano G, et al. Can ferritin levels predict the severity of illness in patients with COVID-19? Cureus 2021;13(1):e12832. DOI: 10.7759/cureus.12832
  12. Gatselis NK, Lygoura V, Lyberopoulou A, et al. Soluble IL-2R levels at baseline predict the development of severe respiratory failure and mortality in COVID-19 patients. Viruses 2022;14(4):787. DOI: 10.3390/v14040787
  13. Toori KU, Qureshi MA, Chaudhry A. Lymphopenia: a useful predictor of COVID-19 disease severity and mortality. Pak J Med Sci 2021;37(7):1984–1988. DOI: 10.12669/pjms.37.7.4085
  14. Zeng F, Huang Y, Guo Y, et al. Association of inflammatory markers with the severity of COVID-19: a meta-analysis. Int J Infect Dis 2020;96:467–474. DOI: 10.1016/j.ijid.2020.05.055
  15. Tam AR, Zhang RR, Lung KC, et al. Early treatment of high-risk hospitalized COVID-19 patients with a combination of interferon beta-1b and remdesivir: a phase 2 open-label randomized controlled trial. Clin Infect Dis 2022;ciac523. DOI: 10.1093/cid/ciac523
  16. Gupta A, Gonzalez-Rojas Y, Juarez E, et al. Early treatment for COVID-19 with SARS-CoV-2 neutralizing antibody sotrovimab. N Engl J Med 2021;385(21):1941–1950. DOI: 10.1056/NEJMoa2107934
  17. Alexander PE, Armstrong R, Fareed G, et al. Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents. Med Hypotheses 2021;153:110622. DOI: 10.1016/j.mehy.2021.110622
  18. Pranata R, Lim MA, Huang I, et al. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst 2020;21(2):1470320320926899. DOI: 10.1177/1470320320926899
  19. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061–1069. DOI: 10.1001/jama.2020.1585
  20. Chen J, Liu Y, Qin J, et al. Hypertension as an independent risk factor for severity and mortality in patients with COVID-19: a retrospective study. Postgrad Med J 2022;98(1161):515–522. DOI: 10.1136/postgradmedj-2021-140674
  21. Mughal M, Gandhi H, Okoh A, et al. Is hypertension (HTN) an independent risk factor for mortality in COVID-19 patients? J Am Coll Cardiol 2021;77(18):3068. DOI: 10.1016/S0735-1097(21)04423-5
  22. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39(33):3021–3104. DOI: 10.1093/eurheartj/ehy339
  23. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58(5): 377–382. DOI: 10.1136/thorax.58.5.377
  24. Lamping DL, Schroter S, Marquis P, et al. The community-acquired pneumonia symptom questionnaire: a new, patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia. Chest 2002;122(3):920–929. DOI: 10.1378/chest.122.3.920
  25. Ministerstvo Okhorony Zdorovia Ukrainy. Derzhavnyi Ekspertnyi Tsentr. Protokol «Nadannia medychnoi dopomohy dlia likuvannia koronavirusnoi khvoroby (COVID-19)». Available at: https://www.dec.gov.ua/wp-content/uploads/2021/01/2021_01_kn_covid-19.pdf [accessed 22, July, 2022].
  26. Online Statistics Suite [Internet]. Stats.Blue. Available from: https://stats.blue/ [accessed 23, July, 2022].
  27. Sun C, Xue M, Yang M, et al. Early prediction of severe COVID-19 in patients by a novel immune-related predictive model. mSphere 2021;6(5):e0075221. DOI: 10.1128/mSphere.00752-21
  28. Zhao Q, Yuan Y, Zhang J, et al. Early predictors of severe COVID-19 among hospitalized patients. J Clin Lab Anal 2022;36(2):e24177. DOI: 10.1002/jcla.24177
  29. Espiritu AI, Reyes NGD, Leochico CFD, et al. Body mass index and its association with COVID-19 clinical outcomes: findings from the Philippine CORONA study. Clin Nutr ESPEN 2022;49:402–410. DOI: 10.1016/j.clnesp.2022.03.013
  30. Shang L, Shao M, Guo Q, et al. Diabetes mellitus is associated with severe infection and mortality in patients with COVID-19: a systematic review and meta-analysis. Arch Med Res 2020;51(7):700–709. DOI: 10.1016/j.arcmed.2020.07.005
  31. Guo J, Zhou B, Zhu M, et al. CURB-65 may serve as a useful prognostic marker in COVID-19 patients within Wuhan, China: a retrospective cohort study. Epidemiol Infect 2020;148:e241. DOI: 10.1017/S0950268820002368
  32. Kaushal K, Kaur H, Sarma P, et al. Serum ferritin as a predictive biomarker in COVID-19. a systematic review, meta-analysis and meta-regression analysis. J Crit Care 2022;67:172–181. DOI: 10.1016/j.jcrc.2021.09.023
  33. Coomes EA, Haghbayan H. Interleukin-6 in COVID-19: a systematic review and meta-analysis. Rev Med Virol 2020;30(6):1–9. DOI: 10.1002/rmv.2141
  34. Sanli DET, Altundag A, Kandemirli SG, et al. Relationship between disease severity and serum IL-6 levels in COVID-19 anosmia. Am J Otolaryngol 2021;42(1):102796. DOI: 10.1016/j.amjoto.2020.102796
  35. Sabaka P, Koščálová A, Straka I, et al. Role of interleukin 6 as a predictive factor for a severe course of COVID-19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak. BMC Infect Dis 2021;21(1):308. DOI: 10.1186/s12879-021-05945-8
  36. Kaya H, Kaji M, Usuda D. Soluble interleukin-2 receptor levels on admission associated with mortality in coronavirus disease 2019. Int J Infect Dis 2021;105:522–524. DOI: 10.1016/j.ijid.2021.03.011
  37. Liu X, Wang H, Shi S, et al. Association between IL-6 and severe disease and mortality in COVID-19 disease: a systematic review and meta-analysis. Postgrad Med J 2021;0:1–9. DOI: 10.1136/postgradmedj-2021-139939
  38. Ma A, Zhang L, Ye X, et al. High levels of circulating IL-8 and soluble IL-2R Are associated with prolonged illness in patients with severe COVID-19. Front Immunol 2021;12:626235. DOI: 10.3389/fimmu.2021.626235
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