IDENTIFICATION OF PREDISPOSING RISK FACTORS OF COVID-19 SEVERITY; A DESCRIPTIVE STUDY
Main Article Content
Keywords
COVID-19 severity, NCDs, Pakistan, Hypertension, Risk factors
Abstract
Coronavirus disease 19 (COVID-19) severity data is highly variable and many factors were linked to increased severity. Owing to the dense population, varied demographic characteristics, and high burden of various diseases, it is important to identify risk factors resulting in severe COVID-19 in Pakistan. It was a descriptive study, and 652 COVID-19-positive patients were enrolled from Mayo Hospital Lahore and grouped into mild and severe cases. Demographic, clinical history and laboratory findings at the time of admission were collected. Data were analyzed using SPSS V21. The results indicated that the patients with age above 30 years showed a significant association with disease severity and with increasing every 10 years, the odds of disease severity became double. Further, male gender (OR 1.729, p 0.002), low socioeconomic status (OR 4.01, p <0.0001), diabetes mellitus (OR 2.52, p 0.001), hypertension (OR 1.81, p 0.01) and heart attack (OR 2.05, p 0.02) were significantly increasing disease severity. Interestingly, malarial history and smoking showed a significant association with a milder form of the disease. We conclude that young people (30 and above) were at significant risk of severe COVID-19 infection. Similarly, diabetes mellitus, hypertension and cardiovascular diseases were identified as independent risk factors for COVID-19 severity in Pakistan.
References
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52. Novak N, Cabanillas B. Viruses and asthma: the role of common respiratory viruses in asthma and its potential meaning for SARS-CoV-2. Immunology. 2020.
53. Pranata R, Soeroto AY, Huang I, Lim MA, Santoso P, Permana H, et al. Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19. Int J Tuberc Lung Dis. 2020;
54. Wang J, Lu Z, Jin M, Wang Y, Tian K, Xiao J, et al. Clinical characteristics and risk factors of COVID-19 patients with chronic hepatitis B: a multi-center retrospective cohort study. Front Med. 2022;
55. Cerbu B, Pantea S, Bratosin F, Vidican I, Turaiche M, Frent S, et al. Liver impairment and hematological changes in patients with chronic hepatitis c and COVID-19: A ret-rospective study after one year of pandemic. Med. 2021;
56. Johannesen TB, Smeland S, Aaserud S, Buanes EA, Skog A, Ursin G, et al. COVID-19 in Cancer Patients, Risk Factors for Disease and Adverse Outcome, a Pop-ulation-Based Study From Norway. Front Oncol. 2021;
57. Meng Y, Meng Y, Lu W, Lu W, Guo E, Guo E, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: A propensity score-matched analysis. J Hematol Oncol. 2020;
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60. Visca D, Ong CWM, Tiberi S, Centis R, D’Ambrosio L, Chen B, et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology. 2021.
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63. Moon AM, Barritt AS. Elevated Liver Enzymes in Patients with COVID-19: Look, but Not Too Hard. Digestive Diseases and Sciences. 2021.
64. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. The Lancet Gastroenterology and Hepatology. 2020.
65. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is asso-ciated with in-hospital death of patients with COVID-19. Kidney International. 2020.
2. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Corona-virus Disease 2019 in China. N Engl J Med. 2020;
3. Szarpak L, Mierzejewska M, Jurek J, Kochanowska A, Gasecka A, Truszewski Z, et al. Effect of Coronary Artery Disease on COVID-19—Prognosis and Risk Assessment: A Systematic Review and Meta-Analysis. Biology (Basel). 2022;
4. Nikoloski Z, Alqunaibet AM, Alfawaz RA, Almudarra SS, Herbst CH, El-Saharty S, et al. Covid-19 and non-communicable diseases: evidence from a systematic literature review. BMC Public Health. 2021;
5. Cenko E, Badimon L, Bugiardini R, Claeys MJ, De Luca G, De Wit C, et al. Cardio-vascular disease and COVID-19: A consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European . Cardiovascular Research. 2021.
6. Singh AK, Singh R. Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19? Diabetes Metab Syndr Clin Res Rev. 2020;
7. Gao Y, Liu M, Chen Y, Shi S, Geng J, Tian J. Association between tuberculosis and COVID-19 severity and mortality: A rapid systematic review and meta-analysis. Jour-nal of Medical Virology. 2021.
8. Ronderos D, Omar AMS, Abbas H, Makker J, Baiomi A, Sun H, et al. Chronic hepati-tis-C infection in COVID-19 patients is associated with in-hospital mortality. World J Clin Cases. 2021;
9. Kalungi A, Kinyanda E, Akena DH, Kaleebu P, Bisangwa IM. Less Severe Cases of COVID-19 in Sub-Saharan Africa: Could Co-infection or a Recent History of Plasmo-dium falciparum Infection Be Protective? Frontiers in Immunology. 2021.
10. Rafique I, Saqib MAN, Munir MA, Qureshi H, Rizwanullah, Khan SA, et al. Preva-lence of risk factors for noncommunicable diseases in adults: Key findings from the Pakistan steps survey. East Mediterr Heal J. 2018;
11. Ashar Malik M zafar. Emerging Challenges and Health System Capacity: The Case of Non- Communicable Diseases in Pakistan; a Review. J Infect Dis Ther. 2014;
12. Hafeez E, Fasih T. Growing Population of Pakistani Youth: A Ticking Time Bomb or a Demographic Dividend. J Educ Educ Dev. 2018;
13. Basit A, Fawwad A, Qureshi H, Shera AS, Ur Rehman Abro M, Ahmed KI, et al. Prevalence of diabetes, pre-diabetes and associated risk factors: Second National Dia-betes Survey of Pakistan (NDSP), 2016-2017. BMJ Open. 2018.
14. Riaz M, Shah G, Asif M, Shah A, Adhikari K, Abu-Shaheen A. Factors associated with hypertension in Pakistan: A systematic review and meta-analysis. PLoS One. 2021;
15. Rehman S, Rehman E, Ikram M, Jianglin Z. Cardiovascular disease (CVD): assessment, prediction and policy implications. BMC Public Health. 2021;
16. Karim AM, Yasir M, Ali T, Malik SK, Ullah I, Qureshi NA, et al. Prevalence of clinical malaria and household characteristics of patients in tribal districts of Pakistan. PLoS Negl Trop Dis. 2021;
17. Seerat I, Mushtaq H, Rafiq M, Nadir A. Frequency and Associated Risk Factors of Hepatitis B Virus and Hepatitis C Virus Infections in Children at a Hepatitis Preven-tion and Treatment Clinic in Lahore, Pakistan. Cureus. 2020;
18. Ullah W, Wali A, Haq MU, Yaqoob A, Fatima R, Khan GM. Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective. Front Public Heal. 2021;
19. Zulfiqar K, Gillani DQ. Socio-Economic Disparities and an Imperative for Inclusive Economic Growth In Pakistan. Journal of the Research Society of Pakistan. 2019.
20. Basit A, Bin Younus B, Waris N, Fawwad A. Prevalence of tobacco use in urban and rural areas of Pakistan; A sub-study from second national diabetes survey of Pakistan (NDSP) 2016-2017. Pakistan J Med Sci. 2020;
21. Akhtar H, Afridi M, Akhtar S, Ahmad H, Ali S, Khalid S, et al. Pakistan’s response to COVID-19: Overcoming national and international hypes to fight the pandemic. JMIR Public Health and Surveillance. 2021.
22. Rafique I, Siddiqui S, Munir MA, Qureshi H, Javed N, Naz S, et al. Experiences of stigma among hepatitis B and C patients in Rawalpindi and Islamabad , Pakistan. EMHJ-Eastern Mediterr Heal J. 2014;20(12):796–803.
23. Zhang H, Wu Y, He Y, Liu X, Liu M, Tang Y, et al. Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study. Front Med. 2022;
24. Starke KR, Petereit-Haack G, Schubert M, Kämpf D, Schliebner A, Hegewald J, et al. The age-related risk of severe outcomes due to covid-19 infection: A rapid review, meta-analysis, and meta-regression. Int J Environ Res Public Health. 2020;
25. Ho FK, Petermann-Rocha F, Gray SR, Jani BD, Vittal Katikireddi S, Niedzwiedz CL, et al. Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants. PLoS One. 2020;
26. 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;
27. Acheampong DO, Barffour IK, Boye A, Aninagyei E, Ocansey S, Morna MT. Male predisposition to severe COVID-19: Review of evidence and potential therapeutic prospects. Biomedicine and Pharmacotherapy. 2020.
28. Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: Sex differences in immune response and cardiovascular comorbidities. Cardiovascular Research. 2020.
29. Klein SL, Flanagan KL. Sex differences in immune responses. Nature Reviews Immu-nology. 2016.
30. Takahashi T, Iwasaki A. Sex differences in immune responses. Science (80- ). 2021;
31. Bwire GM. Coronavirus: Why Men are More Vulnerable to Covid-19 Than Women? SN Compr Clin Med. 2020;
32. Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Public Heal. 2020;
33. Pradhan A, Olsson PE. Sex differences in severity and mortality from COVID-19: are males more vulnerable? Biology of Sex Differences. 2020.
34. Usman MS, Siddiqi TJ, Khan MS, Patel UK, Shahid I, Ahmed J, et al. Is there a smoker’s paradox in COVID-19? BMJ Evidence-Based Medicine. 2021.
35. Zhang H, Ma S, Han T, Qu G, Cheng C, Uy JP, et al. Association of smoking history with severe and critical outcomes in COVID-19 patients: A systemic review and me-ta-analysis. Eur J Integr Med. 2021;
36. Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis. BMC Public Health. 2021;
37. Paleiron N, Mayet A, Marbac V, Perisse A, Barazzutti H, Brocq FX, et al. Impact of Tobacco Smoking on the Risk of COVID-19: A Large Scale Retrospective Cohort Study. Nicotine Tob Res. 2021;
38. Mena GE, Martinez PP, Mahmud AS, Marquet PA, Buckee CO, Santillana M. Socio-economic status determines COVID-19 incidence and related mortality in Santiago, Chile. Science (80- ). 2021;
39. Oh TK, Choi JW, Song IA. Socioeconomic disparity and the risk of contracting COVID-19 in South Korea: an NHIS-COVID-19 database cohort study. BMC Public Health. 2021;
40. Hawkins RB, Charles EJ, Mehaffey JH. Socio-economic status and COVID-19–related cases and fatalities. Public Health. 2020;
41. Patel JA, Nielsen FBH, Badiani AA, Assi S, Unadkat VA, Patel B, et al. Poverty, in-equality and COVID-19: the forgotten vulnerable. Public Health. 2020.
42. Noreen N, Dil S, Niazi SUK, Naveed I, Khan NU, Khan FK, et al. COVID 19 Pan-demic & Pakistan; Limitations and Gaps. Glob Biosecurity. 2020;
43. Gregory JM, Slaughter JC, Duffus SH, Smith TJ, LeStourgeon LM, Jaser SS, et al. Er-ratum. COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes. Diabetes Care 2021;44:526–532. Diabetes Care. 2022;
44. Li G, Chen Z, Lv Z, Li H, Chang D, Lu J. Diabetes Mellitus and COVID-19: Associa-tions and Possible Mechanisms. International Journal of Endocrinology. 2021.
45. Sen S, Chakraborty R, Kalita P, Pathak MP. Diabetes mellitus and COVID-19: Un-derstanding the association in light of current evidence. World J Clin Cases. 2021;
46. Chen J, Liu Y, Qin J, Ruan C, Zeng X, Xu A, et al. Hypertension as an independent risk factor for severity and mortality in patients with COVID-19: a retrospective study. Postgrad Med J. 2021;
47. Du Y, Zhou N, Zha W, Lv Y. Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutr Metab Cardiovasc Dis. 2021;
48. Matsushita K, Ding N, Kou M, Hu X, Chen M, Gao Y, et al. The relationship of COVID-19 severity with cardiovascular disease and its traditional risk factors: A sys-tematic review and meta-analysis. Glob Heart. 2020;
49. Franco PA, Jezler S, Cruz AA. Is asthma a risk factor for coronavirus disease-2019 worse outcomes? The answer is no, but... Current Opinion in Allergy and Clinical Im-munology. 2021.
50. Jeong JS, Kim JS, You YS, Yeom SW, Lee YC. COPD is a risk factor for COVID-19, but does not confer increased severity of the disease. Respir Med. 2021;
51. Lee SC, Son KJ, Han CH, Park SC, Jung JY. Impact of COPD on COVID-19 progno-sis: A nationwide population-based study in South Korea. Sci Rep. 2021;
52. Novak N, Cabanillas B. Viruses and asthma: the role of common respiratory viruses in asthma and its potential meaning for SARS-CoV-2. Immunology. 2020.
53. Pranata R, Soeroto AY, Huang I, Lim MA, Santoso P, Permana H, et al. Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19. Int J Tuberc Lung Dis. 2020;
54. Wang J, Lu Z, Jin M, Wang Y, Tian K, Xiao J, et al. Clinical characteristics and risk factors of COVID-19 patients with chronic hepatitis B: a multi-center retrospective cohort study. Front Med. 2022;
55. Cerbu B, Pantea S, Bratosin F, Vidican I, Turaiche M, Frent S, et al. Liver impairment and hematological changes in patients with chronic hepatitis c and COVID-19: A ret-rospective study after one year of pandemic. Med. 2021;
56. Johannesen TB, Smeland S, Aaserud S, Buanes EA, Skog A, Ursin G, et al. COVID-19 in Cancer Patients, Risk Factors for Disease and Adverse Outcome, a Pop-ulation-Based Study From Norway. Front Oncol. 2021;
57. Meng Y, Meng Y, Lu W, Lu W, Guo E, Guo E, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: A propensity score-matched analysis. J Hematol Oncol. 2020;
58. Mou R, Jin X, Li W, Wu M, Liu X, Liu Z, et al. Prostate cancer: a risk factor for COVID-19 in males?: A protocol for systematic review and meta analysis. Medicine (Baltimore). 2020;
59. Yang L, Chai P, Yu J, Fan X. Effects of cancer on patients with COVID-19: a sys-tematic review and meta-analysis of 63,019 participants. Cancer Biology and Medicine. 2021.
60. Visca D, Ong CWM, Tiberi S, Centis R, D’Ambrosio L, Chen B, et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology. 2021.
61. Zhu B, Feng X, Jiang C, Mi S, Yang L, Zhao Z, et al. Correlation between white blood cell count at admission and mortality in COVID-19 patients: a retrospective study. BMC Infect Dis. 2021;
62. Zhao K, Li R, Wu X, Zhao Y, Wang T, Zheng Z, et al. Clinical features in 52 patients with COVID-19 who have increased leukocyte count: a retrospective analysis. Eur J Clin Microbiol Infect Dis. 2020;
63. Moon AM, Barritt AS. Elevated Liver Enzymes in Patients with COVID-19: Look, but Not Too Hard. Digestive Diseases and Sciences. 2021.
64. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. The Lancet Gastroenterology and Hepatology. 2020.
65. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is asso-ciated with in-hospital death of patients with COVID-19. Kidney International. 2020.
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Mar 21, 2024
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Rana Muhammad Mateen, Muhammad Sohail Afzal, Sarmad Zahoor, Uzma Malik, Hafiz Muhammad Sajid Jehangir, Samara Siddique, Madiha Khalid, Imran Tipu, Ibrar Rafique, Muhammad Ansar, Rukhsana Parveen, & Muhammad Arif Nadeem Saqib. (2024). IDENTIFICATION OF PREDISPOSING RISK FACTORS OF COVID-19 SEVERITY; A DESCRIPTIVE STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 31(3), 1287–1298. https://doi.org/10.53555/jptcp.v31i3.5119
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Author Biographies
Rana Muhammad Mateen
Centre for Applied Molecular Biology, University of the Punjab, Lahore
Muhammad Sohail Afzal
Department of Life sciences, School of Science, University of Management and Technology, Lahore 54770, Pakistan
Sarmad Zahoor
Department of Internal Medicine, KEMU/Mayo Hospital, Lahore, Pakistan
Uzma Malik
Department of Internal Medicine, KEMU/Mayo Hospital, Lahore, Pakistan
Hafiz Muhammad Sajid Jehangir
Department of Internal Medicine, KEMU/Mayo Hospital, Lahore, Pakistan
Samara Siddique
Department of Internal Medicine, KEMU/Mayo Hospital, Lahore, Pakistan
Madiha Khalid
Department of Health Sciences Technology, National Skills University, Islamabad, Pakistan
Imran Tipu
Department of Life sciences, School of Science, University of Management and Technology, Lahore 54770, Pakistan
Ibrar Rafique
Health Research Institute (Ex-Pakistan Health Research Council), National Institutes of Health, Constitution Avenue, Sector G-5/2, Islamabad, Pakistan
Muhammad Ansar
Department of Biochemistry, Quaid Azam University, Islamabad
Rukhsana Parveen
Centre for Applied Molecular Biology, University of the Punjab, Lahore
Muhammad Arif Nadeem Saqib
Department of Health Sciences Technology, National Skills University, Islamabad, Pakistan