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Age and Multimorbidity Predict Death Among COVID-19 Patients

2020; Lippincott Williams & Wilkins; Volume: 76; Issue: 2 Linguagem: Inglês

10.1161/hypertensionaha.120.15324

1524-4563

Guido Iaccarino, Guıdo Grassı, Claudio Borghi, Claudio Ferri, Massimo Salvetti, Massimo Volpe, Arrigo F.G. Cicero, Pietro Minuz, María Lorenza Muiesan, Paolo Mulatero, Giuseppe Mulè, Giacomo Pucci, Carmine Savoia, Leonardo A. Sechi, Stefano Carugo, Francesco Fallo, Cristina Giannattasio, Davide Grassi, Claudio Letizia, Stefano Perlini, Damiano Rizzoni, Riccardo Sarzani, Giuliano Tocci, Franco Veglio, Claudia Agabiti Rosei, Michele Bevilacqua, Valeria Bisogni, Michele Bombelli, Luca Bulfone, Flaminia Canichella, Giovanni Carpani, Massimo Catanuso, Giulia Chiarini, Fernando Chiumiento, Rosario Cianci, Franco Cipollini, Antonio Concistrè, Andrea Dalbeni, R. A. De Blasi, Carolina De Ciuceis, Raffaella Dell’Oro, Antonino Di Guardo, Santo Di Lorenzo, Monica Di Norcia, Roberto Ervo, Elisabetta Eula, Davide Fabbricatore, Elvira Fanelli, Cristiano Fava, E Grasso, Alessandro Grimaldi, Maddalena Illario, C Invernizzi, Elena Iraca, Federica Liegi, Paolo Malerba, Alessandro Maloberti, Costantino Mancusi, Giulia Molinari, Roberta Mussinelli, Anna Paini, Paola Pellimassi, Ornella Piazza, Roberto Pontremoli, Fosca Quarti Tevano, Franco Rabbia, Monica Rocco, Anna Sabena, Francesco Salinaro, Paola Schiavi, Maria Chiara Sgariglia, Francesco Spannella, Sara Tedeschi, Pierluigi Viale,

COVID-19 and healthcare impacts

Several factors have been proposed to explain the high death rate of the coronavirus disease 2019 (COVID-19) outbreak, including hypertension and hypertension-related treatment with Renin Angiotensin System inhibitors. Also, age and multimorbidity might be confounders. No sufficient data are available to demonstrate their independent role. We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to verify whether renin-angiotensin system inhibitors are related to COVID-19 severe outcomes. We analyzed information from Italian patients diagnosed with COVID-19, admitted in 26 hospitals. One thousand five hundred ninety-one charts (male, 64.1%; 66±0.4 years) were recorded. At least 1 preexisting condition was observed in 73.4% of patients, with hypertension being the most represented (54.9%). One hundred eighty-eight deaths were recorded (11.8%; mean age, 79.6±0.9 years). In nonsurvivors, older age, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery diseases, and heart failure were more represented than in survivors. The Charlson Comorbidity Index was significantly higher in nonsurvivors compared with survivors (4.3±0.15 versus 2.6±0.05; P<0.001). ACE (angiotensin-converting enzyme) inhibitors, diuretics, and β-blockers were more frequently used in nonsurvivors than in survivors. After correction by multivariate analysis, only age (P=0.0001), diabetes mellitus (P=0.004), chronic obstructive pulmonary disease (P=0.011), and chronic kidney disease (P=0.004) but not hypertension predicted mortality. Charlson Comorbidity Index, which cumulates age and comorbidities, predicts mortality with an exponential increase in the odds ratio by each point of score. In the COVID-19 outbreak, mortality is predicted by age and the presence of comorbidities. Our data do not support a significant interference of hypertension and antihypertensive therapy on COVID-19 lethality. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT04331574.