Hershey, PA—
Which pre-existing conditions put patients at the highest risk of death from COVID-19? An international review and meta-analysis came up with some answers to that question.

The article in the PLOS One online journal advises that cardiovascular disease, hypertension, diabetes, congestive heart failure, chronic kidney disease, stroke and cancer all can increase mortality rates.

In an effort to improve patient care and help develop interventions to protect high-risk populations, Penn State College of Medicine researchers determined which conditions were the most dangerous. They report that common cardiovascular diseases appear to double a patient’s risk of dying from COVID-19, while the other pre-existing conditions might increase COVID-19 mortality rates one-and-a-half to three times.

“This study suggests that these chronic conditions are not just common in patients with COVID-19, but their presence is a warning sign to a higher risk of death,” explained Paddy Ssentongo, MD, MPH, a doctoral student in epidemiology at the College of Medicine and research assistant professor in Penn State's Department of Engineering Science and Mechanics. “There is a high prevalence of cardiovascular disease and hypertension around the world and in particular, the U.S. With the persistence of COVID-19 in the U.S., this connection becomes crucially important.”

For the review, the authors searched MEDLINE, SCOPUS, OVID, and Cochrane Library databases, and medrxiv.org from December 1, 2019, to July 9, 2020, looking for studies of the risk of COVID-19 mortality in patients with and without pre-existing comorbidities.

Ultimately, 11 pre-existing comorbidities—cardiovascular diseases, hypertension, diabetes, congestive heart failure, cerebrovascular disease, chronic kidney disease, chronic liver disease, cancer, chronic obstructive pulmonary disease, asthma, and HIV/AIDS—were included in the meta-analysis. The 65,484 patients in those studies had COVID-19 and a mean age of 61 years.

Researchers determined that conditions associated with significantly greater risk of mortality from the novel coronavirus were:
• Cardiovascular disease (risk ratio (RR) 2.25 [95% CI = 1.60-3.17], number of studies (n) = 14) 
• Hypertension (1.82 [1.43-2.32], n = 13) 
• Diabetes (1.48 [1.02-2.15], n = 16) 
• Congestive heart failure (2.03 [1.28-3.21], n = 3),
• Chronic kidney disease (3.25 [1.13-9.28)], n = 9) 
• Cancer (1.47 [1.01-2.14), n = 10) 

“Tailored infection prevention and treatment strategies targeting this high-risk population might improve survival,” the authors advise.

“Although the health care community has circulated anecdotal information about the impact of these risk factors in COVID-19 mortality, our systematic review and meta-analysis is the most comprehensive to date that attempts to quantify the risk,” said senior author Vernon Chinchilli, PhD, distinguished professor and chair of public health sciences at Penn State. “As the COVID-19 pandemic continues through 2020 and likely into 2021, we expect that other researchers will build on our work.”

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