Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study
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Abstract
Recent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.
Design
We analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.
Setting
Patients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.
Participants
Admitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.
Primary and secondary outcomes measures
The primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.
Results
We included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).
Conclusions
The accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.
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SciScore for 10.1101/2020.10.01.20205229: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: (10) A waiver for the use hospital record data was obtained from the Medical Ethical Committees of the participating centers. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The present analysis has several limitations. First, data collection was based on data collection forms of the …
SciScore for 10.1101/2020.10.01.20205229: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: (10) A waiver for the use hospital record data was obtained from the Medical Ethical Committees of the participating centers. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The present analysis has several limitations. First, data collection was based on data collection forms of the WHO, which did not include detailed information on cardiovascular disease history. For this reason, we relied on medication use as a surrogate marker for established cardiovascular risk factors or disease, which has been used before in big cohort studies.(31) Nevertheless, some of these drugs might have been prescribed for different indications. Secondly, we only obtained follow-up during the first 21 days, however as depicted in the Kaplan-Meier analysis, almost all events occurred during the first 14 days, in line with earlier descriptions.(4) Finally, we cannot exclude that mortality in the current study is partially caused by other factors than COVID-19. However, as we used 21-day mortality as our primary outcome and only included patients admitted to the hospital with confirmed COVID-19 infection, it is very likely that the majority of deaths were directly attributable to COVID-19. In conclusion, the accumulation of CVD risk factors leads to a stepwise increased risk for short-term mortality in hospitalized COVID-19 patients. Patients with diabetes had the highest risk, followed by similar risks for hypertension and dyslipidemia. Mechanistic studies investigating how CVD risk factors disproportionately affect COVID-19 patients compared to other infectious diseases are warranted.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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