Cardiovascular risk factors and outcomes in COVID-19: A hospital-based study in India

  1. Arvind K. Sharma
  2. Vaseem Naheed Baig
  3. Sonali Sharma
  4. Gaurav Dalela
  5. Raja Babu Panwar
  6. Vishwa Mohan Katoch
  7. Rajeev Gupta

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Abstract

Presence of cardiovascular (CV) risk factors enhance adverse outcomes in COVID-19. To determine association of risk factors with clinical outcomes in India we performed a study.

Methods

Successive virologically confirmed adult patients of COVID-19 at a government hospital were recruited at admission and data on clinical presentation and in-hospital outcomes were obtained. The cohort was classified according to age, sex, hypertension, diabetes and tobacco use. In-hospital death was the primary outcome. Logistic regression was performed to compared outcomes in different groups.

Results

From April to September 2020 we recruited 4645 (men 3386, women 1259) out of 5103 virologically confirmed COVID-19 patients (91.0%). Mean age was 46±18y, hypertension was in 17.8%, diabetes in 16.6% and any tobacco-use in 29.5%. Duration of hospital stay was 6.8±3.7 days, supplemental oxygen was in 18.4%, non-invasive ventilation in 7.1%, mechanical ventilation in 3.6% and 7.3% died. Unadjusted and age-sex adjusted odds ratio(OR) and 95% confidence intervals(CI) for in-hospital mortality, respectively, were: age ≥60y vs <40y, OR 8.47(95% CI 5.87–12.21) and 8.49(5.88–12.25), age 40-59y vs <40y 3.69(2.53–5.38) and 3.66(2.50–5.33), men vs women 1.88(1.41–2.51) and 1.26(0.91–1.48); hypertension 2.22(1.74–2.83) and 1.32(1.02–1.70), diabetes 1.88(1.46–2.43) and 1.16(0.89–1.52); and tobacco 1.29(1.02–1.63) and 1.28(1.00–1.63). Need for invasive and non-invasive ventilation was greater among patients in age-groups 40–49 and ≥60y and hypertension. Multivariate adjustment for social factors, clinical features and biochemical tests attenuated significance of all risk factors.

Conclusion

Cardiovascular risk factors, age, male sex, hypertension, diabetes and tobacco-use, are associated with greater risk of in-hospital death among COVID-19 patients.

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  1. Version published to 10.1371/journal.pgph.0000234
  2. ScreenIT

    SciScore for 10.1101/2021.09.19.21263788: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: 15-17 The registry has been approved by the college administration and institutional ethics committee (CDSCO Registration Number CR/762/Inst/RJ/2015).
    Sex as a biological variableTo evaluate association of COVID-19 related adverse outcomes (death, invasive ventilation, non-invasive ventilation) with age, male sex, hypertension, diabetes and tobacco use, we performed a stepwise logistic regression analysis.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses: The data were computerized and processing was performed using commercially available statistical software, SPSS v.20.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    A study limitation is that we included COVID-19 patients with known hypertension and diabetes at time of admission as risk factor. Given the fact that in India only about half of the patients with hypertension and two-thirds with diabetes are aware of their condition,19 the prevalence of these conditions might have been higher in our cohort. However, many individuals with hypertension present with low BP in acute COVID-19 and therefore estimation of prevalence of hypertension based on measured BP would have been erroneous. Moreover, our unadjusted OR of 2.22 (CI 1.74-2.51) and age-sex adjusted OR of 1.32 (CI 1.02-1.70) is similar to many previous studies and meta-analyses have calculated hypertension related OR in COVID-19 between 1.90 (CI 1.69-2.35)3 and 2.50 (CI 2.15-2.90),5 similar to the present study. We did not inquire the type of anti-hypertensive patients in our study cohort. Certain BP medications such as renin-angiotensin system blockers are known to be useful in COVID-19.20,21 Previous meta-analyses including studies from India have identified diabetes as equally important as hypertension for adverse COVID-19 related outcomes.11,12 In the present study the unadjusted OR for diabetes and deaths were 1.88 (CI 1.46-2.43), however, the risk significantly attenuated after age and sex adjustment to OR 1.16 (CI 0.89-1.52) which is different from the previous studies. In the present study, we included patients with known diabetes only and this is a study limitation.22 It i...

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.09.19.21263788v1 on medRxiv