6533b81ffe1ef96bd127727d
RESEARCH PRODUCT
Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension
Guido IaccarinoGuido GrassiClaudio BorghiClaudio FerriMassimo SalvettiMassimo VolpeArrigo F.g. CiceroPietro MinuzMaria Lorenza MuiesanPaolo MulateroGiuseppe MulèGiacomo PucciCarmine SavoiaLeonardo SechiStefano CarugoFrancesco FalloCristina GiannattasioDavide GrassiClaudio LetiziaStefano PerliniDamiano RizzoniRiccardo SarzaniGiuliano TocciFranco VeglioClaudia Agabiti RoseiMichele BevilacquaValeria BisogniMichele BombelliLuca BulfoneFlaminia CanichellaGiovanni CarpaniMassimo CatanusoGiulia ChiariniFernando ChiumientoRosario CianciFranco CipolliniAntonio ConcistrèAndrea DalbeniRoberto Alberto De BlasiCarolina De CiuceisRaffaella Dell’oroAntonino Di GuardoSanto Di LorenzoMonica Di NorciaRoberto ErvoElisabetta EulaDavide FabbricatoreElvira FanelliCristiano FavaEnzo GrassoAlessandro GrimaldiMaddalena IllarioClaudio InvernizziElena IracaFederica LiegiPaolo MalerbaAlessandro MalobertiCostantino MancusiGiulia MolinariRoberta MussinelliAnna PainiPaola PellimassiOrnella PiazzaRoberto PontremoliFosca Quarti TevanoFranco RabbiaMonica RoccoAnna SabenaFrancesco SalinaroPaola SchiaviMaria Chiara SgarigliaFrancesco SpannellaSara TedeschiPierluigi Vialesubject
MaleCross-sectional studyAngiotensin-Converting Enzyme Inhibitors030204 cardiovascular system & hematologyRenin-Angiotensin System0302 clinical medicine80 and overMedicineodds ratioodds ratio.030212 general & internal medicineViralYoung adultSocieties MedicalAged 80 and overCOVID-19; hypertension; Italy; multimorbidity; odds ratio; Adolescent; Adult; Age Distribution; Age Factors; Aged; Aged 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Coronavirus Infections; Cross-Sectional Studies; Female; Humans; Hypertension; Italy; Male; Middle Aged; Multimorbidity; Pandemics; Pneumonia Viral; Prognosis; Renin-Angiotensin System; Survival Rate; Young Adult; Betacoronavirus; Societies MedicalMortality rateAge FactorsMiddle AgedPrognosisSurvival RateItalyCOVID-19; hypertension; Italy; multimorbidity; odds ratioFemaleCoronavirus InfectionsAdultmedicine.medical_specialtyhypertensionAdolescentmultimorbidityPneumonia ViralCOVID-19; Italy; hypertension; multimorbidity; odds ratio03 medical and health sciencesAngiotensin Receptor AntagonistsYoung AdultBetacoronavirusAge DistributionInternal medicineDiabetes mellitusMedicalInternal MedicineHumansSurvival ratePandemicsAgedbusiness.industrySARS-CoV-2COVID-19Odds ratioPneumoniamedicine.diseaseCross-Sectional StudiesHeart failureCOVID-19; Hypertension; Italy; Multimorbidity; Odds ratio; Adolescent; Adult; Age Distribution; Age Factors; Aged; Aged 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; COVID-19; Coronavirus Infections; Cross-Sectional Studies; Female; Humans; Hypertension; Italy; Male; Middle Aged; Multimorbidity; Pandemics; Pneumonia Viral; Prognosis; Renin-Angiotensin System; SARS-CoV-2; Survival Rate; Young Adult; Betacoronavirus; Societies MedicalbusinessSocietiesKidney diseasedescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2020-01-01 |