1. Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension
- Author
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Guido Iaccarino, Guido Grassi, Claudio Borghi, Claudio Ferri, Massimo Salvetti, Massimo Volpe, Arrigo F.G. Cicero, Pietro Minuz, Maria Lorenza Muiesan, Paolo Mulatero, Giuseppe Mulè, Giacomo Pucci, Carmine Savoia, Leonardo 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, Roberto Alberto 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, Enzo Grasso, Alessandro Grimaldi, Maddalena Illario, Claudio 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, Iaccarino, G, Grassi, G, Borghi, C, Ferri, C, Salvetti, M, Volpe, M, Iaccarino G., Grassi G., Borghi C., Ferri C., Salvetti M., Volpe M., Mule G., SARS-RAS Investigator, Iaccarino, Guido, Grassi, Guido, Borghi, Claudio, Ferri, Claudio, Salvetti, Massimo, Illario, Maddalena, Volpe, Massimo, and Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M, Cicero AFG
- Subjects
Male ,Cross-sectional study ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,Renin-Angiotensin System ,0302 clinical medicine ,80 and over ,Medicine ,odds ratio ,030212 general & internal medicine ,Viral ,Young adult ,Societies, Medical ,Aged, 80 and over ,COVID-19 ,hypertension ,Italy ,multimorbidity ,Adolescent ,Adult ,Age Distribution ,Age Factors ,Aged ,Angiotensin Receptor Antagonists ,Coronavirus Infections ,Cross-Sectional Studies ,Female ,Humans ,Hypertension ,Middle Aged ,Multimorbidity ,Pandemics ,Pneumonia, Viral ,Prognosis ,Survival Rate ,Young Adult ,Betacoronavirus ,Mortality rate ,medicine.medical_specialty ,03 medical and health sciences ,Internal medicine ,Diabetes mellitus ,Medical ,Internal Medicine ,Survival rate ,business.industry ,SARS-CoV-2 ,Odds ratio ,Pneumonia ,medicine.disease ,Heart failure ,business ,Societies ,Kidney disease - Abstract
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 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.
- Published
- 2020