Medical Comorbidities as Predictors of COVID-19 Short-Term Mortality: A Historical Cohort Study (preprint)

Background: While the coronavirus disease 2019 (COVID-19) is most commonly associated with the respiratory system, disorders in other organ systems, such as the cardiovascular, neurologic, or renal, can also contribute to disease fatality. This study aimed to evaluate the relation of comorbidities to COVID-19 short-term mortality. Method: This was a single-center observational study with a historical cohort method at Bethesda Hospital Yogyakarta, Indonesia. COVID-19 diagnosis was made by utilizing reverse transcriptase-polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. Patient data were retrieved from electronic medical records and used for Charlson Comorbidity Index assessments. In-hospital mortality was monitored throughout their hospital stay. Results: This study enrolled 333 patients. According to the total number of comorbidities in Charlson, 11.7% (n=39) of patients had no comorbidities; 30.9% (n=103) of patients had one comorbidity; 20.1% (n=67) of patients had two comorbidities; and 37.2% (n=124) of patients had more than three comorbidities. In multivariate analysis, these variables were significantly related to short-term mortality in COVID-19 patients: older age (odds ratio [OR] per year 1.64; 95% confidence interval [CI] 1.23-2.19; p 0.001), myocardial infarction (OR 3.57 ; 95% CI 1.49-8.56; p: 0.004), diabetes mellitus (OR 2.41; 95 CI 1.17-4.97; p: 0.017), renal disease (OR 5.18 ; 95% CI 2.07-12.97; p <0.001), and longer duration of stay (OR 1.20; 95% CI 1.08-1.32; p <0.001). Conclusion: Our study revealed multiple risk factors for mortality in patients with COVID-19. The coexistence of cardiovascular disease, diabetes, and renal problem are significant predictors of short-term mortality in COVID-19 patients.

Middle cerebral artery territory infarction in a COVID-19 patient

Coronavirus disease 2019 (COVID-19) mainly invades the respiratory system, yet previous reports have shown unusual manifestations of COVID-19, including cerebrovascular events. However, detailed case reports are still lacking. A 57-year-old male presented with sudden unconsciousness and right side lateralization for 6 hours before hospital admission. His test results were positive for severe acute respiratory syndrome coronavirus 2 infection. The head computed tomography (CT) scan showed infarction within the middle cerebral artery region. The scan was repeated 48 hours after admission and showed a massive infarct in the left hemisphere with hemorrhagic transformation. A chest CT showed the appearance of bronchopneumonia with ground-glass opacities in both lungs. The patient's condition was rapidly deteriorating, and he died on the third day after admission. Our findings suggest that ischemic vascular events may simultaneously develop due to the progression of COVID-19. A hypercoagulable state and vascular endothelial dysfunction have been proposed as complications of COVID-19 and are risk factors of thrombotic vascular events.