HYPERTENSION AND RISK FACTORS ASSOCIATED WITH IN-HOSPITAL DEATH IN PATIENTS WITH COVID-19

ABSTRACT

Objective: To explore the prevalence of hypertension and the common risk factors associated with increased death rate among (Covid-19) patients. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, self-reported comorbidities, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients between Feb 2020 and July 2021. The outcomes of interest were death or discharge from the hospital. Logistic regression analysis was used to assess the impact of age, gender, associated comorbidities and some laboratory abnormalities on increased death rate among in-hospital (Covid-19) patients. Results: The prevalence of hypertension, was 59.6%, followed by diabetes (47.3%). COVID-19 patients with hypertension were older (67.0 ± 10.7vs 65.0 ± 13.0 P = 0.001). 70.4% were males. Undiagnosed high blood pressure was detected among 14.5%. Overall mortality was 46.2%, while mortality among normotensives, known hypertensives and undiagnosed hypertension was 47.7%, 54.7% and 37.6%, respectively (p < 0.005). Death was significantly higher among the age group > 65 years compared to ≦ 65 years old (53.6% % vs 39.0% (P = 0.005) irrespective of their blood pressure. Severe respiratory and gastrointestinal symptoms were significantly higher among hypertensives. Type I Respiratory failure 22.1%, and acute kidney injury 11.8% were the most typical complications among hypertensives. Leucocytosis (24.2%), Lymphopenia (56.8%) and higher levels of D-Dimer (47.7%) and C-reactive protein (49.7%) were mainly observed among hypertensive patients. Logistic Regression analysis after adjusting for age significantly showed age OR 1.81, 95% CI (1.12 2.73, p = 0.01), undiagnosed HTN OR 5.65, 95% CI (2.0415.67, p = 0.00), low platelets count OR 6.53, 95% CI, (1.2335.23, p = 0.02), higher levels of urea OR1.67, 95% CI, (1.042.63, p = 0.03) and creatinine OR1.71, 95% CI, (1.0632.70, p = 0.02), were associated with worse prognosis and in-hospital death among Covid- 19 patients. Conclusion: The age group, more than 65 years with undiagnosed BP of more than 140/90, is significantly associated with higher in-hospital death. Thrombocytopenia and elevated urea and creatinine levels were the most prominent laboratory markers and may be used as a potential indicator for prognosis and outcome among Covid 19 hypertensives. (Table Presented).