The study included data from more than 1,500 patients treated at one of 26 Italian hospitals. All patients received care from March 9 to April 9, 2020, and the average age was 66.5 years old. Each COVID-19 diagnosis were confirmed using throat swab samples. While 78% of patients were hospitalized in regular wards, another 15% were treated in the ICU and 7% stayed home.
Initially, the team found that age, hypertension, heart failure (HF), diabetes, CKD and COPD could all be used to predict mortality among these patients. However, after an additional analysis to account for the normal prevalence of these conditions among older patients, just age, diabetes CKD and COPD “maintained their significant impact on the non-survivors.”
The authors did note that HF could still be a key predictor of mortality among these patients.
“Although HF does not reach significance in the multivariable analysis, it should be considered that it is likely that an underestimation of HF with preserved systolic function, which is most common in the elderly, may have contributed to this, and other studies will be required to better define this aspect,” wrote first author Guido Iaccarino, MD, PhD, Federico II University of Naples in Italy, and colleagues.
The team also explored if key CVD medications—angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), for example—seemed to make an impact on a patient’s chance of survival—and found no significant associations.
“Our data show that ARBs do not associate with non-survivors and that ACE inhibitors lose their weak statistical significance when corrected by comorbidities and age,” Iaccarino et al. wrote. “The eventual role of ACE inhibitors deserves further investigations in larger cohorts. On this note, it is challenging to dissect an independent role of ACE inhibitors, since they are the most widely used drugs in patients with relevant comorbidities (diabetes mellitus, CKD, HF, hypertension, and coronary artery disease).”
Finally, the authors found that a high CCI score “is a strong predictor of the risk of death among patients affected by COVID-19.”
“A high score could have an important meaning not only in predicting an unfavorable outcome in COVID-19 patients but also in better identifying people who may benefit from more intense measures of personal isolation, quarantine, and earlier preventive or treatment strategies,” they wrote.