Age and Multimorbidity Predict Death Among COVID-19 Patients
Authors: Iaccarino Guido , Grassi Guido , Borghi Claudio , Ferri Claudio , Salvetti Massimo , Volpe Massimo , Cicero Arrigo F.G. , Minuz Pietro , Muiesan Maria Lorenza , Mulatero Paolo , Mulè Giuseppe , Pucci Giacomo , Savoia Carmine , Sechi Leonardo , Carugo Stefano , Fallo Francesco , Giannattasio Cristina , Grassi Davide , Letizia Claudio , Perlini Stefano , Rizzoni Damiano , Sarzani Riccardo , Tocci Giuliano , Veglio Franco , Agabiti Rosei Claudia , Bevilacqua Michele , Bisogni Valeria , Bombelli Michele , Bulfone Luca , Canichella Flaminia , Carpani Giovanni , Catanuso Massimo , Chiarini Giulia , Chiumiento Fernando , Cianci Rosario , Cipollini Franco , Concistrè Antonio , Dalbeni Andrea , De Blasi Roberto Alberto , De Ciuceis Carolina , Dell’Oro Raffaella , Di Guardo Antonino , Di Lorenzo Santo , Di Norcia Monica , Ervo Roberto , Eula Elisabetta , Fabbricatore Davide , Fanelli Elvira , Fava Cristiano , Grasso Enzo , Grimaldi Alessandro , Illario Maddalena , Invernizzi Claudio , Iraca Elena , Liegi Federica , Malerba Paolo , Maloberti Alessandro , Mancusi Costantino , Molinari Giulia , Mussinelli Roberta , Paini Anna , Pellimassi Paola , Piazza Ornella , Pontremoli Roberto , Quarti Tevano Fosca , Rabbia Franco , Rocco Monica , Sabena Anna , Salinaro Francesco , Schiavi Paola , Sgariglia Maria Chiara , Spannella Francesco , Tedeschi Sara , Viale Pierluigi 
Published: June 2020

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.