Influence of comorbidity on hospital outcomes among patients with COVID-19 using electronic records from a nationwide Healthcare System in Peru
Abstract Background Large cases reported that older age and comorbidity are predictors for poor prognosis in COVID-19 patients. Nevertheless, context-specific evidence relevant in low-and middle-income countries is still pending. Methods Retrospective cohort study using electronic health records of confirmed cases admitted in hospitalization areas from the Peruvian Social Health Insurance. The main variable was the presence of comorbidities and the outcomes were in-hospital mortality or intensive care unit admission, and in/out hospital mortality. We used Kaplan-Meier survival curves with the Log-Rank test to compare time-to-event outcomes between comorbidities groups. Crude and adjusted Cox regression models were used to estimate hazard ratios (HR). Statistical analyses were conducted with a significance level of 5%. Results In patients with ICU admission or in-hospital death, 45.99% had one comorbidity and 50.26% had two or more comorbidities. Using in/out hospital deaths up to 60 days as the outcome, the overall survival of patients with two comorbidities is lower than patients with one comorbidity, and both are lowest than a patient without comorbidities (Log-rank test p = 0.001). After adjusting for sex, age, severity, and hospital care network patients with one comorbidity (HR: 1.16; IC 95 %: 1.04–1.31) and with two or more comorbidities (HR: 1.13; IC 95%: 1.01–1.26) are at higher risk to die compared with those without comorbidities. Conclusion The presence of comorbidities in hospitalized patients with COVID-19 are risk factors for ICU admission and mortality. Proper identification of these factors can help to identify patients at higher risk in hospital admission and provide specialized care to prevent deaths.