Profiles of Independent-Comorbidity Groups in Senior COVID-19 Patients Reveal Low Fatality Associated with Standard Care and Low-Dose Hydroxychloroquine over Antivirals

Abstract

Introduction

The lack of feasible therapies and comorbidities aggravate the COVID-19 case–fatality rate (CFR). However, reports examining CFR associations with diabetes, concomitant cardiovascular diseases, chronic kidney disease, and chronic liver disease (CLD) are limited. More studies assessing hydroxychloroquine (Hcq) and antivirals are needed.

Purpose

To examine associations of COVID-19 CFR in comorbid patient groups each with single comorbidities and after treatment with Hcq, favipiravir, and dexamethasone (Dex), either alone or in combination versus standard care.

Methods

Using statistical analysis, we descriptively determined these associations among 750 COVID-19 patient groups during the last quarter of 2021.

Results

A diabetes comorbidity (40%, n=299) showed twice the fatality (CFR 14%) of the others (CFR 7%; P=0.001). Hypertension (Htn) was the second-commonest comorbidity (29.5%, n=221), with similar CFR to diabetes (15% and 7% for Htn and non-Htn, respectively), but with higher significance (P=0.0006167). Although only 4% (n=30) heart failure (HF) was reported, the CFR (40%) was much higher than in those without it (8%). A similar rate (4%) for chronic kidney disease was reported, with CFRs of 33% and 9% among those with and without it, respectively (P=0.00048). Ischemic heart disease was 11% (n=74), followed by chronic liver disease (0.4%) and history of smoking (1%); however, these were not significant due to the sample sizes. Treatment indicated standard care and Hcq alone or in combination were superior (CFR of 4% and 0.5%, respectively) compared to favipiravir (25%) or Dex (38.5%) independently or in combination (35.4%). Furthermore, Hcq performed well (CFR 9%) when combined with Dex (9%; P=4.28–²⁶).

Conclusion

The dominance of diabetes and other comorbidities with significant association with CFR implied existence of a common virulence mechanism. The superiority of low-dose Hcq and standard care over antivirals warrants further studies.

Keywords:

• COVID-19 medicine treatments
• COVID-19 supportive treatment
• comorbid COVID-19 elders
• COVID-19 survivals and deaths

Data Sharing

All data are included in the paper.

Ethics Approval and Institutional Review Board Statement

Standard guidelines were followed during this research according to the IRB protocols. This study complied with the Declaration of Helsinki. This study was reviewed and approved by the Research Ethics Committee at the University of Ha’il, dated October 22, 2020 and endorsed by University President letter 13675/5/42, 08/03/1441 H; for Deanship Project RG20064, H-2020-187. The KACST Institutional Review Board (IRB) registration numbers are H-8-L-074 IRB log 2021-11. The KACST IRB also approved the study.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Acknowledgment

This research was funded by the Scientific Research Deanship at the University of Ha’il, Saudi Arabia through the project number RG20064. Ha’il College of Medicine (COM) Research Unit is a research-intensive hub that co-ordinates and houses advanced research initiatives.

Author Contributions

All authors made a significant contribution to the work reported, whether in the conception, study design, execution, acquisition of data, analysis, interpretation, or all these areas, took part in drafting, revising, or critically reviewing the article, gave final approval to the version to be published, have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest of any type.