Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis

doi:10.1183/13993003.00547-2020

. 2020 May 14;55(5):2000547.

doi: 10.1183/13993003.00547-2020. Print 2020 May.

Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis

Wei-Jie Guan^{1

2}, Wen-Hua Liang^{3

2}, Yi Zhao^{3

2}, Heng-Rui Liang^{3

2}, Zi-Sheng Chen^{3

4

2}, Yi-Min Li⁵, Xiao-Qing Liu⁵, Ru-Chong Chen¹, Chun-Li Tang¹, Tao Wang¹, Chun-Quan Ou⁶, Li Li⁶, Ping-Yan Chen⁶, Ling Sang⁵, Wei Wang³, Jian-Fu Li³, Cai-Chen Li³, Li-Min Ou³, Bo Cheng³, Shan Xiong³, Zheng-Yi Ni⁷, Jie Xiang⁷, Yu Hu⁸, Lei Liu^{9

10}, Hong Shan¹¹, Chun-Liang Lei¹², Yi-Xiang Peng¹³, Li Wei¹⁴, Yong Liu¹⁵, Ya-Hua Hu¹⁶, Peng Peng¹⁷, Jian-Ming Wang¹⁸, Ji-Yang Liu¹⁹, Zhong Chen²⁰, Gang Li²¹, Zhi-Jian Zheng²², Shao-Qin Qiu²³, Jie Luo²⁴, Chang-Jiang Ye²⁵, Shao-Yong Zhu²⁶, Lin-Ling Cheng¹, Feng Ye¹, Shi-Yue Li¹, Jin-Ping Zheng¹, Nuo-Fu Zhang¹, Nan-Shan Zhong¹, Jian-Xing He²⁷; China Medical Treatment Expert Group for COVID-19

Affiliations

¹ State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
² These authors are joint first authors.
³ Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁴ The sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China.
⁵ Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁶ State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China.
⁷ Wuhan Jin-yintan Hospital, Wuhan, China.
⁸ Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁹ Shenzhen Third People's Hospital, Shenzhen, China.
¹⁰ The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.
¹¹ The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
¹² Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
¹³ The Central Hospital of Wuhan, Wuhan, China.
¹⁴ Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China.
¹⁵ Chengdu Public Health Clinical Medical Center, Chengdu, China.
¹⁶ Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China.
¹⁷ Wuhan Pulmonary Hospital, Wuhan, China.
¹⁸ Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China.
¹⁹ The First Hospital of Changsha, Changsha, China.
²⁰ The Third People's Hospital of Hainan Province, Sanya, China.
²¹ Huanggang Central Hospital, Huanggang, China.
²² Wenling First People's Hospital, Wenling, China.
²³ The Third People's Hospital of Yichang, Yichang, China.
²⁴ Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China.
²⁵ Xiantao First People's Hospital, Xiantao, China.
²⁶ The People's Hospital of Huangpi District, Wuhan, China.
²⁷ Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China drjianxing.he@gmail.com nanshan@vip.163.com.

PMID: 32217650
PMCID: PMC7098485
DOI: 10.1183/13993003.00547-2020

Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis

Wei-Jie Guan et al. Eur Respir J. 2020.

. 2020 May 14;55(5):2000547.

doi: 10.1183/13993003.00547-2020. Print 2020 May.

Authors

Affiliations

¹ State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
² These authors are joint first authors.
³ Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁴ The sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China.
⁵ Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁶ State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China.
⁷ Wuhan Jin-yintan Hospital, Wuhan, China.
⁸ Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁹ Shenzhen Third People's Hospital, Shenzhen, China.
¹⁰ The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.
¹¹ The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
¹² Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
¹³ The Central Hospital of Wuhan, Wuhan, China.
¹⁴ Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China.
¹⁵ Chengdu Public Health Clinical Medical Center, Chengdu, China.
¹⁶ Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China.
¹⁷ Wuhan Pulmonary Hospital, Wuhan, China.
¹⁸ Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China.
¹⁹ The First Hospital of Changsha, Changsha, China.
²⁰ The Third People's Hospital of Hainan Province, Sanya, China.
²¹ Huanggang Central Hospital, Huanggang, China.
²² Wenling First People's Hospital, Wenling, China.
²³ The Third People's Hospital of Yichang, Yichang, China.
²⁴ Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China.
²⁵ Xiantao First People's Hospital, Xiantao, China.
²⁶ The People's Hospital of Huangpi District, Wuhan, China.
²⁷ Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China drjianxing.he@gmail.com nanshan@vip.163.com.

PMID: 32217650
PMCID: PMC7098485
DOI: 10.1183/13993003.00547-2020

Abstract

Background: The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide.

Objective: To evaluate the risk of serious adverse outcomes in patients with COVID-19 by stratifying the comorbidity status.

Methods: We analysed data from 1590 laboratory confirmed hospitalised patients from 575 hospitals in 31 provinces/autonomous regions/provincial municipalities across mainland China between 11 December 2019 and 31 January 2020. We analysed the composite end-points, which consisted of admission to an intensive care unit, invasive ventilation or death. The risk of reaching the composite end-points was compared according to the presence and number of comorbidities.

Results: The mean age was 48.9 years and 686 (42.7%) patients were female. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached the composite end-points. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD (HR (95% CI) 2.681 (1.424-5.048)), diabetes (1.59 (1.03-2.45)), hypertension (1.58 (1.07-2.32)) and malignancy (3.50 (1.60-7.64)) were risk factors of reaching the composite end-points. The hazard ratio (95% CI) was 1.79 (1.16-2.77) among patients with at least one comorbidity and 2.59 (1.61-4.17) among patients with two or more comorbidities.

Conclusion: Among laboratory confirmed cases of COVID-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.

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Conflict of interest statement

Conflict of interest: Wei-jie Guan has nothing to disclose. Conflict of interest: Wen-hua Liang has nothing to disclose. Conflict of interest: Yi Zhao has nothing to disclose. Conflict of interest: Heng-rui Liang has nothing to disclose. Conflict of interest: Zi-sheng Chen has nothing to disclose. Conflict of interest: Yi-min Li has nothing to disclose. Conflict of interest: Xiao-qing Liu has nothing to disclose. Conflict of interest: Ru-chong Chen has nothing to disclose. Conflict of interest: Chun-li Tang has nothing to disclose. Conflict of interest: Tao Wang has nothing to disclose. Conflict of interest: Chun-quan Ou has nothing to disclose. Conflict of interest: Li has nothing to disclose. Conflict of interest: Ping-yan Chen has nothing to disclose. Conflict of interest: Ling Sang has nothing to disclose. Conflict of interest: Wei Wang has nothing to disclose. Conflict of interest: Jian-fu Li has nothing to disclose. Conflict of interest: Cai-chen Li has nothing to disclose. Conflict of interest: Li-min Ou has nothing to disclose. Conflict of interest: Bo Cheng has nothing to disclose. Conflict of interest: Shan Xiong has nothing to disclose. Conflict of interest: Zheng-yi Ni has nothing to disclose. Conflict of interest: Jie Xiang has nothing to disclose. Conflict of interest: Yu Hu has nothing to disclose. Conflict of interest: Lei Liu has nothing to disclose. Conflict of interest: Hong Shan has nothing to disclose. Conflict of interest: Chun-liang Lei has nothing to disclose. Conflict of interest: Yi-xiang Peng has nothing to disclose. Conflict of interest: Li Wei has nothing to disclose. Conflict of interest: Yong Liu has nothing to disclose. Conflict of interest: Ya-hua Hu has nothing to disclose. Conflict of interest: Peng has nothing to disclose. Conflict of interest: Jian-ming Wang has nothing to disclose. Conflict of interest: Ji-yang Liu has nothing to disclose. Conflict of interest: Zhong Chen has nothing to disclose. Conflict of interest: Gang Li has nothing to disclose. Conflict of interest: Zhi-jian Zheng has nothing to disclose. Conflict of interest: Shao-qin Qiu has nothing to disclose. Conflict of interest: Jie Luo has nothing to disclose. Conflict of interest: Chang-jiang Ye has nothing to disclose. Conflict of interest: Shao-yong Zhu has nothing to disclose. Conflict of interest: Lin-ling Cheng has nothing to disclose. Conflict of interest: Feng Ye has nothing to disclose. Conflict of interest: Shi-yue Li has nothing to disclose. Conflict of interest: Jin-ping Zheng has nothing to disclose. Conflict of interest: Nuo-fu Zhang has nothing to disclose. Conflict of interest: Nan-shan Zhong reports grants from the National Health Commission and Dept of Science and Technology of Guangdong Province, during the conduct of the study. Conflict of interest: Jian-xing He has nothing to disclose.

Figures

**FIGURE 1**
a) The time-dependent risk of reaching the composite end-points between patients with or without any comorbidity. b) The time-dependent risk of reaching the composite end-points between patients without any comorbidity, patients with a single comorbidity and patients with two or more comorbidities. Cox proportional hazard regression models were applied to determine the potential risk factors associated with the composite end-points, with the hazard ratio and 95% confidence interval being reported.

**FIGURE 2**
Predictors of the composite end-points in the proportional hazards model. Hazard ratio (95% confidence interval) are shown for the risk factors associated with the composite end-points (admission to intensive care unit, invasive ventilation or death). The comorbidities were classified according to the organ systems as well as the number. The scale bar indicates the hazard ratio. Cox proportional hazard regression models were applied to determine the potential risk factors associated with the composite end-points, with the hazard ratio (95% confidence interval) being reported. The model has been adjusted with age and smoking status.

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References

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1. World Health Organization. Coronavirus disease (COVID-19) situation reports www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ Date last accessed: 10 March 2020.
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[1] World Health Organization. www.who.int Date last accessed: 10 March 2020.

[2] World Health Organization. www.who.int Date last accessed: 10 March 2020.

[3] World Health Organization. Coronavirus disease (COVID-19) situation reports www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ Date last accessed: 10 March 2020.

[4] World Health Organization. Coronavirus disease (COVID-19) situation reports www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ Date last accessed: 10 March 2020.

[5] Huang C, Wang Y, Li X, et al. . Clinical features of patients with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506. doi:10.1016/S0140-6736(20)30183-5 - DOI - PMC - PubMed

[6] Huang C, Wang Y, Li X, et al. . Clinical features of patients with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506. doi:10.1016/S0140-6736(20)30183-5 - DOI - PMC - PubMed

[7] Chen N, Zhou M, Dong X, et al. . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–513. doi:10.1016/S0140-6736(20)30211-7 - DOI - PMC - PubMed

[8] Chen N, Zhou M, Dong X, et al. . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–513. doi:10.1016/S0140-6736(20)30211-7 - DOI - PMC - PubMed

[9] Wang D, Hu B, Hu C, et al. . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; in press [https://doi.org/10.1001/jama.2020.1585]. doi:10.1001/jama.2020.1585 - DOI - PMC - PubMed

[10] Wang D, Hu B, Hu C, et al. . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; in press [https://doi.org/10.1001/jama.2020.1585]. doi:10.1001/jama.2020.1585 - DOI - PMC - PubMed

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Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis

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Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis

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