Page 36 - JCTR-11-1

Journal of Clinical and
Translational Research Dexamethasone in critical COVID-19

Table 1. (Continued)
Features Patient number (%) Demise
Yes No
n (%) n (%)
Urea
Distribution - n (%)
<48.5 5 (22.7) 1 (20.0) 4 (80.0)
≥48.5 17 (77.3) 8 (47.1) 9 (52.9)
Abbreviations: AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CI: Confidence interval; BMI: Body mass index.

The predominant chronic conditions indicated Table 2. Relevant chronic comorbidities
concomitant diseases. Table 2 presents the relevant chronic
comorbidities. Among the deceased patients, 55% had Comorbidities n Percentage
been diagnosed with hypertension, 44% had diabetes and/ Hypertension 11 50.0
or insulin therapy, 33% had a history of cardiovascular Diabetes/Insulin therapy 7 31.8
disease (including atrial fibrillation and congestive heart Cardiovascular disease (Atrial fibrillation, CHF) 4 18.2
failure), and 22% had a history of stroke. Stroke history 3 13.6

4. Discussion Abbreviation: CHF: Congestive heart failure.
Epidemiological data suggest that SARS-CoV-2 such as diabetes, hypertension, and cardiovascular or
predominantly affects older adults with chronic diseases cerebrovascular diseases, contribute substantially to this
due to their weakened immune function, which aligns risk. 13
with the present findings, where the mean patient age was
62.14 years. The lower susceptibility of women to viral Among the recorded deaths in this study, 50% of patients
9
infections may be linked to the protective role of the X had hypertension, 31.8% had diabetes and/or required
chromosome and sex hormones, which enhance immune insulin therapy, 18.2% had a history of cardiovascular
responses. However, the number of infected females and disease (including atrial fibrillation and congestive heart
10
males in this study was equivalent. failure), and 13.6% had a history of stroke. In a cohort
of 41 patients, 13 (32%) were admitted to the ICU due to
A retrospective cohort study conducted in Lombardy, the need for a high-flow nasal cannula or more advanced
Italy, among critically ill COVID-19 patients admitted to oxygen support to manage hypoxemia. The majority
ICUs found that males with hypertension, cardiovascular of patients were male (30 [73%]), and less than half had
disease, and diabetes were the most prevalent comorbidities underlying conditions (13 [32%]), including diabetes (8
and were associated with a high fatality rate. In this study, [20%]), hypertension (6 [15%]), and cardiovascular disease
the most common comorbidities were hypertension (6 [15%]). 13
(54%), diabetes (36%), and cardiovascular disease (27%).
Similarly, the Lombardy study reported that 60.5% (95% In an Italian cohort, the median length of ICU stay was
CI, 58.9% – 62.2%) of patients had at least one comorbidity, 12 days (interquartile range 6 – 21; range 0 – 87), with
11
with hypertension being the most frequent (42.1%; 95% CI, 87% of patients requiring intubation. The average ICU
40.5% – 43.6%), followed by hypercholesterolemia (16.5%; stay in this cohort was 14.4 days, with 86.4% of patients
95% CI, 15.3% – 17.8%) and heart disease (16.2%; 95% CI, intubated. All patients who died were on mechanical
14.9% – 17.4%). 11 ventilation. Consistent with previous findings, the length
of hospital stay and the need for mechanical ventilation
Most COVID-19 studies have not identified obesity as a were identified as risk factors for coinfections.
mortality risk factor, often due to the lack of body mass index
(BMI) or total body weight data, as in this study. Without Ten of the 22 patients in this study were infected with
BMI data, the degree of obesity in the population could not Acinetobacter baumannii, and a moderate correlation
be assessed. However, obese patients are more likely to was found between the length of stay and A. baumannii
12
develop critical illness compared to nonobese individuals, infection (Spearman ρ = 0.592; P < 0.005). In addition,
and they frequently have other metabolic disorders, such as a strong correlation was observed between the number
diabetes. This is significant because the cumulative risk of of days on mechanical ventilation and A. baumannii
mortality increases with obesity-associated comorbidities. infection (Spearman ρ = 0.740; P < 0.001). This represents
Metabolic syndrome and conditions related to obesity, a significant increase compared to the historical rate

Volume 11 Issue 1 (2025) 30 doi: 10.36922/jctr.24.00036