Apr 15, 2020
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People with what co-morbidity are more likely to die from COVID-19?

What is the correlation of various chronic diseases and mortality from COVID - 19 ? Why do chronic smokers die of the pathogen most often?

On April 8, Chinese researchers from Weifang Medical University (潍坊 医学院) published in a peer-reviewed journal the first meta-analysis of various non-correlations Coronavirus-related diagnoses and severity COVID - . They looked at existing publications on the subject and found six retrospective studies rated at least six on the Newcastle-Ottawa scale and examining a total of 97 diseases. Based on these six studies, a meta-analysis was built. Among the analyzed articles:

  • six describe studies of patients with COVID - 19 and high blood pressure (hypertension), diabetes and chronic obstructive pulmonary disease (COPD);
  • in five studies, patients with concomitant liver diseases were described;
  • in four - with malignant tumors, kidney diseases and cardiovascular diseases;
  • in three are described as follows the same patients with cerebrovascular diseases of the brain.

Conclusions of meta-analysis

In patients with COVID - and cerebrovascular or cardiovascular diseases, hypertension, diabetes or COPD there was an increased risk of a severe course of the disease.

The odds ratio (OR) of 1 means that there is no correlation, OS> 1 means a positive correlation, and OS <1 - negative. For the concomitant diseases studied, the following OS indicators were:

  • for cerebrovascular diseases OS = 3, 89, that is, such people have complications with the course of the disease in 3, 85 times more often than people without concomitant pathologies;
  • for cardiovascular diseases - 2, 90 times more often;
  • for chronically elevated blood pressure - 2, 19 times more often;
  • diabetes - in 2, 47 times more often;

  • COPD - 5, 97 times more often;
  • No significant correlation was found for liver diseases, malignant tumors or kidney diseases.
  • “A meta-analysis revealed that hypertension, diabetes, COPD, cardiovascular and cerebrovascular diseases are a significant risk factor for patients with COVID- , "the researchers conclude. “Knowing these factors can help to more accurately identify such patients with COVID - , which are at high risk, ”and maybe develop a special treatment protocol for them. Doctors should be especially careful with patients with COPD, since COVID - 19 and COPD high comorbidity.

    In another similar meta-analysis, seven studies were analyzed in preprint format, and COPD also highlighted as one of the indications of a poor outcome of the course COVID - .

    Why is COPD so bad?

    COPD is a damage to the lungs that causes the destruction of air bubbles - the alveoli. This leads to a deterioration in gas exchange and difficulty breathing. COPD is almost untreatable. 47 - 89% of cases of COPD result from long-term smoking.

    Researchers from the University of British Columbia found that the cells of lung smokers and patients with COPD have increased expression of the ACE2 receptor (ACE2), which SARS-CoV-2 uses to penetrate the cells. “We found that patients with COPD and smokers in the airways have an increased level of ACE-2, which may increase the risk of complications with COVID - 19 , "they said.

    This increased expression of ACE2 receptors is actually a protective mechanism that triggers in response to damage to the alveoli. “Although an elevated level of ACE2 can protect a patient from severe lung damage,” it can increase the risk of complications from coronavirus disease, as the virus uses this receptor to enter epithelial cells.

    Tobias Welte, coordinator of the national campaign against COVID - 19 in Germany suggests that personalized therapy may be useful for such patients, in which it makes sense to try to change ACE2 levels to improve survival in patients with COVID - 19 .

    Only encouraging what of the former 86776 smokers have levels of ACE-2 - same as people who have never smoked.

    Therefore, now, probably, is the best time to motivate yourself to abandon this bad habit.

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