Retrospective assessment of the association between co-morbid disease burden and biochemical parameters in hospitalized hypertensive COVID-19 patients

Co-morbid disease burden in hypertensive COVID-19 patients



COVID-19, Hypertension, CRP, Comorbidities, Troponin, Dimer


Background/Aim: Hypertension (HT) was examined as a risk factor affecting the progression of the 2019 novel coronavirus disease (COVID-19). In COVID-19 patients, it can be found in many co-morbid diseases, along with hypertension. It is not clear whether the co-morbid burden of the disease affects the prognosis in hypertensive COVID-19 patients and which biochemical parameters may be indicative of this. Therefore, this study was designed to determine the effect of co-morbid disease burden on biochemical parameters in hospitalized hypertensive COVID-19 patients.

Methods: After receiving approval from the University Ethics Committee, demographic, clinical, radiological, and laboratory data of 250 hospitalized hypertensive COVID-19 patients between May 2020 and Sept 2020 were screened. Patients with missing records and unclear history of hypertension drug use were excluded from the study. A total of 215 patients were included in the study. Patients were divided into four groups according to the co-morbidity status: (1) HT alone (Group HT0), (2) HT+ Diabetes Mellitus (DM) (Group HTDM1), (3) HT+one co-morbidity exclude DM (Group HT2), and (4) HT+at least two co-morbidities (Group HT3).

Results: We analyzed the data of 105 female and 110 male patients. Of the 215 patients whose data were evaluated in this study, 15 patients died. Two hundred people were discharged with recovery. The mortality rate was 7%. Of the hypertension patients, 34.9% had DM, 32.6% had coronary artery disease (CAD), 30.2% had chronic obstructive pulmonary disease (COPD), 16.3% had heart failure (HF), 23.3% had chronic kidney failure (CKD), and 9.3% had cerebrovascular disease (CVD). Twenty-five percent were smokers. Urea, creatinine, direct bilirubin (DBil), and Troponin-I values were significantly higher in the Group HT3 compared to the Group HT0, Group HTDM1, and Group HT2 (P < 0.001, P < 0.001, P < 0.001, P = 0.002 respectively). Glomerular filtration rate (GFR) and albümin levels were significantly lower in Group HT3 than in Group HT0, Group HTDM1, and Group HT2 (P < 0.001 and P < 0.001, respectively). The logistic regression model was statistically significant (χ2(7) = 69.088 and P < 0.001); advanced age, decrease in GFR and plateletcrit (PCT) levels, and increase in D-dimer and DBil levels were observed as predictive parameters of mortality in all hospitalized COVID-19 HT patients.

Conclusion: We determined that SARS-CoV-2 pneumonia patients with HT plus at least two co-morbidities were more serious than other patient groups in terms of organ damage and biochemical variables. In our study, we observed an increase in urea, creatinine, D-dimer, Dbil, and Troponin-I values and a decrease in GFR and albumin values as the co-morbidity burden increased in hypertensive COVID-19 patients. However, a decrease in GFR and hemogram PCT levels and an increase in D-dimer and DBil levels could be risk factors for mortality.


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Desjardins MR, Hohl A, Delmelle EM. Rapid surveillance of COVID-19 in the United States using a prospective space-time scan statistic: Detecting and evaluating emerging clusters. Appl Geogr. 2020;118:102202. DOI:

Singh AK, Gupta R, Misra A. Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers. Diabetes Metab Syndr. 2020;14(4):283-7. DOI:

Bai L, Yang D, Wang X, Tong L, Zhu X, Zhong N, et al. Chinese experts’ consensus on the Internet of Things-aided diagnosis and treatment of coronavirus disease 2019 (COVID-19). Clinical eHealth. 2020;3:7-15. DOI:

Ye F, Xu S, Rong Z, Xu R, Liu X, Deng P, et al. Delivery of infection from asymptomatic carriers of COVID-19 in a familial cluster. Int J Infect Dis. 2020; 94:133-8. DOI:

Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;21:100331. DOI:

Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect. 2020;80(5):e7-e13. DOI:

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3. DOI:

Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;75(18):2352-71. DOI:

Alifano M, Alifano P, Forgez P, Iannelli A. Renin-angiotensin system at the heart of COVID-19 pandemic. Biochimie. 2020;174:30-3. DOI:

Gupta R, Misra A. Contentious issues and evolving concepts in the clinical presentation and management of patients with COVID-19 infectionwith reference to use of therapeutic and other drugs used in Co-morbid diseases (Hypertension, diabetes etc). Diabetes Metab Syndr. 2020;14(3):251-4. DOI:

Tan W, Aboulhosn J. The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease. Int J Cardiol. 2020;309:70-7. DOI:

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. DOI:

Du Y, Zhou N, Zha W, Lv Y. Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutr Metab Cardiovasc Dis. 2021;31(3):745-55. DOI:

Jafari-Oori M, Moradian ST, Ebadi A, Jafari M, Dehi M. Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study. Heart Lung. 2022;52:136-45. DOI:

Batiha GE, Gari A, Elshony N, Shaheen HM, Abubakar MB, Adeyemi SB, et al. Hypertension and its management in COVID-19 patients: The assorted view. Int J Cardiol Cardiovasc Risk Prev. 2021;11:200121. DOI:

Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE, et al. COVID-19 and co-morbidities: Deleterious impact on infected patients. J Infect Public Health. 2020 Dec;13(12):1833-9. doi: 10.1016/j.jiph.2020.07.014. Epub 2020 August 4. PMID: 32788073; PMCID: PMC7402107. DOI:

Nassar M, Daoud A, Nso N, Medina L, Ghernautan V, Bhangoo H, et al. Diabetes Mellitus and COVID-19: Review Article. Diabetes Metab Syndr. 2021 Nov-Dec;15(6):102268. doi: 10.1016/j.dsx.2021.102268. Epub 2021 September 4. PMID: 34562865; PMCID: PMC8416292. DOI:

Wang X, Liu Z, Li J, Zhang J, Tian S, Lu S, et al. Impacts of Type 2 Diabetes on Disease Severity, Therapeutic Effect, and Mortality of Patients With COVID-19. J Clin Endocrinol Metab. 2020 Dec 1;105(12):dgaa535. doi: 10.1210/clinem/dgaa535. PMID: 32979271; PMCID: PMC7543468. DOI:

Cordero A, García-Gallego CS, Bertomeu-González V, Fácila L, Rodríguez-Mañero M, Escribano D, et al. Mortality associated with cardiovascular disease in patients with COVID-19. REC: CardioClinics. 2021;56(1):30–8. DOI:

Peña JE, Rascón-Pacheco RA, Ascencio-Montiel IJ, González-Figueroa E, Fernández-Gárate JE, Medina-Gómez OS, et al. Hypertension, Diabetes and Obesity, Major Risk Factors for Death in Patients with COVID-19 in Mexico. Arch Med Res. 2021;52(4):443-9. DOI:

Najera H, Ortega-Avila AG. Health and Institutional Risk Factors of COVID-19 Mortality in Mexico, 2020. Am J Prev Med. 2021;60(4):471-7. DOI:

Eid RA, Attia AM, Hassan M, Shaker MA, Kamal MA. Demographic, clinical, and laboratory characteristics of patients with COVID-19 during the second and third waves of the pandemic in Egypt. J Infect Public Health. 2021;14(10):1358-66. DOI:

Albalawi O, Alharbi Y, Bakouri M, Alqahtani A, Alanazi T, Almutairi AZ, et al. Clinical characteristics and predictors of mortality among COVID-19 patients in Saudi Arabia. J Infect Public Health. 2021;14(8):994-1000. DOI:

Yilmaz A, Sabirli R, Seyit M, Ozen M, Oskay A, Cakmak V, et al. Association between laboratory parameters and CT severity in patients infected with COVID-19: A retrospective, observational study. Am J Emerg Med. 2021;42:110-4. DOI:

Le Stang MB, Desenclos J, Flamant M, Chousterman BG, Tabibzadeh N. The Good Treatment, the Bad Virus, and the Ugly Inflammation: Pathophysiology of Kidney Involvement During COVID-19. Front Physiol. 2021;12:613019. DOI:

Creeden JF, Gordon DM, Stec DE, Hinds TD Jr. Bilirubin as a metabolic hormone: the physiological relevance of low levels. Am J Physiol Endocrinol Metab. 2021;320(2):E191-E207. DOI:

Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver Int. 2020;40(6):1278-81. DOI:

Çavuş Z, Tezdönen M, Çekme M, Türkmen ÜA. Determination of Plateletcrit, Mean Platelet Volume in Patients with COVID‐19 Pneumonia. J Immunol Clin Microbiol. 2021;6(2):81-9.

Gao Y, Li Y, Yu X, Guo S, Ji X, Sun T, et al. The impact of various platelet indices as prognostic markers of septic shock. PLoS One. 2014;9(8):e103761. DOI:

Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020;13(11):1265-75. DOI:






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Kaynak Çağdaş, Karageçili H. Retrospective assessment of the association between co-morbid disease burden and biochemical parameters in hospitalized hypertensive COVID-19 patients: Co-morbid disease burden in hypertensive COVID-19 patients. J Surg Med [Internet]. 2022 Aug. 31 [cited 2022 Sep. 28];6(8):723-8. Available from: