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Relations of Treatments for Cardiometabolic Co-Morbidities with Critical Outcomes and Mortality in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19): A Retrospective Cohort Study

Background: Available evidence indicates that COVID-19 patients with preexisting cardiometabolic diseases (CMD) such as diabetes, hypertension, and cardiovascular disease (CVD) are more likely to have poor outcomes. We investigated  whether pre-admission treatments for CMD may have impact on clinical outcomes in hospitalized COVID-19 patients. 
 
Methods: We conducted a retrospective cohort study of 1,525 COVID-19 patients admitted to two designated hospitals in Wuhan, China from January 21, 2020 to March 14, 2020 when majority of the initial COVID-19 patients were hospitalized. All medical records were reviewed by a panel of physicians to determine history of CMD and medications. The primary endpoint was critical illness comprised of admission to intensive care unit (ICU), mechanical ventilation, and use of extracorporeal membrane oxygenation (ECMO). Confirmed secondary endpoint was all-cause mortality. Multivariable logistic regression and Cox regression were used for analyzing primary and secondary endpoint, respectively. 
 
Findings: Of the 1,525 patients with COVID-19, 623 (40.9%) had CMD history. Compared with patients without CMD, those with CMD but without treatment had a 3-fold increased risk of critical illness (OR, 3.13; 95% CI, 1.86-5.20), and a 3-fold greater risk of death (HR, 3.08; 95% CI, 1.91-4.99). Among those with CMD comorbidities, the pre-admission treatment for CMD was associated with significantly lower risk of developing critical illness (OR, 0.28; 95% CI, 0.16-0.47) and death (HR, 0.25; 95% CI, 0.16-0.40). These findings were most salient in older patients (> 65 y). Moreover, in patients with hypertension, those treated with ACEI/ARB did not have higher risk of critical illness or death than those who were on other antihypertensive medications. 
 
Interpretation: This large retrospective cohort of COVID-19 patients support the notion that pre-admission management of CMD comorbidities significantly improve clinical outcomes and prognosis of COVID-19, especially among those aged > 65 years. 
 
Funding Statement: This work was supported by the Science and Technology Program of Guangzhou (No.201803040012), the National Key Research and Development Program of China (No.2017YFC1307603, No.2016YFC1301305) and the Key Area R&D Program of Guangdong Province (No.2019B020227005). 
 
Declaration of Interests: None. 
 
Ethics Approval Statement: The study was approved by the institution ethics review board (IRB) of Guangdong Provincial People's Hospital and the two collaborating hospitals. This study used only deidentified retrospective data and written-informed consent was waived during the pandemic.