Figure 1
Participating countries and patient recruitment in the WHF COVID-19 study.
N = number of patients recruited in the study by participating country.
Table 1a
Hospital level resources and facilities available at the participating sites (Overall).
| SPECIALISTS | N (%) |
|---|---|
| Respiratory consultants (N = 34) | 31 (91%) |
| Infectious disease specialists (N = 34) | 28 (82%) |
| Cardiologists (N = 35) | 34 (97%) |
| Equipment’s for advanced care | |
| ICU (N = 39) | 39 (100%) |
| Ventilators (N = 39) | 39 (100%) |
| No. of ventilators, mean (SD) (N = 33) | 40.4 (44.8) |
| ECG (N = 39) | 39 (100%) |
| ECHO (N = 39) | 38 (97%) |
| ECMO (N = 37) | 22 (59%) |
| Cardiac Cath lab (N = 39) | 33 (85%) |
| COVID-19 admissions in the last month, mean (SD) (N = 35) | 275.1 (561.9) |
| Administrative status of hospital (N = 38) | |
| Community/District Hospital | 8 (21%) |
| University Hospital | 18 (47%) |
| Private clinic | 5 (13%) |
[i] * Analysis excludes missing values.
N = total number of hospitals (denominator); n = hospitals with available resources (numerator); SD = standard deviation; ICU = intensive care unit; ECG = electrocardiogram; ECHO = echocardiogram; ECMO = extracorporeal membrane oxygenation.
Table 1b
Hospital level resources and facilities by WHO region and World Bank income groups.
| WHO REGION (MODIFIED) (NO. OF SITES) | SPECIALISTS^ | ICU/VENTILATORS | ADVANCED CARE* |
|---|---|---|---|
| North America (n = 1) | 100% | 100% | 100% |
| Europe (n = 9) | 100% | 100% | 100% |
| Western Pacific (n = 3) | 100% | 100% | 100% |
| Middle East (n = 1) | 100% | 100% | 100% |
| Latin America (n = 7) | 100% | 100% | 100% |
| Southeast Asia (n = 10) | 83% | 100% | 95% |
| Africa (n = 9) | 71% | 100% | 67% |
| WORLD BANK INCOME GROUPS (NO. OF SITES) | SPECIALISTS^ | ICU/VENTILATORS | ADVANCED CARE* |
| LIC (n = 4) | 42% | 100% | 75% |
| LMIC (n = 15) | 89% | 100% | 82% |
| UMIC (n = 8) | 100% | 100% | 100% |
| HIC (n = 13) | 100% | 100% | 100% |
[i] ^ Respiratory, Infectious disease, Cardiologists; * ECHO, Cath lab; ICU = intensive care unit.
LIC = low-income countries; LMIC = low- and middle-income countries; UMIC = upper-middle income countries; HIC = high-income countries.
Table 2a
Demographic and clinical characteristics of study participants.
| SURVIVORS | IN-HOSPITAL DEATHS N (%) | POST DISCHARGE 30-DAY DEATHS, N (%) | P-VALUE FOR DIFFERENCE | ||
|---|---|---|---|---|---|
| N | N (%) | ||||
| N | 5313 | 4512 (84.9) | 683 (12.9) | 118 (2.6) | |
| Age, mean (SD) | 57.0 (16.1) | 55.6 (16.0) | 64.8 (14.2) | 65.4 (13.4) | <0.001 |
| Male | 3159 (59.4) | 2642 (83.6) | 431 (13.6) | 86 (2.7) | <0.001 |
| Female | 2154 (40.5) | 1870 (86.8) | 252 (11.7) | 32 (1.5) | |
| Ethnic Origin | <0.001 | ||||
| Caucasian | 800 (15.1) | 749 (93.6) | 45 (5.6) | 6 (0.8) | |
| Hispanic | 542 (10.2) | 403 (74.4) | 134 (24.7) | 5 (0.9) | |
| Black | 796 (15.0) | 669 (84) | 117 (14.7) | 10 (1.3) | |
| Middle Eastern | 315 (5.9) | 283 (89.8) | 18 (5.7) | 14 (4.4) | |
| Asian | 2442 (46.0) | 2046 (83.8) | 324 (13.3) | 72 (2.9) | |
| Other | 346 (6.5) | 303 (84.4) | 45 (12.5) | 11 (3.1) | |
| World Bank income groups | <0.001 | ||||
| LIC | 376 (7.1) | 331 (88) | 39 (10.4) | 6 (1.6) | |
| LMIC | 2526 (47.5) | 2141 (81.3) | 403 (15.3) | 89 (3.4) | |
| UMIC | 1044 (19.6) | 742 (79.2) | 181 (19.3) | 14 (1.5) | |
| HIC | 1367 (25.7) | 1298 (95) | 60 (4.4) | 9 (0.7) | |
| Education | <0.001 | ||||
| Up to primary | 510 (9.6) | 388 (76.1) | 110 (21.6) | 12 (2.4) | |
| Up to secondary | 1162 (21.9) | 1011 (87) | 123 (10.6) | 28 (2.4) | |
| College/University | 1264 (23.8) | 1140 (90.2) | 111 (8.8) | 13 (1.0) | |
| Unknown | 2291 (43.1) | 1906 (82.5) | 338 (14.6) | 65 (2.8) | |
| Smoking status | <0.001 | ||||
| Never | 3080 (58.0) | 2664 (86.5) | 359 (11.7) | 56 (1.8) | |
| Current | 370 (7.0) | 342 (92.2) | 22 (5.9) | 7 (1.9) | |
| Former | 751 (14.1) | 645 (85.9) | 89 (11.9) | 17 (2.3) | |
| Unknown | 1110 (20.9) | 861 (77.5) | 212 (19.1) | 38 (3.4) | |
| Body mass index (Kg/m2), mean (SD) | 26.9 (5.3) | 0.35 | |||
| Underweight (<18) | 71 (1.3) | 65 (91.5) | 5 (7.0) | 1 (1.4) | |
| Normal weight (18–24) | 1414 (26.6) | 1246 (87.9) | 147 (10.4) | 25 (1.8) | 0.57 |
| Overweight (25–29) | 1289 (24.3) | 1137 (88.3) | 139 (10.8) | 12 (0.9) | |
| Obese (≥30) | 831 (15.6) | 730 (88.2) | 88 (10.6) | 10 (1.2) |
[i] SD = standard deviation.
Table 2b
COVID-19 symptoms and comorbidities among study participants.
| COVID-SYMPTOMS AND VITAL SIGNS | OVERALL | SURVIVORS | IN-HOSPITAL DEATHS N (%) | POST DISCHARGE 30-DAY DEATHS N (%) |
|---|---|---|---|---|
| N (%) | N (%) | |||
| Diagnosed by using RT-PCR | 5050 (95.0) | 4299(85.0) | 644(13.0) | 107(2.0) |
| Median time from symptom onset to admission (IQR) in minutes | 5 (3–8) | 5 (3–8) | 5 (3–8) | 4 (2–7) |
| History of self-reported fever | 3526 (66.4) | 3002 (85.0) | 459 (13) | 65 (2) |
| Cough | 3624 (68.2) | 3087 (85.0) | 472 (13) | 65 (2) |
| Dyspnoea OR Tachypnoea | 3308 (62.3) | 2689 (81.0) | 534(16.0) | 85 (3) |
| Heart rate (beats/min), mean (SD) | 92.1 (17.8) | 91.2 (17.0) | 96.9 (21.6) | 95.7 (17.3) |
| Bradycardia (HR < 60 bpm) mean (SD) | 128.8 (20.9) | 85 (84) | 15 (15) | 1 (1) |
| Tachycardia (HR > 100 bpm) mean (SD) | 78.2 (13.0) | 1103 (78) | 265 (19) | 41 (3) |
| Systolic BP (mmHg), mean (SD) | 1341 (25.2) | 128.7 (19.9) | 129.7 (25.4) | 129.7 (26.3) |
| Diastolic BP (mmHg), mean (SD) | 1341 (25.2) | 78.5 (12.5) | 76.4 (15.4) | 77.0 (14.9) |
| Shortness of Breath (SOB) | 1335 (25.1) | |||
| No | 479 (9.0) | 1251(93) | 66 (5) | 24 (2) |
| SOB < 100 m | 225 (4.2) | 1047(78) | 252 (19) | 37 (3) |
| SOB 100–500 m | 5050 (95.0) | 364(76) | 96 (20) | 19 (4) |
| SOB > 500 m | 5 (3–8) | 203(90) | 15 (7) | 7 (3) |
| Co-morbidities (Cardiovascular) | ||||
| Hypertension | 2511 (47.3) | 2060 (82) | 398 (16) | 53 (2) |
| Diabetes | 1700 (32.0) | 1346 (79) | 306 (18) | 48 (3) |
| Coronary artery disease | 580 (10.9) | 446 (77) | 103 (18) | 31 (5) |
| Heart Failure | 290 (5.5) | 238 (82) | 45 (16) | 7 (2) |
| Stroke | 197 (3.7) | 159 (81) | 28 (14) | 10 (5) |
| Atrial Fibrillation | 159 (3.0) | 134 (84) | 22 (14) | 3 (2) |
| Peripheral vascular disease | 106 (2.0) | 85 (80) | 18 (17) | 3 (3) |
| Cardiomyopathies | 60 (1.1) | 53 (88) | 6 (10) | 1 (2) |
| Rheumatic Heart Disease | 56 (1.1) | 49 (88) | 7 (13) | 0 (0) |
| Chagas disease | 36 (0.7) | 34 (94) | 2 (6) | 0 (0) |
| Congenital heart disease | 182 (3.4) | 166 (91) | 9 (5) | 7 (4) |
| Valvular disease | 118 (2.2) | 94 (80) | 21(18) | 3 (3) |
| Co-morbidities (Non-Cardiovascular) | ||||
| Chronic kidney disease | 404 (7.6) | 299 (74) | 86 (21) | 19 (5) |
| Chronic pulmonary disease | 208 (3.9) | 160 (77) | 44 (21) | 5 (2) |
| Asthma | 219 (4.1) | 200 (91) | 18 (8) | 1 (0) |
| Chronic Immunosuppression | 136 (2.6) | 110 (81) | 25 (18) | 1 (1) |
| HIV | 71 (1.3) | 62 (87) | 6 (8) | 3 (4) |
| Tuberculosis | 56 (1.1) | 49 (88) | 7 (13) | 0 (0) |
| Cancer on chemotherapy | 114 (2.1) | 90 (79) | 20 (18) | 4 (4) |
| Renal replacement therapy | 62 (1.2) | 45 (73) | 16 (26) | 1 (2) |
| Previous organ transplant | 45 (0.8) | 38 (84) | 7 (16) | 0 (0) |
[i] Rt-PCR = Reverse Transcription Polymerase Chain Reaction; SD = standard deviation; IQR = Inter quartile range; BP = blood pressure; SOB = Shortness of breath; HIC = high income countries; UMIC = upper middle-income countries; LMIC = lower middle-income countries; LIC = low-income countries; HIV = Human immunodeficiency virus.
Figure 2a
Comparison of in-hospital deaths and post-discharge 30-day deaths among COVID-19 patients by ethnic groups.
* p < 0.001 for in-hospital deaths between Caucasians vs. Hispanics, Blacks, and Asians.
* P < 0.001 for post-discharge 30-day deaths between Caucasians vs. Middle Eastern and Asians.
Figure 2b
Comparison of in-hospital deaths and post-discharge 30-day deaths in COVID-19 patients by World Bank income groups.
* p < 0.001 for both in-hospital deaths and post-discharge 30-day deaths between HIC vs. LIC, LMIC, and UMIC.
HIC = high income countries; UMIC = upper middle-income countries; LMIC = lower middle-income countries; LIC = low-income countries.
Table 3
ECG, ECHO, and laboratory findings among COVID-19 patients at admission.
| OVERALL N (%) | SURVIVORS N (%) | IN-HOSPITAL DEATHS N (%) | POST DISCHARGE 30-DAY DEATHS N (%) | P-VALUE FOR DIFFERENCE | |
|---|---|---|---|---|---|
| ECG data (N = 3490) | |||||
| Atrial fibrillation (yes) | 131 (2.5) | 97 (2.1) | 31 (4.5) | 3 (2.5) | 0.003 |
| T-wave changes (yes) | 774 (14.6) | 593 (13.1) | 153 (22.4) | 28 (23.7) | <0.001 |
| QT/QTC duration, median (IQR) | 419.0 (331.5, 447.0) | 415.5 (259.0, 445.0) | 428.0 (360.0, 457.0) | 448.0 (413.5, 467.0) | <0.001 |
| ECHO findings (Median, IQR) (N = 259) | |||||
| Ejection fraction 1. Teicholz (EF1), | 59.1 (49.0, 64.0) | 60.0 (52.0, 64.0) | 55.0 (45.0, 64.0) | 59.0 (59.0, 60.0) | 0.23 |
| Ejection fraction 2. Visual estimations (EF2), | 55.0 (45.0, 60.0) | 55.0 (45.0, 60.0) | 51.5 (45.0, 59.0) | 50.0 (35.0, 55.0) | 0.082 |
| Right ventricular function | 0.002 | ||||
| Mildly/severely abnormal | 47 (0.9) | 28 (59.1) | 18 (38.6) | 1 (2.3) | |
| Laboratory parameters (median, IQR) (N = 4330) | |||||
| Hemoglobin, mmol/L | 7.9 (7.1, 8.8) | 8.0 (7.1, 8.8) | 7.8 (6.6, 8.7) | 7.5 (6.5, 8.4) | <0.001 |
| WBC count, x10^9/L | 4.7 (0.0, 8.4) | 5.1 (0.0, 8.5) | 0.0 (0.0, 7.5) | 0.0 (0.0, 6.9) | <0.001 |
| Platelets, 10^3/µL | 230.5 (168.0, 336.0) | 233.0 (170.0, 342.0) | 219.0 (157.0, 306.0) | 228.0 (154.0, 425.0) | <0.001 |
| ALT/SGPT, μmol/(s•L) | 0.6 (0.4, 1.0) | 0.6 (0.4, 1.0) | 0.7 (0.4, 1.1) | 0.6 (0.4, 1.1) | 0.003 |
| AST/SGOT, μmol/(s•L) | 0.7 (0.5, 1.1) | 0.7 (0.5, 1.0) | 0.8 (0.5, 1.4) | 0.8 (0.5, 1.3) | <0.001 |
| Creatinine-conversion, μmol/L | 87.5 (70.6, 113.2) | 85.0 (69.0, 107.0) | 99.9 (74.3, 150.3) | 104.3 (82.2, 195.4) | <0.001 |
| Sodium, mmol/L | 137.0 (134.0, 140.0) | 137.0 (134.0, 140.0) | 136.3 (133.0, 140.0) | 136.0 (133.0, 139.0) | 0.10 |
| Potassium, mmol/L | 4.2 (3.8, 4.7) | 4.2 (3.8, 4.6) | 4.3 (3.8, 4.9) | 4.5 (4.1, 5.0) | <0.001 |
| CRP, mg/L | 53.8 (17.4, 110.7) | 48.0 (15.7, 100.0) | 93.2 (40.2, 174.0) | 82.9 (21.5, 156.1) | <0.001 |
| ESR, mm/hr | 43.0 (25.0, 67.0) | 41.0 (24.0, 65.0) | 52.0 (34.0, 81.0) | 53.0 (40.0, 79.0) | <0.001 |
| Troponin, ng/mL | 1.0 (0.1, 9.0) | 1.0 (0.1, 9.0) | 0.1 (0.0, 11.0) | 20.0 (2.9, 32.0) | 0.007 |
| Troponin T, pg/mL | 9.0 (0.5, 24.9) | 8.0 (0.6, 20.0) | 21.0 (5.5, 64.5) | 0.1 (0.0, 16.0) | <0.001 |
| BNP, pmol/L | 7.8 (1.5, 28.1) | 6.0 (1.2, 21.4) | 16.0 (5.1, 49.4) | 19.9 (2.2, 44.1) | <0.001 |
| NT-proBNP, pmol/L | 60.1 (12.1, 254.4) | 46.7 (10.3, 224.2) | 110.7 (34.3, 415.5) | 505.5 (285.5, 1641.0) | <0.001 |
| CK-Mb, ukat/L, | 0.2 (0.0, 13.0) | 0.2 (0.0, 13.0) | 0.5 (0.0, 19.0) | 0.0 (0.0, 0.6) | 0.001 |
| Total cholesterol, mmol/L | 4.0 (3.1, 5.0) | 4.2 (3.4, 5.2) | 3.4 (2.7, 4.3) | 3.9 (2.5, 4.4) | <0.001 |
| HbA1c, | 6.9 (6.1, 8.5) | 6.9 (6.1, 8.5) | 7.0 (6.2, 8.4) | 6.4 (5.9, 9.7) | 0.80 |
| D-dimer, mg/FEU/L | 1.0 (0.4, 4.4) | 0.9 (0.4, 3.9) | 1.8 (0.7, 4.8) | 2.5 (1.2, 26.5) | <0.001 |
| Ferritin, μg/L | 514.1 (225.3, 1001.9) | 476.0 (197.5, 962.0) | 687.7 (350.3, 1365.2) | 656.6 (392.0, 1068.0) | <0.001 |
| IL-6, pg/mL | 25.2 (8.7, 64.7) | 21.6 (7.0, 52.0) | 65.8 (21.9, 125.0) | 36.0 (17.6, 133.5) | <0.001 |
| Urea (BUN), mmol/L, | 8.5 (5.5, 14.6) | 7.7 (5.2, 12.9) | 13.9 (7.9, 23.8) | 17.0 (10.4, 28.2) | <0.001 |
| PT (seconds) | 13.4 (12.0, 15.9) | 13.3 (12.0, 15.6) | 13.9 (12.1, 16.7) | 13.2 (11.7, 16.7) | 0.012 |
| INR ratio | 1.1 (0.9, 1.3) | 1.1 (0.9, 1.2) | 1.1 (1.0, 1.3) | 1.1 (0.0, 1.3) | 0.015 |
[i] IQR = interquartile range; mmol/L millimoles per liter; mg/L = milligrams per liter.
Table 4
Clinical outcomes among COVID-19 patients at discharge.
| OUTCOMES AT DISCHARGE | OVERALL N (%) | SURVIVORS N (%) | IN-HOSPITAL DEATHS, N (%) | POST DISCHARGE 30-DAY DEATHS, N (%) | P-VALUE FOR DIFFERENCE |
|---|---|---|---|---|---|
| Median length of hospital stays (IQR) | 9 (6–14) | 9 (6–14) | 10 (5–17) | 10 (6- 14.5) | 0.679 |
| ICU admission | 1668 (31.4) | 1173 (26.0) | 430 (63.0) | 65 (55.1) | <0.001 |
| Number of days in ICU (N = 1600), median (IQR) | 7 (3–13) | 7 (3–11) | 9 (4–15) | 11 (3–13) | <0.001 |
| Pneumonia | 1991 (37.5) | 1575 (34.9) | 385 (56.4) | 31 (26.3) | <0.001 |
| Acute Respiratory Distress Syndrome | 723 (13.6) | 421 (9.3) | 285 (41.7) | 17 (14.4) | <0.001 |
| Acute renal injury | 436 (8.2) | 207 (4.6) | 216 (31.6) | 13 (11.0) | <0.001 |
| Cardiac arrest | 294 (5.5) | 56 (1.2) | 236 (34.6) | 2 (1.7) | <0.001 |
| Anaemia | 445 (8.4) | 310 (6.9) | 123 (18.0) | 12 (10.2) | <0.001 |
| Shock | 288 (5.4) | 52 (1.2) | 228 (33.4) | 8 (6.8) | <0.001 |
| Acute Heart Failure | 200 (3.8) | 100 (2.2) | 95 (13.9) | 5 (4.2) | <0.001 |
| Liver dysfunction | 235 (4.4) | 172 (3.8) | 56 (8.2) | 7 (5.9) | <0.001 |
| Atrial Fibrillation | 126 (2.4) | 86 (1.9) | 36 (5.3) | 4 (3.4) | <0.001 |
| Pulmonary embolism | 116 (2.2) | 87 (1.9) | 26 (3.8) | 3 (2.5) | <0.001 |
| Myocardial Infarction | 84 (1.6) | 63 (1.4) | 18 (2.6) | 3 (2.5) | <0.001 |
| Myocarditis | 47 (0.9) | 22 (0.5) | 24 (3.5) | 1 (0.8) | <0.001 |
| Ischemic Stroke | 56 (1.1) | 38 (0.8) | 16 (2.3) | 2 (1.7) | 0.003 |
| Blocks | 77 (1.4) | 58 (1.3) | 19 (2.8) | 0 (0.0) | 0.033 |
| Ventricular arrhythmia | 60 (1.1) | 38 (0.8) | 21 (3.1) | 1 (0.8) | <0.001 |
| Pericarditis | 30 (0.6) | 27 (0.6) | 3 (0.4) | 0 (0.0) | 0.58 |
| Haemorrhagic Stroke | 43 (0.8) | 35 (0.8) | 8 (1.2) | 0 (0.0) | 0.046 |
| Endocarditis | 14 (0.3) | 12 (0.3) | 2 (0.3) | 0 (0.0) | 0.49 |
[i] IQR = interquartile range; ICU = intensive cardiac unit.
Table 5a
Factors associated with overall mortality in COVID-19 hospitalized patients.
| UNADJUSTED RISK | ADJUSTED RISK1 | ADJUSTED RISK2 | ADJUSTED RISK3 | |
|---|---|---|---|---|
| RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | |
| Age (years) | ||||
| <45 (Ref) | 1.0 | 1.0 | 1.0 | 1.0 |
| 46–60 | 1.92 (1.48, 2.48) | 1.91 (1.48, 2.47) | 1.81 (1.40, 2.34) | 1.78 (1.38, 2.30) |
| ≥60 | 3.59 (2.87, 4.50) | 3.76 (3.00, 4.70) | 3.45 (2.74, 4.36) | 3.40 (2.69, 4.28) |
| Sex | ||||
| Female (Ref) | 1.0 | 1.0 | 1.0 | 1.0 |
| Male | 1.24 (1.09, 1.42) | 1.20 (1.05, 1.36) | 1.19 (1.05, 1.36) | 1.16 (1.01, 1.33) |
| Ethnicity | ||||
| Caucasian | 1.0 | 1.0 | 1.0 | 1.0 |
| Hispanic | 4.02 (2.97, 5.44) | 4.09 (3.03, 5.51) | 3.99 (2.96, 5.38) | 3.90 (2.89, 5.25) |
| Black | 2.5 (1.84, 3.41) | 2.88 (2.12, 3.92) | 2.84 (2.09, 3.85) | 2.52 (1.87, 3.42) |
| Middle Eastern | 1.59 (1.04, 2.43) | 1.55 (1.02, 2.36) | 1.53 (1.00, 2.32) | 1.57 (1.03, 2.39) |
| Asian | 2.54 (1.92, 3.37) | 2.78 (2.1, 3.67) | 2.63 (1.99, 3.48) | 2.50 (1.90, 3.30) |
| Other | 2.45 (1.71, 3.5) | 2.50 (1.75, 3.56) | 2.42 (1.70, 3.44) | 2.15 (1.51, 3.06) |
| Region | ||||
| Europe | 1.0 | 1.0 | 1.0 | 1.0 |
| Asia Pacific | 0.33 (0.17, 0.67) | 0.33 (0.17, 0.67) | 0.40 (0.2, 0.79) | 0.41 (0.2, 0.81) |
| Latin America | 3.90 (2.9, 5.25) | 3.90 (2.9, 5.25) | 3.72 (2.77, 5.01) | 3.65 (2.71, 4.92) |
| Middle East | 1.62 (1.05, 2.52) | 1.62 (1.05, 2.52) | 1.54 (0.99, 2.38) | 1.60 (1.03, 2.48) |
| North America | 1.04 (0.34, 3.22) | 1.04 (0.34, 3.22) | 0.96 (0.31, 2.96) | 1.02 (0.33, 3.14) |
| Southeast Asia | 3.42 (2.6, 4.51) | 3.42 (2.60, 4.51) | 3.45 (2.61, 4.56) | 3.34 (2.52, 4.42) |
| Sub Saharan Africa | 3.17 (2.36, 4.26) | 3.17 (2.36, 4.26) | 3.49 (2.61, 4.67) | 3.27 (2.44, 4.37) |
| Income group | ||||
| HIC | 1.0 | 1.0 | 1.0 | |
| LIC | 2.37 (1.66, 3.39) | 2.62 (1.84, 3.73) | 2.6 (1.83, 3.71) | 2.49 (1.74, 3.57) |
| LMIC | 3.62 (2.83, 4.62) | 3.55 (2.79, 4.53) | 3.42 (2.67, 4.37) | 3.22 (2.50, 4.14) |
| UMIC | 4.29 (3.32, 5.55) | 4.02 (3.11, 5.19) | 3.94 (3.04, 5.09) | 3.72 (2.86, 4.83) |
| Smoking status | ||||
| Never (Ref) | 1.0 | 1.0 | 1.0 | 1.0 |
| Current smoker | 0.58 (0.4, 0.83) | 0.70 (0.49, 1) | 0.71 (0.5, 1.02) | 0.71 (0.5, 1.02) |
| Former smoker | 1.05 (0.86, 1.28) | 0.88 (0.72, 1.08) | 0.90 (0.73, 1.10) | 0.90 (0.73, 1.10) |
| Unknown | 1.67 (1.45, 1.92) | 1.46 (1.27, 1.69) | 1.48 (1.28, 1.72) | 1.48 (1.28, 1.72) |
| Pre-existing conditions | ||||
| Hypertension | 1.40 (1.23, 1.60) | 1.07 (0.94, 1.23) | 1.01 (0.88, 1.15) | 1.03 (0.90, 1.18) |
| Coronary heart disease | 1.62 (1.37, 1.90) | 1.32 (1.13, 1.55) | 1.26 (1.07, 1.49) | 1.32 (1.12, 1.57) |
| Stroke | 1.29 (0.96, 1.73) | 1.09 (0.82, 1.46) | 1.08 (0.81, 1.45) | 1.14 (0.85, 1.53) |
| Heart failure | 1.19 (0.92, 1.53) | 1.16 (0.90, 1.48) | 1.11 (0.87, 1.43) | 1.19 (0.92, 1.53) |
| Renal disease | 1.83 (1.53, 2.19) | 1.60 (1.35, 1.90) | 1.58 (1.32, 1.89) | 1.59 (1.33, 1.90) |
| COPD/Asthma | 1.02 (0.81, 1.30) | 0.96 (0.76, 1.2) | 0.96 (0.77, 1.21) | 1.00 (0.79, 1.26) |
| Diabetes | 1.68 (1.48, 1.91) | 1.29 (1.13, 1.46) | 1.29 (1.13, 1.46) | 1.26 (1.11, 1.44) |
| Tuberculosis | 0.82 (0.41, 1.65) | 0.78 (0.4, 1.54) | 0.80 (0.41, 1.57) | 0.83 (0.41, 1.67) |
| HIV | 0.84 (0.45, 1.55) | 1.05 (0.58, 1.9) | 1.08 (0.60, 1.97) | 1.18 (0.65, 2.13) |
| Oxygen therapy | 3.02 (2.52, 3.62) | 2.59 (2.15, 3.12) | 2.54 (2.11, 3.06) | 2.53 (2.11, 3.05) |
| ICU admission | 3.48 (3.05, 3.96) | 2.91 (2.52, 3.37) | 2.96 (2.56, 3.42) | 2.84 (2.45, 3.30) |
| Respiratory rate | 1.07 (1.06, 1.07) | 1.06 (1.05, 1.07) | 1.06 (1.05, 1.07) | 1.06 (1.05, 1.07) |
| Medications | ||||
| Beta-blockers | 0.92 (0.76, 1.11) | 0.98 (0.83, 1.15) | 0.94 (0.8, 1.11) | 0.98 (0.83, 1.16) |
| Diuretics oral | 1.17 (0.96, 1.43) | 1.17 (0.98, 1.39) | 1.13 (0.95, 1.35) | 1.14 (0.95, 1.36) |
| ACE – inhibitors | 0.72 (0.57, 0.91) | 0.84 (0.67, 1.06) | 0.81 (0.64, 1.02) | 0.83 (0.66, 1.04) |
| Anti-platelets/NOACs | 1.35 (1.13, 1.61) | 1.19 (1.03, 1.38) | 1.14 (0.99, 1.32) | 1.18 (1.01, 1.37) |
| ARBs | 1.21 (1.01, 1.45) | 1.00 (0.86, 1.17) | 0.97 (0.83, 1.13) | 1.01 (0.87, 1.18) |
| Statins | 1.03 (0.85, 1.23) | 0.91 (0.78, 1.07) | 0.85 (0.72, 1.00) | 0.88 (0.75, 1.04) |
| Anti-diabetic drugs | 0.69 (0.55, 0.87) | 0.96 (0.82, 1.12) | 0.71 (0.59, 0.85) | 0.74 (0.62, 0.89) |
| NSAIDs | 0.35 (0.2, 0.62) | 0.43 (0.25, 0.76) | 0.44 (0.25, 0.76) | 0.45 (0.26, 0.79) |
| RAAS inhibitors | 0.96 (0.8, 1.15) | 0.96 (0.8, 1.15) | 0.95 (0.79, 1.14) | 0.95 (0.79, 1.14) |
| BMI | ||||
| 18.0–24.9 | 1.0 | 1.0 | 1.0 | 1.0 |
| <18.0 | 0.70 (0.32, 1.52) | 1.04 (0.48, 2.25) | 1.02 (0.47, 2.2) | 1.00 (0.46, 2.17) |
| 25.0–29.9 | 0.97 (0.79, 1.19) | 0.95 (0.78, 1.16) | 0.93 (0.77, 1.14) | 0.94 (0.77, 1.15) |
| ≥30 | 0.98 (0.77, 1.23) | 1.03 (0.81, 1.30) | 0.98 (0.78, 1.24) | 0.98 (0.78, 1.24) |
[i] RR = relative risk; CI = confidence interval; BMI = body mass index, NOAC = Novel oral anticoagulants; NSAIDs = Nonsteroidal anti-inflammatory drugs; ACE = angiotensin converting enzyme inhibitors’ ARB = angiotensin receptor blockers; RASS = Renin-angiotensin-aldosterone system; ICU = intensive care unit; HIV = human immunodeficiency virus; COPD = chronic obstructive pulmonary disease; HIC = high income countries; UMIC = upper middle-income countries; LMIC = lower middle-income countries; LIC = low-income countries.
Adjusted risk1 (Model 1): adjusted for demographic variables (age, sex, ethnicity).
Adjusted risk2 (Model 2): adjusted for demographic and clinical characteristics (Diabetes, COPD/asthma).
Adjusted risk3 (Model 3): adjusted for demographic and clinical characteristics and smoking.
Table 5b
Factors associated with major adverse cardiovascular events in COVID-19 hospitalized patients.
| UNADJUSTED RISK | ADJUSTED RISK1 | ADJUSTED RISK2 | ADJUSTED RISK3 | |
|---|---|---|---|---|
| RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | |
| Age (years) | ||||
| <45 (Ref) | 1.0 | 1.0 | 1.0 | 1.0 |
| 46–60 | 2.06 (1.67, 2.53) | 2.03 (1.65, 2.51) | 1.91 (1.55, 2.36) | 1.90 (1.54, 2.34) |
| ≥60 | 2.94 (2.43, 3.55) | 2.90 (2.40, 3.50) | 2.63 (2.17, 3.2) | 2.59 (2.13, 3.15) |
| Sex | ||||
| Female (Ref) | 1.0 | 1.0 | 1.0 | 1.0 |
| Male | 1.25 (1.11, 1.41) | 1.25 (1.11, 1.40) | 1.25 (1.11, 1.4) | 1.30 (1.15, 1.47) |
| Ethnicity | ||||
| Caucasian | 1.0 | 1.0 | 1.0 | 1.0 |
| Hispanic | 1.16 (0.93, 1.44) | 1.17 (0.94, 1.45) | 1.14 (0.92, 1.41) | 1.10 (0.89, 1.36) |
| Black | 0.75 (0.6, 0.94) | 0.83 (0.66, 1.03) | 0.82 (0.65, 1.02) | 0.78 (0.62, 0.98) |
| Middle Eastern | 1.27 (0.99, 1.63) | 1.22 (0.96, 1.56) | 1.20 (0.94, 1.53) | 1.16 (0.91, 1.48) |
| Asian | 1.05 (0.89, 1.24) | 1.10 (0.93, 1.30) | 1.05 (0.89, 1.23) | 1.03 (0.87, 1.21) |
| Other | 1.33 (1.05, 1.67) | 1.30 (1.04, 1.64) | 1.26 (1.00, 1.58) | 1.27 (1.01, 1.6) |
| Region | ||||
| Asia Pacific | 0.07 (0.03, 0.15) | 0.08 (0.03, 0.17) | 0.08 (0.03, 0.18) | 0.08 (0.04, 0.18) |
| Europe | 1.0 | 1.0 | 1.0 | 1.0 |
| Latin America | 0.98 (0.79, 1.21) | 0.95 (0.77, 1.17) | 0.93 (0.75, 1.14) | 0.92 (0.74, 1.13) |
| Middle East | 1.27 (0.99, 1.62) | 1.21 (0.95, 1.53) | 1.19 (0.94, 1.51) | 1.17 (0.92, 1.49) |
| North America | 1.39 (0.86, 2.27) | 1.35 (0.84, 2.16) | 1.27 (0.79, 2.04) | 1.25 (0.78, 2.02) |
| Southeast Asia | 1.26 (1.08, 1.48) | 1.28 (1.10, 1.50) | 1.23 (1.05, 1.44) | 1.22 (1.04, 1.42) |
| Sub Saharan Africa | 0.93 (0.77, 1.13) | 0.99 (0.82, 1.20) | 0.98 (0.81, 1.19) | 0.98 (0.81, 1.19) |
| Income group | ||||
| HIC | 1.0 | 1.0 | 1.0 | 1.0 |
| LIC | 0.69 (0.49, 0.98) | 0.73 (0.51, 1.03) | 0.72 (0.51, 1.02) | 0.68 (0.48, 0.97) |
| LMIC | 1.64 (1.40, 1.91) | 1.59 (1.36, 1.85) | 1.52 (1.30, 1.79) | 1.45 (1.23, 1.71) |
| UMIC | 1.87 (1.57, 2.22) | 1.74 (1.46, 2.07) | 1.69 (1.42, 2.01) | 1.64 (1.37, 1.95) |
| Smoking status | ||||
| Never (Ref) | 1.0 | 1.0 | 1.0 | 1.0 |
| Current smoker | 0.61 (0.45, 0.81) | 0.59 (0.44, 0.79) | 0.60 (0.45, 0.81) | 0.60 (0.45, 0.81) |
| Former smoker | 1.16 (1.00, 1.36) | 0.92 (0.79, 1.08) | 0.92 (0.78, 1.08) | 0.92 (0.78, 1.08) |
| Unknown | 1.11 (0.97, 1.27) | 1.00 (0.87, 1.15) | 0.98 (0.85, 1.13) | 0.98 (0.85, 1.13) |
| Pre-existing chronic conditions | ||||
| Hypertension | 1.67 (1.49, 1.87) | 1.36 (1.21, 1.53) | 1.29 (1.14, 1.45) | 1.29 (1.14, 1.45) |
| Coronary heart disease | 2.37 (2.11, 2.67) | 1.87 (1.64, 2.12) | 1.82 (1.6, 2.07) | 1.82 (1.60, 2.07) |
| Stroke | 1.67 (1.34, 2.07) | 1.29 (1.04, 1.6) | 1.28 (1.04, 1.59) | 1.31 (1.06, 1.62) |
| Heart failure | 2.77 (2.43, 3.17) | 2.49 (2.16, 2.87) | 2.43 (2.11, 2.8) | 2.46 (2.13, 2.84) |
| Renal disease | 1.92 (1.66, 2.23) | 1.68 (1.45, 1.95) | 1.62 (1.39, 1.89) | 1.62 (1.39, 1.88) |
| COPD/Asthma | 1.17 (0.97, 1.42) | 1.04 (0.86, 1.25) | 1.04 (0.86, 1.26) | 1.06 (0.88, 1.28) |
| Diabetes | 1.59 (1.43, 1.78) | 1.31 (1.17, 1.47) | 1.32 (1.17, 1.47) | 1.30 (1.16, 1.46) |
| Tuberculosis | 0.75 (0.39, 1.42) | 0.80 (0.43, 1.51) | 0.80 (0.43, 1.5) | 0.80 (0.43, 1.50) |
| HIV | 0.59 (0.31, 1.14) | 0.92 (0.48, 1.78) | 0.94 (0.49, 1.82) | 0.94 (0.49, 1.82) |
| Oxygen therapy | 2.47 (2.13, 2.87) | 2.1 (1.80, 2.46) | 2.05 (1.75, 2.40) | 2.09 (1.85, 2.35) |
| ICU admission | 2.18 (1.96, 2.43) | 2.14 (1.89, 2.42) | 2.1 (1.86, 2.36) | 2.09 (1.85, 2.35) |
| Respiratory rate | 1.02 (1.02, 1.03) | 1.03 (1.02, 1.04) | 1.03 (1.02, 1.04) | 1.03 (1.02, 1.04) |
| Medications | ||||
| Beta-blockers | 1.29 (1.12, 1.48) | 1.39 (1.23, 1.57) | 1.34 (1.18, 1.52) | 1.33 (1.18, 1.51) |
| Diuretics oral | 1.44 (1.24, 1.67) | 1.57 (1.37, 1.80) | 1.53 (1.33, 1.74) | 1.54 (1.34, 1.77) |
| ACE – inhibitors | 1.21 (1.03, 1.41) | 1.37 (1.17, 1.60) | 1.31 (1.12, 1.53) | 1.33 (1.13, 1.55) |
| Anti-coagulant/anti-platelets/NOACs drugs | 1.67 (1.45, 1.92) | 1.59 (1.41, 1.79) | 1.53 (1.35, 1.73) | 1.53 (1.35, 1.73) |
| Angiotensin II receptor blockers | 0.89 (0.77, 1.04) | 1.00 (0.87, 1.15) | 0.97 (0.84, 1.11) | 0.98 (0.85, 1.12) |
| Statins | 1.41 (1.23, 1.62) | 1.36 (1.2, 1.54) | 1.29 (1.14, 1.47) | 1.32 (1.16, 1.50) |
| Anti-diabetic drugs | 0.55 (0.46, 0.66) | 0.95 (0.83, 1.10) | 0.68 (0.58, 0.8) | 0.68 (0.58, 0.80) |
| NSAIDs (regular use) | 0.90 (0.68, 1.19) | 1.22 (0.93, 1.60) | 1.21 (0.93, 1.59) | 1.21 (0.92, 1.58) |
| RASS inhibitors | 1.05 (0.91, 1.22) | 0.98 (0.84, 1.13) | 0.97 (0.84, 1.12) | 0.96 (0.83, 1.11) |
| BMI (Kg/m2) | ||||
| 18.0–24.9 | 1.0 | 1.0 | 1.0 | 1.0 |
| <18.0 | 0.55 (0.27, 1.13) | 0.86 (0.43, 1.73) | 0.85 (0.42, 1.71) | 0.82 (0.42, 1.61) |
| 25.0–29.9 | 0.93 (0.79, 1.1) | 0.91 (0.77, 1.07) | 0.90 (0.76, 1.05) | 0.89 (0.75, 1.04) |
| ≥30 | 1.05 (0.88, 1.26) | 1.07 (0.89, 1.29) | 1.00 (0.83, 1.20) | 1.00 (0.83, 1.21) |
[i] BMI = body mass index, NOAC = Novel oral anticoagulants; NSAIDs = Nonsteroidal anti-inflammatory drugs; ACE = angiotensin converting enzyme inhibitors’ ARB = angiotensin receptor blockers; RAAS = Renin-angiotensin-aldosterone system; ICU = intensive care unit; HIV = human immunodeficiency virus; COPD = chronic obstructive pulmonary disease; HIC = high income countries; UMIC = upper middle-income countries; LMIC = lower middle-income countries; LIC = low-income countries.
Adjusted risk1 (Model 1): adjusted for demographic variables (age, sex, ethnicity).
Adjusted risk2 (Model 2): adjusted for demographic and clinical characteristics (Diabetes, COPD/asthma).
Adjusted risk3 (Model 3): adjusted for demographic and clinical characteristics and smoking.