Clinical characteristics and Co-morbidities among patients admitted with COVID-19

Background During the Coronavirus Disease-2019 (COVID-19) pandemic, several characteristics of COVID-19 patients, based on demographics, clinical symptoms, and the presence of comorbidities, were found to be associated with the complications developed. COVID-19 symptoms vary greatly and are more prominent with comorbid diseases. Therefore, the aim of this study to find the clinical characteristics and its association with different comorbidities. Methods This is a retrospective study that was performed on the data obtained from medical records of 3999 patients in Riyadh. Demographic data, clinical symptoms and comorbidities were noted on the day of hospital admission. Complications developed during the COVID -19 infection were observed. Results The average age of patients were 49.55 years old. Fever was the most common symptom among the patients (85.85%), followed by cough (85.85%), and shortness of breath (83.25%). The most common comorbidities were diabetes mellitus (39.51%), hypertension (33.91%), and asthma (9.45%), with chronic rhinosinusitis being the least common (0.5%). Pneumonia affected 61.90% of the patients admitted to the hospital. Furthermore, 8.73% got acute respiratory distress syndrome (ARDS), and 7.25% acquired pneumonia and Acute ARDS simultaneously. Co-morbidities were significantly correlated with complications developed during COVID-19. Conclusion Hypertension and diabetes mellitus were two of the most common symptoms observed. Clinical symptoms, comorbidities, and complications are higher in female patients compared to male patients and most of the patients’ developed complications.


Introduction
Coronavirus disease 2019 , caused by a highly contagious virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first appeared in China around the end of 2019 and quickly spread across the globe. The World Health Organization declared COVID-19 a pandemic in March 2020. Experts in the field of medicine are still discovering more about the natural course and severity of COVID-19. Previous studies have explained the baseline characteristics, symptoms, and clinical outcomes of patients with COVID-19 [1].
COVID-19 symptoms vary greatly, ranging from asymptomatic to mild to severe pneumonia-like symptoms [2]. ARDS is caused by a large number of COVID-19 pneumonia cases, and it usually develops on day eight or nine after the onset of symptoms [3]. A substantial number of COVID-19 pneumonia patients admitted to the ICU have comorbidities that have a detrimental impact on the disease's prognosis [4]. Several studies have already described clinical features, demographics, and laboratory data parameters at the time of admission. Moreover, a number of studies have detailed the clinical outcomes, comorbidities, and complications [5]. However, the fact that many patients were still in hospitals at the time of publication skewed the results. As a result, more reliable data on co-morbidities and complications is needed. Furthermore, a large number of samples is required to better understand the association of comorbidities of COVID-19 patients with complications developed during the disease.
This study describes the baseline characteristics, symptoms, comorbidities, and complications developed during COVID-19 patients admitted to Prince Mohammed Bin Abdulaziz Hospital in Riyadh.

Patients and study design
This is a retrospective descriptive study that was conducted in E-mail addresses: Dr.omair@yahoo.com, goalhussain.imam@gmail.com. All of the information was gathered from hospital medical records and included demographic information, clinical symptoms and signs, and complications that developed during the COVID-19 disease. Observed comorbidities were Diabetes Mellitus (DM), Hypertension (HTN), asthma, and Chronic Rhinosinusitis (CRS). On the day of admission to the hospital, the following clinical symptoms were noted: fever, cough, shortness of breath, diarrhoea, fatigue, vomiting, headache, sore throat, nausea, loss of appetite, malaise, chest pain, abdominal pain, loss of smell, loss of taste, dizziness, runny nose, rhinorrhoea, and palpitation. Most of the patients experienced complications such as pneumonia, Acute Respiratory Distress Syndrome (ARDS), and septic shock during COVID-19. The research has been registered with research registry with registration number: researchregistry7821. In addition, this article has been submitted in line with the STROCSS guidelines [6].

Statistical analysis
The data was entered into Microsoft Excel, which cleaned it all up for analysis. Variables were then imported into IBM SPSS (Statistical Package for Social Sciences) version 26 for statistical analysis. Descriptive analysis of baseline and clinical characteristics of patients was performed. Qualitative variables were expressed as numbers and percentages, while quantitative variables were expressed as means, medians, and interquartile ranges (IQR). The Pearson correlation coefficient was used to examine the relationship between the number of comorbidities and complications developed during the COVID-19 infection, and the chi-square test was used to examine the association. A p-value of 0.05 was considered statistically significant.

Results
Data was collected from patients admitted to the hospital between March 2020 and April 2021 from a total of 3999 COVID-19 patients. The average age and standard deviation of the male patients, was 51.59 ± 16.12 and female was 48.83 ± 14.15. The median age of male patients was 53 and the median age for female patients was 48. The mean value of the Body Mass Index (BMI) of patients was 29.48 ± 6.94. It has been observed that asymptomatic COVID-19 cases were higher in male patients (67.5%) compared to female patients (32.5%). Among 3999 cases, 1353 (33.83%) cases were from Saudi Arabia, 10.50% from India and 7.68% from Syria (Table 1).
The majority of patients were in the age group of 50-59 years, with males accounting for 25.2% and females accounting for 22.6% of the total group. DM was the most common comorbidity among females, accounting for 42.61% of all females, followed by hypertension (42.52%), asthma (12.96%), and CRS (0.76%). In males, DM accounted for 38.54%, followed by Hypertension (30.85%), Asthma (8.20%) and CRS (0.37%) of the total population. Male patients were shown to have a lower prevalence of diabetes (4.07%), hypertension (11.76%), and asthma (4.76%) than female patients (Table 4).
From our study, 701 female patients (66.82%) and 1793 male patients (60.6%) had developed respiratory issues such as pneumonia, ARDS, and septic shock during the COVID-19 period. Female COVID-19   (Table 4). There was a statistically significant correlation observed between comorbidities and complications developed during COVID-19 disease; 29% of the patients had one co-morbidity, 26.2% of the patients had two co-morbidities, and 15.67% of the patients had more than three comorbidities and developed complications during COVID-19 (Table 5).

Discussion
In this descriptive study, we analysed the baseline characteristics, clinical symptoms, and complications developed during the COVID-19 infection of 3999 patients admitted to Prince Mohammed Bin Abdulaziz Hospital in Riyadh. In our study, the median age of the male patients was higher than that of female patients in most of the patients, both male and female were in the age group of 50-59 years. COVID-19 infection was found to be higher compared to the younger age group. Symptomatic COVID-19 was found to be higher in both sex. Fever and cough were the most commonly reported clinical symptoms in patients with COVID-19 infection [7][8][9][10]. In our study, the most prevalent symptom were fever, cough and shortness of breath. A study of approximately 370,000 confirmed COVID-19 cases with known symptom status reported to the Centers for Disease Control and Prevention (CDC) in the United States highlighted the variety of related symptoms similar to our study [11]. Obesity-related comorbidities have been linked to more severe COVID-19 complications and higher mortality, whereas a high BMI has been associated with hospitalization and poor survival [12]. In this study it has been observed that patients had higher BMI (29.48 ± 6.94).
Studies have shown a higher mortality rate in COVID-19 patients with pre-existing comorbidities to the patient without comorbidity. The most often reported comorbidity in COVID-19 patients are hypertension, DM and cardiovascular disease [13,14] We found that, regarding comorbidities such as DM, hypertension was the more common symptom observed in patients at the time of hospital admission. In our study female patients had higher proportion of comorbidities such as hypertension and DM similar to other studies [15][16][17]. There is a greater fear    that patients who have asthma will get more complications and be more likely to get COVID-19. But from our study, it shows that overall 9.45% of the COVID-19 patients had existing asthma problems, of which 12.96% of the patients were females and 8.20% were males. Currently, there is no strong evidence to prove that the increased infection rate of COVID-19 with those asthma conditions. However, its actual contribution to risk may be influenced by the presence of other behavioural factors, such as smoking and those associated with other comorbidities [18]. We found a higher incidence of pneumonia and ARDS during the COVID infection. In a stratified analysis, we observed that female patients developed more complications such as pneumonia and ARDS [19][20][21][22]. Wang et al. [23] reported that 46.4% of patients with COVID-19 had multiple comorbidities, and 72.2% of comorbid patients required ICU hospitalization. Another recent meta-analysis reported that severe COVID-19 was highly associated with the underlying diseases such as HTN (21.1%), DM (9.7%), and respiratory system diseases [24]. Co-morbidities were significantly correlated with complications developed during the COVID-19. Twenty nine percent of the patients had at least one major comorbidity. In addition to that, 26.2% of the patients had at least two comorbidities, and 15.67% of the patients had more than three comorbidities. These patients developed clinical complications such as pneumonia, ARDS, and septic shock [25]. In our study, it has been found that there was a significant association between comorbidities and complications developed during COVID -19.
Several studies found severe COVID-19 to be accompanied by comorbidities [18,23,25,26] and also added evidence to that highlighting the number of comorbidities as a strong risk factor for COVID-19 severity [27,28]. A large sample study conducted by Chudasama et al. described that multimorbidity was associated with a greater risk of outcomes in COVID-19 [29]. Our study results are also strongly consistent with previous studies that found the rise in the number of co morbidities increases the risk of complications or outcomes.
The study analysis was conducted with a limited number of variables and those are not sufficient to determine the risk factor more precisely. Lack of information like severity, survival data, length of hospital stay, and ventilator stay might lead to bias. The quality of different studies was different from each other. Different studies analysed different factors to assess the risk factor of comorbidities associated with the severity and clinically developed complications of COVID-19 patients. Secondly, the judgment criteria for severe and non-severe patients were not included in the study. Future studies should evaluate the impact of different comorbidities on COVID-19 severity and mortality using more detailed models.

Conclusion
This study demonstrated that there is a significant correlation between comorbidities and complications developed during the COVID-19. Clinical symptoms, comorbidities and complications is higher in female patients compared to male patients. In this study, diabetes mellitus and hypertension were the most prevalent comorbidities in patient with COVID -19 infection, and patient with co morbidities developed more complications. Hence, presence of comorbidities would be the risk for developing complications during the COVID-19 infection.

Ethical approval
The study was approved by the Scientific and Research Ethics Committee of the University of Prince Mohammed Bin Abdulaziz Hospital in Riyadh.

Ethical approval
Research studies involving patients require ethical approval. Please state whether approval has been given, name the relevant ethics committee and the state the reference number for their judgement.
Institutional review board approval was obtained accordingly.

Guarantor
The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

Consent
Informed consent was obtained according and in guidelines of the declaration of Helsinki.

Author contributions
Please specify the contribution of each author to the paper, e.g. study concept or design, data collection, data analysis or interpretation, writing the paper, others, who have contributed in other ways should be listed as contributors.
All authors contributed evenly to the conceptualization, drafting, data analysis, writing and proofreading of the research.

Registration of research studies
1. Name of the registry: Research Registry 2. Unique Identifying number or registration ID: researchregistry7821 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): https://www.researchregistry.com/registe r-now#user-researchregistry/registerresearchdetails/625eb360 11413d001f745d9b/

Declaration of competing interest
The author declares no conflict of interest.

Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi. org/10.1016/j.amsu.2022.103898.