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. 2024 Nov 26;13(23):7182.
doi: 10.3390/jcm13237182.

Multimorbidity and COVID-19 Outcomes in the Emergency Department: Is the Association Mediated by the Severity of the Condition at Admission?

Alberto Catalano  1   2 , Carlotta Sacerdote  3   4 , Marco Alvich  5 , Alessandra Macciotta  1   2 , Lorenzo Milani  1 , Cinzia Destefanis  1 , Kibrom Teklay Gebru  1 , Barbara Sodano  1   6 , Lisa Padroni  1 , Maria Teresa Giraudo  1 , Giovannino Ciccone  7 , Eva Pagano  7 , Adriana Boccuzzi  8 , Valeria Caramello  8 , Fulvio Ricceri  1
Affiliations

Multimorbidity and COVID-19 Outcomes in the Emergency Department: Is the Association Mediated by the Severity of the Condition at Admission?

Alberto Catalano et al. J Clin Med. .

Abstract

Background/Objectives: Charlson Comorbidity Index (CCI) is one of the most reliable indicators to assess the impact of multimorbidity on COVID-19-related outcomes. Moreover, the patient's clinical conditions are associated with SARS-CoV-2 outcomes. This study aimed to analyze the association between multimorbidity and COVID-19-related outcomes, evaluating whether the National Early Warning Score 2 (NEWS2) mediated these associations. Methods: Data were obtained through the platform "EPICLIN". We analyzed all patients who tested positive for COVID-19 after accessing the emergency department (ED) of San Luigi Gonzaga (Orbassano) and Molinette (Turin) hospitals from 1 March to 30 June 2020. Different outcomes were assessed: non-discharge from the ED, 30-day mortality, ICU admission/death among hospitalized patients, and length of hospitalization among surviving patients. Two subgroups of patients (<65 and 65+ years old) were analyzed using logistic regressions, Cox models, and mediation analyses. Results: There was a greater risk of not being discharged or dying among those who were younger and with CCI ≥ 2. Moreover, the higher the CCI, the longer the length of hospitalization. Considering older subjects, a greater CCI was associated with a higher risk of death. Regarding the mediation analyses, multimorbidity significantly impacted the hospitalization length and not being discharged in the younger population. Instead, in the older population, the NEWS2 played a mediation role. Conclusions: This research showed that multimorbidity is a risk factor for a worse prognosis of COVID-19. Moreover, there was a strong direct effect of CCI on not being discharged, and the NEWS2 was found to act as mediator in the association between multimorbidity and COVID-19-related outcomes.

Keywords: COVID-19; Charlson comorbidity index; SARS-CoV-2; hospitalization; intensive care unit; mortality; multimorbidity; national early warning score 2.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pure direct effect, total indirect effect, and total effect over time related to the length of hospitalization for the younger population (<65 years), stratified by Charlson Comorbidity Index.
Figure 1
Figure 1
Pure direct effect, total indirect effect, and total effect over time related to the length of hospitalization for the younger population (<65 years), stratified by Charlson Comorbidity Index.
Figure 2
Figure 2
Pure direct effect (PDE), total indirect effect (TIE), and total effect (TE) over time related to the length of hospitalization for the elderly population (65+ years), stratified by Charlson Comorbidity Index.
Figure 2
Figure 2
Pure direct effect (PDE), total indirect effect (TIE), and total effect (TE) over time related to the length of hospitalization for the elderly population (65+ years), stratified by Charlson Comorbidity Index.
See this image and copyright information in PMC

References

    1. World Health Organization WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19—11 March 2020. [(accessed on 28 November 2023)]. Available online: https://www.who.int/director-general/speeches/detail/who-director-genera....
    1. World Health Organization WHO Director-General’s Opening Remarks at the Media Briefing—5 May 2023. [(accessed on 28 November 2023)]. Available online: https://www.who.int/director-general/speeches/detail/who-director-genera....
    1. World Health Organization WHO Coronavirus (COVID-19) Dashboard|WHO Coronavirus (COVID-19) Dashboard with Vaccination Data. [(accessed on 28 November 2023)]. Available online: https://covid19.who.int/
    1. Li J., Huang D.Q., Zou B., Yang H., Hui W.Z., Rui F., Yee N.T.S., Liu C., Nerurkar S.N., Kai J.C.Y., et al. Epidemiology of COVID-19: A Systematic Review and Meta-Analysis of Clinical Characteristics, Risk Factors, and Outcomes. J. Med. Virol. 2021;93:1449–1458. doi: 10.1002/jmv.26424. - DOI - PMC - PubMed
    1. Dessie Z.G., Zewotir T. Mortality-Related Risk Factors of COVID-19: A Systematic Review and Meta-Analysis of 42 Studies and 423,117 Patients. BMC Infect. Dis. 2021;21:855. doi: 10.1186/s12879-021-06536-3. - DOI - PMC - PubMed

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