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Clinical Medicine Insights 

DOI: https://doi.org/10.52845/CMI/2022-3-3-2 

CMI 03 (03), 322−329 (2022) ISSN (O) 2694-4626

Research Article          Open Access Journal

What Does Comorbid Status Implication with the End Status of Corona 

Virus Disease (Covid-19) Patients? 

Melati Noormaulidya Putri
1
, Muhammad Syarif

1
, Iwan Aflanie

2
, Endah Labati S

2
, 

Fauzie Rahman
3
, Husnul Fatimah

4
, Zuhrufa Wanna Yolanda

4
, 

Corresponding Author: Fauzie Rahman   
fauzie21@ulm.ac.id

1
Undergraduate Student of 

Public Health Study Program , 

Faculty of Medicine, Lambung 
Mangkurat University 
2
Medical Study Program, Faculty 

of Medicine, University of Lambu- 
ng Mangkurat 

3
Public Health Study Program , 

Faculty of Medicine, University of 

Lambung Mangkurat 

4
Association of Alumni Faculty of 

Medicine, University of Lambung 

Mangkurat. 

Abstract 

Background: The prevalence of confirmed cases of Covid-19 is quite 

high and tends to continue to increase. Based on data, South 

Kalimantan Province in early mid-2021 experienced a high spike in 

cases, resulting in a large number of deaths, especially in the City of 

Banjarbaru. Covid-19 active cases in South Kalimantan in July 2021 

were recorded at 5,279 cases (12.41%) out of a total of 42,527 positive 

cases. Many research results on risk factors for Covid-19 cases, the 

results vary widely. People with comorbidities are a very vulnerable 

group.  

Objective: to analyze whether comorbid status has implications for the 

final status of Covid-19 patients in inpatients at the Idaman Hospital, 

Banjarbaru City.  

Methods: Quantitative research using an observational design through a 

case-control approach. The population is 300 respondents and the 

research sample is 60 respondents with a sample group of 30 people and 

a control group of 30 people. The data used is data from the case form 

report (CFR). The dependent variable in this study was the final status 

(died/recovered) in inpatients diagnosed as positive for Covid-19 at the 

Idaman Hospital, Banjarbaru City, while the independent variables were 

age, gender, hypertension, diabetes mellitus, pneumonia, heart failure, 

kidney failure. chronic chronic disease (CKD) and stroke (CVA). Data 

were analyzed univariately and bivariately with chi-square to obtain 

adjusted OR. Results: Analysis using the chi-square test showed that 

chronic kidney failure (p=0, 026) has implications for the mortality 

status of patients with a risk of dying 10 times compared to patients 

without comorbidities, and heart disease (p=0.045) with a risk of dying 

6 times compared to patients without heart disease. Conclusion: 

Chronic kidney disease (CKD) and heart disease are the highest risk 

factors that affect death in patients with Covid-19. 

Keywords:  Covid-19, Comorbidity, Mortality 

Copyright : © 2021 The Authors. Published by Medical Editor and 

Educational Research Publishers Ltd. This is an open access article 

under the CC BY-NC-ND license (https://creativecommons.org/lic 

enses/by-nc-nd/4.0/). 

https://creativecommons.org/lic%20enses/by-nc-nd/4.0/
https://creativecommons.org/lic%20enses/by-nc-nd/4.0/


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Introduction

Determination Covid-19 declared a pandemic by 

the World Health Organization (WHO) on March 

11, 2020, based on cases of Covid-19 which is 

spreading rapidly infecting populations in many 

countries. SARS-CoV-2 or Novel Coronavirus is 

the name for a virus that plays a role in disease 

Covid-19 or coronavirus disease. More severe 

illnesses, such as Middle East Severe Acute 

Respiratory Syndrome, can follow a series of mild 

symptoms such as the common cold. The cause is 

a large family of dominant coronaviruses infecting 

the respiratory tract in the human body. The first 

reported case in Indonesia coincided on March 2, 

2021 (Directorate General of Disease Prevention 

and Control, 2020). The mode of transmission of 

the virus is by spreading through splashes of 

saliva produced by an infected person when 

coughing, sneezing, or even when the person 

exhales. Droplets can't stay in the air, so they 

quickly fall and stick to other surfaces. Even 

transmission can occur when breathing air 

containing the virus. 

The prevalence of confirmed cases of Covid-19 is 

quite high and tends to continue to increase. Based 

on data, South Kalimantan Province in early mid-

2021 experienced a high spike in cases, resulting 

in a large number of deaths, especially in 

Banjarbaru City. Active Covid-19 cases in South 

Kalimantan Province in July 2021 were recorded 

at 5,279 cases (12.41%) out of a total of 42,527 

positive cases (Covid-19 Task Force, 2021). 

Research conducted by Sijia Tian et al., entitled 

Characteristics of Covid-19 infection in 

Beijingwith demographic, epidemiological, 

clinical, and laboratory tests for Covid-19, it was 

found that the average age of the patients was 47.5 

years and 51.5% were women, 73.3% of patients 

were residents of Beijing, 26.0% of whom had 

been to Wuhan, 60.4% had close contact with 

confirmed cases, The most common symptoms at 

onset of illness were fever (82.1%), cough 

(45.8%), fatigue (26.3%), dyspnea (6.9%) and 

headache (6.5%) . The average incubation period 

is 6.7 days, the time interval for getting sick and 

seeing a doctor is 4.5 days (Tian et al., 2020). 

Comorbid disease is a comorbid disease or 

congenital disease that can worsen the infection 

situation Covid-19 and can also reduce the 

immune system (Mazuki et al., 2021). The 

Indonesian Ministry of Health stated that one of 

the vulnerable groups was exposed to Covid-19 

are people who have comorbid diseases, this 

group is also at high risk of death (Indonesian 

Ministry of Health, 2020). The role of the family 

is important in disease prevention Covid-19 so 

that prevalence can decrease (Pranata, et al, 2021). 

Case prevalence Covid-19 with comorbidities 

globally by 57.7% and cases Covid-19 

noncomorbidity of 42.3%. Comorbid disease in 

Covid-19, that is hypertension, diabetes mellitus, 

cardiovascular disease (CVD), chronic obstructive 

pulmonary syndrome (COPD), chronic kidney 

disease (CKD), cancer and other comorbidities 

including liver disease, GI disorders, 

immunocompromised, neurogical disorders, 

psychiatric disorders, metabolic disorders, blood 

disorders, transplant, chronic pancreatitis, 

connective tissue disorder, smoking, obesity, 

hyperlipidemia. Percentage of patients Covid-19 

with the highest comorbid hypertension at 27.4% 

and followed by DM 17.4%, CVD 8.9%, COPD 

7.5%, cancer 2.6%, CKD 3.5%, other diseases 

15.5% (Bajgain dk., 2020) 

The results of the studies described previously 

showed that comorbidity was a risk factor for 

severity and mortality in patients Covid-19. 

Therefore, to answer this question, this research 

was conducted with the aim of analyzed whether 

comorbid status had implications for the final 

status of Covid-19 patients in inpatients at the 

Idaman Hospital, Banjarbaru City. 

Methods 

This type of research is a quantitative study using 

an analytic observational design using a case 

control approach. The population in this study 

were all inpatients Covid-19 at the Idaman 

Hospital of Banjarbaru City 2021. Number of 

positive confirmed patients Covid-19 at the 

Idaman Hospital from January-March 2021, 

namely, a total of 300 people. The sample size for 

cases, namely, patients who were confirmed 

positive and had been declared dead were 30 

cases, while for controls were 30 confirmed cases. 

Covid-19 and declared cured. The source of data 

in this study is the medical record report at the 



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 Idaman Hospital, Banjarbaru City 

The data that has been collected was analyzed 

univariately using the frequency distribution table 

for each variable and bivariate analysis with the 

chi-square test to determine the implications 

between the two variables and calculating the 

odds ratio (OR), Fisher's alternative test was used 

if the chi-square test did not meet the 

requirements. 

Results and Discussion 

A. Characteristics of Respondents 

Table 1.1 Distribution of respondents based on characteristics 

Characteristics Frequency (f) Percent (%) 

Age 

Productive 46 76.7 

Non Productive 14 23.3 

Gender 

Woman 37 61.7 

Man 23 38.3 

Status 

Healed 30 50 

Die 30 50 

Hypertension 

Yes 31 51.7 

Not 29 48.3 

Diabetes mellitus 

Yes 27 45 

Not 33 55 

Pneumonia 

Yes 10 16.7 

Not 50 83.3 

Heart 

Yes 11 18.3 

Not 49 81.7 

CKD 

Yes 9 15 

Not 51 85 

stroke 

Yes 4 6.7 

Not 56 93.3 

Data source: Year 2021 

Table 1. Shows the age distribution based on the 

productive age category as many as 46 people 

(76.7%) compared to non-productive age 

respondents as many as 14 (23.3%). Gender was 

dominated by 37 women (61.7%) and the final 

status of patients for those who died 30 people 

(50%) and recovered as many as 30 people (50%

%). Several comorbid diseases that have 

implications for the status of inpatients at the 

Idaman Banjarbaru Hospital, namely hypertension 

disease are 31 people (51.7%), diabetes mellitus 

are 27 people (45%), patients who have heart 

disease are 11 people (18.3%), patients with 

kidney failure (CKD) as many as 9 people (15%) 

and stroke patients as many as 4 people (6.7%). 



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Table 2. Bivariate Analysis 

Variable Case Control 
0R (95% CI) p-value 

N % N(%) (%) 

Age 
0.467 

(0.135-1.609) 
0.360 Productive 21 70% 25 83.3% 

Non Productive 9 30% 5 16.7% 

Gender 
0.490 

(0.170-1.414) 
0.288 Woman 21 70 16 53.3 

Man 9 30 14 45.7 

Hypertension 
0.386 

(0.136-1.094) 
0.121 Yes 19 63.3 12 40 

Not 18 36.7 11 60 

Diabetes mellitus 
0.874 

(0.316-2.418) 
1,000 Yes 13 43.3 14 46.7 

Not 17 56.7 16 53.3 

Pneumonia 
2,739 

(0.635-11.823) 
0.299 Yes 7 23.3 3 10 

Not 23 76.7 27 90 

Heart 

6,000 (1,172-30,725) 0.045 Yes 9 30 2 6.7 

Not 21 70% 28 93.3 

CKD 
10,545 

(1,227-90,662) 
0.026 Yes 8 26.7 1 3.3 

Not 22 73.3 29 96.7 

Stroke 
3,222 

(0.316-32.889) 
0.612 Yes 3 10 1 3.3 

Not 27 90 29 96.7 

Data source: Year 2022 

Analysis between individual characteristic 

variables and the patient's final status COVID-19 

shown in table 2. People with heart disease had 6 

times the risk of dying compared to those without 

heart disease and it was not statistically significant 

(p=0.045). Meanwhile, people who have kidney 

failure have a 10.5 times risk of dying compared 

to patients who do not have kidney failure and it is 

statistically significant (p=0.026). 

Discussion 

According to the Centers for Disease Control and 

Prevention (CDC) shows that 94% of cases of 

death Covid-19 in the United States occurs in 

patients with comorbidities. Patients who have 

comorbidities need attention because their 

conditions are more vulnerable so that when 

infected, Covid-19 can have fatal consequences. 

The Ministry of Health lists 12 co-morbidities 

Covid-19 the most in positive patients Covid-19. 

Five of them are hypertension, diabetes mellitus, 

heart disease, lung disease, and kidney disease. 

People who already have this disease must strictly 

implement health protocols to avoid transmission 

Covid-19 (CDC, 2021). 

In table 2 it is known that, out of 46 people of 

productive age, 21 people died as a result of 

Covid-19, while out of 14 people who were 

unproductive, 9 people died. The results of 

bivariate analysis obtained p = 0.360 (α> 0.05), 

which means that there is no statistically 

significant implication between age and the final 

status of comorbid patients affected. Covid-19. 

This is in line with the research of Elviani et al, 

(2021) which stated that the majority of 

respondents were in the age range of 26-35 years, 

amounting to 141 respondents. This shows that 

this age is productive age. At productive age, the 

possibility of contracting Covid-19 will be larger, 

this is due to high mobility and activities outside 

B. Bivariate Analysis Results 



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the home. The frequency and social interaction of 

productive groups is also higher. 

The Center for Strategic and International Studies 

(CSIS) also stated that infection transmission 

came from groups with relatively high mobility, 

namely, relatively young age groups. Deployment 

Covid-19 in Italy has struck every age group. 

Initially, most of the recorded cases occurred 

among the elderly, but as the corona virus spreads, 

younger people are infected in greater numbers 

(Kalantari, 2020). This means that all ages are at 

risk for infection Covid-19, and Productive age is 

the age most at risk due to high mobility and 

social activities. Although it is risky, this can be 

prevented by continuing to follow health protocols 

(wearing masks, washing hands, doing physical 

and social distancing and avoiding crowds). 

The number of women as respondents in this 

study were 37 people, 21 of whom died due to 

Covid-19, while the 23 men who were the 

respondents, 9 of them died. The results of 

statistical tests showed p = 0.288 (α> 0.05), which 

means that gender has no implications for the final 

status of comorbid patients affected Covid-19. 

Men are more sensitive to SARS-CoV-2 so that 

male gender is a risk factor Covid-19bbecause 

they are more out of the house for working 

conditions and more in the community, therefore 

they are more likely to be infected. Differences in 

behavior between men and women, especially in 

terms of health education, as well as their lack of 

attention to the issue of social distancing, are 

issues that should not be ignored (Rashedi et al, 

2020). 

There were 31 hypertension patients, 19 of whom 

died due to hypertension Covid-19, while out of 

29 people who did not suffer from hypertension, 

18 people died. The results of statistical analysis 

showed p = 0.121 (α> 0.05) which means that 

there is no implication between hypertension 

status and the final status of comorbid patients 

affected Covid-19. This is not in line with the data 

found in the data on comorbid conditions found in 

patients Covid-19in Indonesia until July 29, 2021, 

hypertension is still the most common comorbid 

condition, at 50.4%. In a study conducted by 

Gunawan et al, regarding the Effect of 

Hypertension on Infected Patients Covid-19. The 

study stated that hypertension can worsen the 

condition of infected patients Covid-19This virus 

will bind to Angiotensin converting enzyme 2 

(ACE2), an enzyme attached to the outer surface 

of several organs in the body, after binding to the 

enzyme, the virus can enter the organ and cause 

the patient to become infected. Covid-19 

(Gunawan et al, 2020). 

There were 27 diabetes mellitus patients, 13 of 

whom died from diabetes mellitus Covid-19. The 

results of statistical analysis showed p = 1,000 (α> 

0.05) which means that there is no implication 

between hypertension and the final status of 

affected comorbid patients. Covid-19. Diabetes is 

the most common metabolic disease in the world. 

It is a disease that weakens the immune system. 

The number of people with diabetes in the world 

is increasing, especially in developing countries. 

Researchers have shown that diabetes increases 

the risk Covid-19. Diabetic patients are less 

responsive to treatment and have a higher risk of 

death. In diabetic patients, innate immunity is 

compromised due to increased blood glucose 

levels so that glycosylation of cytokines impairs 

cytokine-dependent function of type 1 helper T 

lymphocytes (Th1). Pulmonary microangiopathy, 

oxidative stress-induced tissue damage in 

hyperglycemia, and pulmonary inflammation 

predispose patients to Covid-19, as is the case in 

patients susceptible to tuberculosis (Rashedi et al, 

2020). These diabetic patients have a 2 times 

greater risk of developing severe or critical illness 

requiring treatment in an intensive care unit 

(Longato et al, 2020; Wang et al, 2020). On 

hospitalization, patients with diabetes mellitus are 

three times at risk of dying from diabetes mellitus 

Covid-19. Diabetes mellitus is an independent risk 

factor for age and gender (Setyarini, 2021). 

There were 10 pneumonia patients, 7 of whom 

died from Covid-19. The results of the statistical 

test analysis showed the p-value = 0.299, from the 

p-value in the statistical test results, the decision 

Ho was rejected (p>0.05), which means that there 

is no implication between pneumonia and the risk 

of death from Covid-19 in Banjar Regency. This 

is not relevant to the Senewe Research (2020) 

which states that the most common risk factor for 

comorbidities is pneumonia at 18.2% (Senewe, 

2020). 

Patients with heart disease were found as many as 

11 people, 9 of whom died from Covid-19. The 

results of statistical analysis obtained p = 0.045 (α 



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<0.05) which means that there are significant 

implications between heart disease and the final 

status of comorbid patients affected Covid-19. 

Odds Ratio (5% CI:1.172-30,725) shows that 

Covid-19 patients have a 6 times higher risk of 

dying than Covid-19 patients who do not have 

comorbidities. Comorbid factors Covid-19 the 

third and fourth ranks are hypertension and 

cardiovascular system disease, with a percentage 

of 3.10% and 2.86%, respectively. This is in line 

with the analysis of 5 journals showing that from 

2 journals that reported the presence of comorbid 

cardiovascular disease and hypertension, namely 

the research of Satria et al (2020) and Sanyasi & 

Pramudita (2020) have contributed a fairly high 

number, which if added up to more than 5, 96%. 

Cardiovascular disease and hypertension are 

associated with smoking, hypertension, and 

diabetes mellitus, which are thought to be at risk 

of increasing the excretion of ACE2 receptors or 

angiotensin converting enzyme 2 (Susilo et al, 

2020). Indeed, there are no research results that 

confirm the exact link between hypertension and 

severity Covid-19 (Yang et al, 2020). However, in 

general the severity Covid-19it will be easier to 

occur in people with hypertension which are 

generally associated with complications of other 

health problems and factors of old age so that it is 

difficult to separate the influence of each factor. 

The results of Yang & Yan's (2020) study showed 

that 358 patients were infected Covid-19 and 

confirmed by nasal and/or throat swab. 66 patients 

(18%) died of Covid-19. 60.6% were male (OR 

1.87, P 0.041), 22.7% were >64 years old (OR 

2.097, P 0.041), and 83.3% were comorbid risk 

factors. Diabetes mellitus (30.3%) (OR 4.348, P 

0.000) and cardiovascular disease (10.6%) (OR 

4.319, P 0.016) were the highest risk factors for 

death in Covid-19. The presence of acute 

inflammation and decreased organ function (heart, 

kidney, liver, and hematology) experienced by 

patients at the beginning of treatment can increase 

the risk of death due to infection. Covid-19 

(Setyarini, 2021). 

There were 9 patients with chronic kidney failure, 

8 of whom died as a result of Covid-19. The 

results of the bivariate analysis showed p=0.026 

(α<0.05), which means that there are statistically 

significant implications between heart disease and 

the final status of comorbid patients affected 

Covid-19. Odds Ratio (5% CI:1.172-30,725) 

showed that Covid-19 patients had a 10 times 

higher risk of dying than Covid-19 patients who 

did not have cardiac comorbidities. This is in line 

with a meta-analysis involving 76,993 patients in 

10 publications that listed chronic kidney disease 

as one of the seven most common comorbidities 

in patients Covid-19 hospitalized (Emami et al, 

2020). Subsequent analysis found that chronic 

kidney disease was the most common risk factor 

for Covid-19 weight worldwide at any age and 

explains the increased risk Covid-19 severe for 

about one in four high-risk individuals worldwide 

(Council et al, 2021). Chronic kidney disease is 

well known to be a risk factor for severe bacterial 

and viral infections. Many theories have explained 

why comorbid chronic kidney disease increases 

the risk of developing serious infectious diseases 

and even death. Chronic kidney disease patients 

have pro-inflammatory status and functional 

effects on innate and acquired immune cells 

resulting in increased susceptibility to infection 

(Ishigami et al, 2017). In addition, there is an 

increased risk of pneumonia and upper respiratory 

tract infections in patients with chronic kidney 

disease who may also be co-infected with Covid-

19. 

There were 4 stroke patients, and 3 of them died 

due to Covid-19. The results of the bivariate 

analysis obtained p=0.612 (α> 0.05), which means 

that there is no statistically significant implication 

between stroke and the final status of comorbid 

patients affected by Covid-19. Stroke or CVA 

(Cerebro Vascular Accident) is also one of the 

comorbid factors for Covid-19 in Indonesia. The 

results of the study in the form of a review of 5 

journals, showed that there were 2 journals that 

clearly provided information on stroke as a 

comorbid factor for Covid-19, namely, the 

research of Satria et al (2020) and Sanyasi & 

Pramudita (2020). Another study stated that there 

were 4 cases of patients diagnosed with Covid-19 

who were also suffering from a stroke or had a 

history of stroke (Satria et al, 2020). These results 

are relatively new, because existing reports do not 

clearly mention stroke or CVA as a comorbid 

factor for Covid-19 (Karyono & Wicaksana, 

2020). 56 patients with chronic diseases also 

mostly have experienced organ damage. When 

exposed to the Corona virus, the damage to these 

organs can become more severe, 



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Intensive action to reduce person-to-person 

transmission of Covid-19 is needed to control this 

outbreak, especially in vulnerable populations, 

especially those with comorbid hypertension and 

diabetes. It is also relevant to the research 

conducted by Raden Muhammad Ali Satria with 

the title analysis of risk factors for death with 

comorbid Covid-19 (Setyarini, 2021) 

Conclusion 

Comorbid status has implications for the final 

status of the patient Covid-19at the Idaman 

Hospital in Banjarbaru City. Confirmed patient 

Covid-19 with comorbid cardiac status with 

p=0.045 (OR=6,000) and chronic kidney failure 

with p=0.026 (OR=10,545) had a higher risk of 

death than patients without these comorbidities. 

The most dominant comorbid factors were 

patients with a history of chronic kidney failure. 

Suggestion 

It is hoped that these findings can be used as a 

basis for policy making and educational program 

planning strategies to improve patient monitoring 

and treatment Covid-19 especially in patients who 

have comorbid diseases and other non-

communicable diseases. Communities and 

individuals can maintain their lifestyle by always 

adhering to health protocols. 

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How to Cite Putri, M. N., Syarif, M. ., Aflanie, I. 

., S, E. L. ., Rahman, F. ., Fatimah, H. ., & 

Yolanda, Z. W. . (2022). What Does Comorbid 

Status Implication with the End Status of 

Corona Virus Disease (Covid-19) Patients?. 

Clinical Medicine Insights, 3(3), 322–329. 

https://doi.org/10.52845/CMI/2022-3-3-2 




