295J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 Original Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 Mohammad Ali Khaksar1*, Elham Zanganeh Yousefabadi2, Reza Taleb Zadeh1, Homeira Rashidi3, Mahmood Maniati4, Nima Bakhtiari5 1Student Research Committee, Ahvaz Joundishapour University of Medical Sciences, Ahvaz, Iran. 2Department of Internal Medicine, Jundishapour University of Medical Sciences, Ahvaz, Iran. 3Diabetes Research Center, Jundishapour University of Medical Sciences, Ahvaz, Iran. 4Department of General Courses, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 5Pain Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran. *Correspondence to: Mohammad Ali Khaksar (E-mail: khaksar.ma@ajums.ac.ir) (Submitted: 10 July 2021 – Revised version received: 02 August 2021 – Accepted: 25 August 2021 – Published online: 26 October 2021) Abstract Objectives: The purpose of this study is to evaluate the prevalence of comorbidities in hospitalized COVID-19 patients and its effects on the severity of the disease. The coronavirus pandemic has been a challenging problem for health care systems since December 2019. Methods: This was a retrospective, cross-sectional study analyzing data related to the epidemiological characteristics of COVID-19 patients admitted to Razi Hospital in Ahvaz, Iran from November 2020 to February 2021. The data on patient demographic characteristics including age, gender, and underlying diseases were collected from patient records. Patients whose data were unavailable or incomplete were excluded from the study. Results: The mean age of all of the 730 patients studied was 56.30 ± 16.36 years, and 53.7% of them were men. Nearly 40% of the patients reported more than one comorbidity, with diabetes mellitus being the most frequent one (37.5%) followed by hypertension (35.3%) and ischemic heart disease (24.9). In addition, 21.5% of the patients required intensive care unit admission. Finally, 11.9% of the patients had respiratory distress and became intubated, and approximately 13.6% of the patients died. Hyperlipidemia, liver failure, tuberculosis, and elevated inflammatory biomarkers are risk factors for ICU admission and death. Conclusion: We found that male gender, older age, hyperlipidemia, liver failure, TB, having more than one comorbidity, and elevated inflammatory biomarkers were significantly associated with the risk of severe COVID-19 disease. Keywords: Comorbidities, COVID-19, hospitalized patients ISSN 2413-0516 Introduction In December, 2019, several cases of pneumonia of unknown origin were reported in Wuhan, Hubei Province, China. The disease spread to China and other countries of the world rapidly. The cause of this viral infection was later found to be a virus from the coronavirus family which was detected by a sample of patients’ throat swabs. Subsequently, it was named 2019nCOV by WHO. As the infection swept alarmingly across the globe, WHO announced it as an epidemic and it came to be known as COVID-19.1 Comorbidities are one of the factors that contribute to the severity of COVID-19 disease. Throughout the world, researchers have been investigating risk factors that deterio- rate the condition of COVID-19 patients. Various studies have shown that diabetes mellitus, hypertension, and cardiovas- cular diseases have been common comorbidities in COVID-19 patients that are associated with poor prognosis of the disease and an increased chance of hospitalization and mortality.2-4 Given the increasing prevalence of the disease, it is almost impossible to prevent its spread, and since there is no defini- tive treatment for this disease, it is recommended that health systems focus on preventive measures and factors contributing to the severity of the disease.5 According to previous COV epidemics including SARS COV which throughout China in 2003 and MERS CVV affecting the Middle East in 20126,7 and due to the uncertain future of the covid-19 epidemic and possible future epidemics that there is no definitive treatment during the epidemic time and also due to limited medical facilities, health care systems must notice to factors such as comorbidities that affect disease severity and its mortality. The present study aims to evaluate the prevalence of comorbidities and their correlation with prognosis and mor- tality rate in COVID-19 patients in the south of Iran. Materials and Methods Patients and Data Gathering This was a retrospective, cross-sectional study that was carried out at the Razi hospital, Ahvaz, Iran, after receiving approval from the Research Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1399.867). The present study evaluated 730 patients who had been infected with COVID-19 and hospitalized in November 2020 to February 2021. To this aim, we evaluated and extracted data from medical records of patients who were diagnosed with COVID-19 infection based on a positive RT-PCR test or typ- ical radiological manifestations on a spiral chest CT scan. Initially, the patients were investigated in terms of the severity of the disease (including patients with underlying dis- eases such as cardiovascular disease, hypertension, diabetes, underlying respiratory diseases, and BMI over 40 as well as immunocompromised patients such as those with a history of taking corticosteroids, chemotherapy, malignancies, trans- plantation, and HIV-positivity). The patients were divided into two groups, namely the Severe group involving patients requiring intensive care unit, and the non-severe group 296 J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 Original M. Ali Khaksar et al. including patients who did not need intensive care unit and were admitted in the general ward. Since no electronic medical record system was available at the time of hospitalization of the patients, patient data were recorded by physicians and nurses in patient paper medical records. Data about the underlying disease was determined according to the patients’ self-declaration at the time of admission. COVID-19 patients with unavailable or incomplete data were excluded from the study. To collect data on the patients’ underlying disease, the information about the underlying disease was first catego- rized (yes vs. no), and then the number of underlying diseases (single vs. multiple) was collected. During the hospitalization period, the patients were examined on a daily basis by specialist physicians, and patient’s information and vital signs were recorded manually and accu- rately by physicians and nurses in the patients’ medical record. The recorded data included admission at the general ward, admission at the ICU, duration of admission at the ICU, need for mechanical ventilation, discharge from the hospital, dura- tion of hospitalization, and death. Statistical Analysis In this study, the data were analyzed using SPSS version 24 (IBM Corp., Armonk, NY, USA). Continuous (normally dis- tributed) variables were represented as means ± SDs with 95% confidence intervals (CI), and percentiles, frequencies, and percentages were used for categorical variables. Non-normally distributed variables were represented as medians with 25% and 75% values. Mann-Whitney U test was used for non- normally distributed variables. The χ2 test, or Fisher’s exact test, was used to compare categorical variables between groups, while Spearman rho test, was used to compare con- tinuous (Non-normally) variables between groups. A P < 0.05 was considered statistically significant. Results In the present study, we investigated 730 patients whose mean age was 56.30 ± 16.36, and 53.7% of them were male. One- third of the patients had no comorbidity while the rest had at least one comorbidity. The most common comorbidity was diabetes mellitus (37.5%) followed by hypertension (35.3%), ischemic heart disease (24.9%) and hyperlipidemia (11%). Other clinical characteristics are presented in Table 1. Totally, out of the 730 patients, 157 (21.5%) were admitted to the intensive care unit (ICU), and the rest were admitted to general wards (78.5%). According to our results, patients who had been admitted to ICU were significantly older than those admitted to general wards (mean 26/17 ± 86/60 years vs. 89/15 ± 05/55 years, P = 001/0). More males than women were admitted to ICU, but the difference was not significant (93(23.7%) versus 64 (18.9%) P = 0.125). In addition, we found that ICU admission was significantly associated with hyperlipidemia (P : 0.014), liver failure (P : 0.026), and tuber- culosis (P < 0.022). Patients who had more comorbidities were more likely to be admitted to ICU. Also, patients who were admitted to ICU had significantly higher inflammatory biomarkers like ESR (P : 0.008), CRP (P < 0.001), and LDH (P : < 0.001). The length of stay at ICU was longer for patients who were older (P < 0.001) and had hyperlipidemia (P : 0.015), Table 1. Demographics and clinical characteristics of patient (N = 730) Demographic data n (%) Age (year) Mean ± SD 56.30 ± 16.36 Min - Max 21 – 104 Sex Male 392 (53.7) Female 338 (46.3) History of comorbidities Diabetes Mellitus 274 (37.5) Hyperlipidemia 80 (11) Hypertension 258 (35.3) Ischemic heart disease 182 (24.9) Cerebrovascular accident 27 (3.7) Rheumatoid arthritis 17 (2.3) Hypothyroidism 24 (3.3) Systemic Lupus Erythematosus 3 (.4) Asthma 45 (6.2) Liver failure 9 (1.2) Kidney transplantation 12 (1.6) Chronic kidney disease 65 (8.9) Chronic obstructive pulmonary disease 6 (0.8) Tuberculosis 6 (0.8) Comorbidity 0 244 (33.4) 1 194 (26.6) >1 292 (40) Laboratory investigations Erythrocyte Sedimentation Rate Mean ± SD 51.01 ± 31.61 Min - Max 3 – 348 C-reactive protein Mean ± SD 51.44 ± 32.16 Min - Max 1 – 151 Lactate dehydrogenase Mean ± SD 608.93 ± 333.56 Min - Max 85 – 3784 Complications Death 99 (13.6) Outcome ICU 157 (21.5) Intubation 87 (11.9) Duration of hospital stay (day) Mean ± SD 7.11 ± 4.36 Min - Max 1 – 38 Duration of ICU stay (day) Mean ± SD 1.35 ± 3.54 Min - Max 0 – 37 Values are presented as numbers and percentages (%). 297J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 M. Ali Khaksar et al. Original Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 liver failure (P : 0.015), and tuberculosis (P : 0.006) in their medical history as well as those having elevated inflammation biomarkers. Other clinical characteristics are presented in Tables 2, 3, 6. In this study, 99 patients (13.5%) died, and a higher mor- tality rate was observed among the elderly, males, patients with liver failure and tuberculosis, as well as those having more comorbidities and elevated ESR, CRP, and LDH levels. Other clinical characteristics are presented in Table 4. In our study, no association was found between the length of stay at hospital and any comorbidity. However, patients who had elevated inflammatory bio markers were hospitalized for a longer period (Table 5). Discussion In this retrospective descriptive-analytical study performed in the first surge of coronavirus pandemic in Khuzestan province, Iran, we examined the effect of comorbidities on the prognosis and mortality of 730 Covid-19 patients admitted to Razi Hos- pital of Ahvaz, Iran. According to our results, more than half of the admitted patients were male (53.7%), and one third of the patients had no underlying disease. However, at least one underlying disease was reported for the remaining patients, with diabetes mellitus being the most common, followed by hypertension, ischemic heart disease, and hyperlipidemia, respectively. In addition, mortality rate and the rate of ICU admission in this study were 13.6% and 21.5%, respectively. The Covid-19 pandemic in Iran has become one of the major health system challenges in recent decades. Because older people are at a greater risk for complications of Covid-19 owing to the effects of aging on the immune system, in our study, as in other studies, older people were more likely to develop the severe form of the disease as attested by their greater need for ICU admission and their high mortality rate. Also, previous studies on SARS and MERS have shown that old age is associated with higher mortality rates.8-11 The results of Pijls et al. showed that the risk of developing Covid-19 disease, the severity of the disease, the need for hos- pitalization in the intensive care unit (ICU), and the mortality rate in men with Covid-19 are higher.12 Also, the results of another study conducted in Iran showed that men were more likely to get Covid-19 than women, while there was no sig- nificant difference in the severity of the disease between the sexes.11 In the present study, men had a higher risk of getting the disease in general and the severe form of the disease in par- ticular, which could be due to the more pronounced presence of men in the community, taking care of economic issues, and lack of proper observance of health protocols such as wearing masks and social distancing. Also, the high level of ACE2 in men can justify this difference.13 In this study, the mortality rate was higher in men but the need for ICU hospitalization in men was not significantly different from that of women. Guan et al. reported that 25.1% of their patients had at least one underlying disease, and the most common comorbidities were hypertension (16.9%) and diabetes (8.2%), respectively.3 Another study by Liu et al. showed that 19.7% of patients with Covid-19 had comorbidities, with diabetes (10.2%) being the most common, followed by hypertension (9.5%) and car- diovascular disease (7.3%).4 A similar study conducted in Iran showed that the prevalence of comorbidities in patients with coronavirus was 48.8% and the prevalence of internal diseases and coronary artery disease were 29.3% and 14.6%, respectively.11 In the present study, two thirds of patients reported at least one underlying disease, with the most under- lying disease being diabetes mellitus (37.5%) followed by hypertension (35.3%), ischemic heart disease (24.8%) and hyperlipidemia (11%). In the present study, 37.5% of the patients mentioned dia- betes in their past medical history, which was higher than the rate reported in other studies and could be attributed to the high prevalence of diabetes in Khuzestan province,14 the high risk of COVID-19 among diabetic patients, high disease severity, and hospitalization,15 This result can also be justified by the tendency of physicians to hospitalize diabetic patients with COVID-19 who have uncontrolled blood sugar due to insulin deficiency in Iran and the strict protocols of the studied hos- pital in the first surge of COVID-19 regarding the hospitaliza- tion of patients with underlying disease and those with mild severity. Other possible causes are differences in thresholds for hospitalization. Among other important comorbidities in this study, hypertension, ischemic heart disease, and hyperlipidemia are the notable, and their prevalence was high compared to sim- ilar studies.4,11 This can be explained by the high prevalence of obesity, hypertension and hyperlipidemia in Khuzestan province and the ignorance of the many people living there of their diseases, which constitute the main risk factors for cor- onary artery disease in this region.16,17 Again, this result can be attributed to the protocols of our medical center regarding hospitalization of patients. Various studies have shown that diabetes, hypertension, cardiovascular disease, cerebrovascular accidents, chronic obstructive pulmonary disease, and chronic kidney disease can predispose patients to severe disease and various com- plications.18,19 Two studies in China found that hypertension, cardiovascular disease, and cerebrovascular events were sig- nificantly associated with disease severity, while diabetes was not associated with disease severity.20,21 In the present study, cerebrovascular accidents and chronic kidney disease were correlated with the rate of intubation, which could be due to the high risk of respiratory failure in the underlying disease. In another study conducted in Iran, patients with chronic kidney disease were reported to have a higher chance of developing a severe form of the disease compared with the general popula- tion,22 We also found no association between other underlying diseases and the severity of the disease, which could be due to our center’s protocols regarding the hospitalization of patients with mild underlying disease. Many patients also use RAAS inhibitors, which can improve patients outcomes.23 Another cause of this can be the immediate control of underlying dis- eases by doctors and medical staff in our center. However, in this study, the more the underlying disease of the patients, the higher the mortality rate. In the present study, hyperlipidemia, liver failure and tuberculosis had a significant relationship with high mortality and hospitalization in ICU. However, in a systematic review and meta-analysis study by Fang et al., no association dis- ease was found between the mentioned factors and disease severity,19 In another study by Chen et al. tuberculosis and chronic liver disease had no association with disease severity.24 One more study in China found that hyperlipidemia was not associated with disease severity and mortality.25 The relation- ship between liver disease and disease severity can be due to 298 J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 Original M. Ali Khaksar et al. Table 2. Demographics and clinical characteristics of patients regarding non-intensive care unit (ICU) and ICU admission Demographic data Non-ICU n = 416 ICU n = 352 P-value Age (year) (Mean ± SD) 55.05 ± 15.89 60.86 ± 17.26 <0.001* Sex Male 299 (52.2) 93 (59.2) 0.125 Female 274 (47.8) 64 (40.8) History of comorbidities Diabetes Mellitus: Yes 209 (76.3) 65 (23.7) 0.265 No 364 (79.8) 92 (20.2) Hyperlipidemia: Yes 54 (67.5) 26 (32.5) 0.014* No 519 (79.8) 131 (20.2) Hypertension: Yes 194 (75.2) 64 (24.8) 0.11 No 379 (80.3) 93 (19.7) Ischemic heart disease: Yes 134 (73.6) 48 (26.4) 0.076 No 439 (80.1) 109 (19.9) Cerebrovascular accident: Yes 17 (63) 10 (37) 0.056 No 556 (79.1) 147 (20.9) Rheumatoid arthritis: Yes 14 (82.4) 3 (17.6) >0.99 No 559 (78.4) 154 (21.6) Hypothyroidism: Yes 22 (91.7) 2 (8.3) 0.133 No 551 (78) 155 (22) Systemic Lupus Erythematosus: Yes 3 (100) 0 (0) >0.99 No 570 (78.4) 157 (21.6) Asthma: Yes 38 (84.4) 7 (15.6) 0.453 No 535 (78.1) 150 (21.9) Liver failure: Yes 4 (44.4) 5 (55.6) 0.026* No 569 (78.9) 152 (21.1) Kidney transplantation: Yes 11 (91.7) 1 (8.3) 0.478 No 562 (78.3) 156 (2.7) Chronic kidney disease: Yes 48 (73.8) 17 (26.2) 0.344 No 525 (78.9) 140 (21.1) Chronic obstructive pulmonary disease: Yes 4 (66.7) 2 (33.3) 0.614 No 569 (78.6) 155 (21.4) Tuberculosis: Yes 2 (33.3) 4 (66.7) 0.022* No 571 (78.9) 153 (21.1) Comorbidity 0 201 (35.1) 43 (27.4) 1 154 (26.9) 40 (25.5) 0.091 >1 218 (38) 74 (47.1) Laboratory investigations Erythrocyte Sedimentation Rate (Mean ± SD) 49.37 ± 31.02 57 ± 33.09 0.008* C-reactive protein (Mean ± SD) 47.83 ± 31.10 64.59 ± 32.65 <0.001* Lactate dehydrogenase (Mean ± SD) 553.8 ± 259.4 809.7 ± 470.4 <0.001* Values are presented as numbers and percentages (%). *P-value <0.05 is significant. 299J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 M. Ali Khaksar et al. Original Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 Table 3. Demographics and clinical characteristics of intubation COVID-19 patients compared to non-intubation patients Demographic data non-intubation n = 416 intubation n = 352 P-value Age (year) (Mean ± SD) 55.21 ± 16.05 64.38 ± 16.45 <0.001* Sex Male 336 (52.3) 56 (64.4) 0.039* Female 307 (47.7) 31 (35.6) History of comorbidities Diabetes Mellitus: Yes 236 (86.1) 38 (13.9) 0.238 No 407 (89.3) 49 (10.7) Hyperlipidemia: Yes 67 (83.8) 13 (16.3) 0.203 No 576 (88.6) 74 (11.4) Hypertension: Yes 220 (85.3) 38 (14.7) 0.094 No 423 (89.6) 49 (10.4) Ischemic heart disease: Yes 154 (84.6) 28 (15.4) 0.065 No 489 (89.2) 59 (10.8) Cerebrovascular accident: Yes 20 (74.1) 7 (25.9) 0.032* No 623 (88.6) 80 (1.4) Rheumatoid arthritis: Yes 15 (88.2) 2 (11.8) >0.99 No 628 (88.1) 85 (11.9) Hypothyroidism: Yes 23 (95.8) 1 (4.2) 0.34 No 620 (87.8) 86 (12.2) Systemic Lupus Erythematosus: Yes 3 (100) 0 (0) >0.99 No 640 (88) 87 (12) Asthma: Yes 42 (93.3) 3 (6.7) 0.346 No 601 (87.7) 84 (12.3) Liver failure: Yes 6 (66.7) 3 (33.3) 0.081 No 637 (88.3) 84 (11.7) Kidney transplantation: Yes 12 (100) 0 (0) 0.378 No 631 (87.9) 87 (12.1) Chronic kidney disease: Yes 52 (80) 13 (20) 0.044* No 591 (88.9) 74 (11.1) Chronic obstructive pulmonary disease: Yes 5 (83.3) 1 (16.7) 0.534 No 638 (88.1) 86 (1.9) Tuberculosis: Yes 2 (33.3) 4 (66.4) 0.002* No 641 (88.5) 83 (11.5) Comorbidity 0 221 (34.4) 23 (26.4) 0.060 1 175 (27.2) 19 (21.8) >1 247 (38.4) 45 (51.7) Laboratory investigations Erythrocyte Sedimentation Rate (Mean ± SD) 49.60 ± 40 61.41 ± 34.21 0.001* C-reactive protein (Mean ± SD) 49.01 ± 31.53 69.41 ± 31.24 <0.001* Lactate dehydrogenase (Mean ± SD) 567.2 ± 262.8 920.9 ± 565.4 <0.001* Values are presented as numbers and percentages (%). *P-value <0.05 is significant. 300 J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 Original M. Ali Khaksar et al. Table 4. Demographics and clinical characteristics of survived COVID-19 patients compared to expire patients Demographic data Live n = 631 Death n = 99 P-value Age (year)(Mean ± SD) 54.87 ± 16.04 65.45 ± 15.43 <0.001* Sex Male 328 (52) 64 (64.6) 0.023* Female 303 (48) 35 (35.4) History of comorbidities Diabetes Mellitus: Yes 232 (31.8) 42 (15.3) 0.315 No 399 (87.5) 57 (12.5) Hyperlipidemia: Yes 65 (81.3) 15 (18.8) 0.165 No 566 (87.1) 84 (12.9) Hypertension: Yes 214 (82.9) 44 (17.1) 0.054 No 417 (88.3) 55 (11.7) Ischemic heart disease: Yes 150 (82.4) 32 (17.6) 0.080 No 481 (87.8) 67 (12.2) Cerebrovascular accident: Yes 21 (77.8) 6 (22.2) 0.244 No 610 (86.8) 93 (13.2) Rheumatoid arthritis: Yes 15 (88.2) 2 (11.8) <0.99 No 616 (86.4) 97 (13.6) Hypothyroidism: Yes 21 (87.5) 3 (12.5) <0.99 No 610 (86.4) 96 (13.6) Systemic Lupus Erythematosus: Yes 3 (100) 0 (0) <.099 No 628 (86.4) 99 (13.6) Asthma: Yes 41 (91.1) 4 (8.9) 0.499 No 590 (86.1) 95 (13.9) Liver failure: Yes 4 (44.4) 5 (55.6) 0.003* No 627 (87) 94 (13) Kidney transplantation: Yes 12 (100) 0 (0) 0.386 No 619 (86.2) 99(13.8) Chronic kidney disease: Yes 52 (80) 13 (20) 0.127 No 579 (87.1) 86 (12.9) Chronic obstructive pulmonary disease: Yes 5 (83.3) 1 (16.7) 0.584 No 626 (86.5) 98 (13.5) Tuberculosis: Yes 2 (33.3) 4 (0.5) 0.004* No 629 (86.9) 95 (13.1) Comorbidity 0 220 (34.9) 24 (24.2) 0.048* 1 169 (26.8) 25 (25.3) >1 242 (38.4) 50 (50.5) Laboratory investigations Erythrocyte Sedimentation Rate (Mean ± SD) 49.93 ± 31.25 57.89 ± 33.14 0.015* C-reactive protein (Mean ± SD) 48.64 ± 31.43 69.29 ± 31.21 <0.001* Lactate dehydrogenase (Mean ± SD) 559.3 ± 245.8 928.7 ± 568.7 <0.001* Values are presented as numbers and percentages (%). *P-value <0.05 is significant. 301J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 M. Ali Khaksar et al. Original Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 Table 5. Association between demographics and clinical characteristics and duration of hospital stay (day) Demographic data Duration of hospital stay (day) (Mean ± SD) P-value Age (year) (Spearman’s rho) 0.056 0.130 Sex Male 7.35 ± 4.60 0.196 Female 6.83 ± 4.05 History of comorbidities Diabetes Mellitus No 7.09 ± 4.42 0.848 Yes 7.15 ± 4.27 Hyperlipidemia No 7.05 ± 4.38 0.109 Yes 7.60 ± 4.17 Hypertension No 7.07 ± 4.44 0.532 Yes 7.19 ± 4.21 Ischemic heart disease No 7.09 ± 4.27 0.693 Yes 7.18 ± 4.63 Cerebrovascular accident No 7.11 ± 4.35 0.994 Yes 7.22 ± 4.58 Rheumatoid arthritis No 7.12 ± 4.38 0.779 Yes 6.53 ± 3.54 Hypothyroidism No 7.12 ± 4.39 0.821 Yes 6.67 ± 3.47 Systemic Lupus Erythematosus No 7.12 ± 4.37 0.676 Yes 5.67 ± 2.08 Asthma No 7.09 ± 4.26 0.960 Yes 7.33 ± 5.71 Liver failure No 7.11 ± 4.35 0.669 Yes 7 ± 5.31 Kidney transplantation No 7.12 ± 4.38 0.841 Yes 6.50 ± 3.34 Chronic kidney disease No 7.11 ± 4.42 0.692 Yes 7.08 ± 3.73 Chronic obstructive pulmonary disease No 7.10 ± 4.32 0.897 Yes 8.67 ± 8.69 Tuberculosis No 7.08 ± 4.35 0.063 Yes 10.50 ± 4.97 Comorbidity 0 6.88 ± 4.31 0.358 1 7.36 ± 4.50 >1 7.14 ± 4.31 Laboratory investigations Erythrocyte Sedimentation Rate (Spearman’s rho) 0.196 <0.001* C-reactive protein (Spearman’s rho) 0.105 0.004* Lactate dehydrogenase (Spearman’s rho) 0.173 <0.001* *P-value <0.05 is significant. Table 6. Association between demographics and clinical characteristics and duration of ICU stay (day) Demographic data Duration of ICU stay (day) (Mean ± SD) P-value Age (year) (Spearman’s rho) 0.147 <0.001* Sex Male 1.45 ± 3.70 0.148 Female 1.24 ± 3.35 History of comorbidities Diabetes Mellitus No 1.37 ± 3.73 0.345 Yes 1.33 ± 3.21 Hyperlipidemia No 1.28 ± 3.50 0.015 Yes 1.91 ± 3.88 Hypertension No 1.28 ± 3.63 0.119 Yes 1.48 ± 3.39 Ischemic heart disease No 1.34 ± 3.65 0.117 Yes 1.38 ± 3.21 Cerebrovascular accident No 1.34 ± 3.56 0.073 Yes 1.70 ± 3.01 Rheumatoid arthritis No 1.37 ± 3.57 0.659 Yes 0.82 ± 2.10 Hypothyroidism No 1.39 ± 3.59 0.099 Yes 0.29 ± 1.08 Systemic Lupus Erythematosus No 1.36 ± 3.55 — Yes 0 Asthma No 1.34 ± 3.35 0.389 Yes 1.58 ± 5.77 Liver failure No 1.33 ± 3.52 0.015* Yes 3.33 ± 4.80 Kidney transplantation No 1.37 ± 3.57 0.240 Yes 0.25 ± 0.87 Chronic kidney disease No 1.35 ± 3.62 0.376 Yes 1.35 ± 2.68 Chronic obstructive pulmonary disease No 1.33 ± 3.46 Yes 4.67 ± 9.20 0.360 Tuberculosis No 1.33 ± 3.52 0.006* Yes 4.50 ± 5.13 Comorbidity 0 1.19 ± 3.31 0.142 1 1.49 ± 4.25 >1 1.39 ± 3.20 Laboratory investigations Erythrocyte Sedimentation Rate (Spearman’s rho) 0.089 0.016* C-reactive protein (Spearman’s rho) 0.180 <0.001* Lactate dehydrogenase (Spearman’s rho) 0.256 <0.001* *P-value <0.05 is signifcant. 302 J Contemp Med Sci | Vol. 7, No. 5, September–October 2021: 295–302 Prevalence of Comorbidities and its Impacts in Hospitalized Patients with COVID-19 Original M. Ali Khaksar et al. the prohibition of taking certain drugs in patients with a his- tory of liver problems on the one hand, and the organ failure caused by Covid-19, on the other. In our study, there was a relationship between the history of tuberculosis and high severity of the disease, which could be due to old lung damage and reduced lung reserve in these patients, as well as the reac- tivation of TB and TB superinfection on Covid, leading the patient to respiratory failure. Another predictor of disease severity in various studies and ours was the high level of inflammatory markers in patients’ tests, which in addition to predicting the severity of the disease, can be used as a response to treatment factor.20, 24 Conclusion 1. We found that male gender, older age, hyperlipidemia, liver failure, TB, having more than one comorbidity, and elevated inflammatory biomarkers were significantly associated with the risk of severe COVID-19 disease. Declaration of Patient Consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial Support and Sponsorship This research was supported by grants (APRD-9915) from the Air pollution respiratory Disease research Center by the Vice Chancellor of Research and Development, Ahvaz Jundishapur University of Medical Sciences (Iran). Conflicts of Interest There are no conflicts of interest.  This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly. 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