Changes

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OBESITY

Obesity is considered the epidemic of the 21st century, as its numbers are increasing in the adult population and, what is more worrying, in children. Being overweight/obese has been identified in numerous studies as a predictor of hospital admission and admission to the ICU, especially in patients under 65 years of age. The SEMI-COVID-19 registry shows its presence in 21% of patients.

The increased risk in these patients has been attributed to a higher level of

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DIABETES

This risk factor has been identified in 17% of the cases reported (8.9% of hospital admissions in Spain). It is clearly a higher risk factor for hospital admission, admission to the ICU and death. The biological mechanism on which this risk factor is based is that described for hypertension.

The prevalence of reported diabetes also shows important geographical differences, with regions registering a prevalence of around 5%, such as the Balearic Islands (Illes Balears), La Rioja and Cantabria, and others around 10%, such as Galicia and Extremadura. The difference between men and women may also be significant (see the Basque Country [Euskadi/País Vasco]).

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HEART FAILURE

Heart failure has been described, either under this term or as a cardiovascular disease, as the most prevalent risk factor in the population diagnosed with COVID-19 (up to 30%) and is present in more than 50% of COVID-19 patients admitted to the ICU in Spain, according to several studies. Its mechanism of action is the same as for diabetes and hypertension.

There are two clear patterns: one geographical and the other by sex. Castile and León (Castilla y León) and the Region of Valencia (Comunitat Valenciana) show a very high prevalence, around 14%. The data for Extremadura and Castile-La Mancha (Castilla-La Mancha) warrant a separate reading, with prevalences that are 30% lower than those in the regions with higher prevalence.

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CHRONIC KIDNEY DISEASE

Chronic Kidney Disease (CKD) is included in the range of comorbidities that are associated with worse COVID-19 outcomes. Kidneys have ACE-2 receptors and are primarily involved in the renin-angiotensin-aldosterone system that regulates blood pressure. These are usually patients with added comorbidities, such as diabetes and hypertension, who have a weakened immune system.

Although studies linking CKD and COVID-19 are limited, increased mortality has been observed in these patients, especially in advanced stages of CKD. Other researches have not found an increased admission to the ICU of CKD patients infected by SARS-CoV-2.

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HIV-AIDS

HIV infection and AIDS diagnosis is not usually listed as a risk factor in most studies as such; immunodeficiency is. However, this term is very broad and difficult to define. So a pathology like VIH-AIDS, with a well-established information system and a clear impact on the immune system, especially cell-mediated immunity, was opted for in this study.

How the vulnerability of an immunocompromised patient fits in with immune hyperactivation is not fully understood. There is no strong evidence to support an increased risk in immunocompromised patients. In the case of HIV/AIDS, studies suggest not so much an association with increased susceptibility to infection, but some association with rising fatalities. In the SEMI-COVID-19 registry, COVID-19 cases with HIV infection represent 0.7%. It is not possible to draw conclusions on its possible implication for the clinical severity of COVID-19 with such a low number of cases.