Document Type : Original Article


1 Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran

2 Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran Health Economics Policy Research Center, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran

3 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran


BACKGROUND: COVID‑19 pandemic has spread all over the world. However, information regarding
clinical characteristics and prognostic factors is scarce. The aim of this study was to explore the
impact of preexistent chronic comorbid conditions and multimorbidity on risk of mortality in patients
with COVID‑19.
MATERIALS AND METHODS: We designed a retrospective, cross‑sectional, observational,
single‑center study. Data were analyzed from all consecutive patients diagnosed with COVID‑19 who
admitted in a pandemic hospital affiliated with Tabriz University of Medical Sciences, Tabriz, Iran,
from February 20, 2020, to September 25, 2020. The independent effects of preexistent conditions
were evaluated using multivariate logistic regression model.
RESULTS: A total of 2597 hospitalized patients with COVID‑19 were included. At least one preexistent
condition was observed in 36.5% of study population. Multivariate logistic regression analysis showed
that older age, male sex, diabetes, cardiovascular disease, hypertension, cancer, chronic kidney
diseases, liver diseases, and chronic obstructive pulmonary disease were associated with increased
risk of mortality. In addition, the number of comorbidities was significantly associated with increased
odds of mortality compared to no‑comorbidity.
CONCLUSION: The results of this study suggest that patients with comorbidities have an increased
risk of in‑hospital mortality following COVID‑19 infection.


1. WHO. WHO Director‑General’s Opening Remarks at the Media
Briefing on COVID‑19 – February 2, 2020. Available from: https://‑director‑generals-opening‑remarks‑at‑the‑media‑briefing‑on‑covid‑19‑‑11‑march‑2020 [Last accessed on 2021 Feb 20].
2. COVID‑19 Dashboard by the Center for Systems Science and
Engineering (CSSE). Available from: https://coronavirus.jhu.
edu/map.html. [Last accessed on 2020 Feb 17].
3. Tandon T, Dubey AK, Dubey S, Arora E, Hasan MN. Effects of
COVID‑19 pandemic lockdown on medical advice seeking and
medication practices of home‑bound non‑COVID patients. J Educ
Health Promot 2021;10:28.
4. Saji JA, Babu BP, Sebastian SR. Social influence of COVID‑19:
An observational study on the social impact of post‑COVID‑19
lockdown on everyday life in Kerala from a community
perspective. J Educ Health Promot 2020;9:360.
5. Ministry of Health and Medical Education of Iran. National
Committee on COVID‑19 Epidemiology and Iranian CDC
Ministry of Health and Medical Education of Iran: Daily Situation
Report on Coronavirus Disease (COVID‑19) in Iran; Available
from: [Last accessed on 2020 Mar 29].
6. Takian A, Raoofi A, Kazempour‑Ardebili S. COVID‑19 battle
during the toughest sanctions against Iran. Lancet 2020;395:1035‑6.
7. Allameh SF, Nemati S, Ghalehtaki R, Mohammadnejad E,
Aghili SM, Khajavirad N, et al. Clinical characteristics and
outcomes of 905 COVID‑19 patients admitted to Imam Khomeini
Hospital Complex in the Capital City of Tehran, Iran. Arch Iran
Med 2020;23:766‑75.
8. Feng Y, Ling Y, Bai T, Xie Y, Huang J, Li J, et al. COVID‑19 with
different severities: A multicenter study of clinical features. Am
J Respir Crit Care Med 2020;201:1380‑8.
9. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid
advice guideline for the diagnosis and treatment of 2019 novel
coronavirus (2019‑nCoV) infected pneumonia (standard version).
Mil Med Res 2020;7:4.
10. Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA.
Multimorbidity and mortality in older adults: A systematic review
and meta‑analysis. Arch Gerontol Geriatr 2016;67:130‑8.
11. Loprinzi PD, Addoh O, Joyner C. Multimorbidity, mortality, and
physical activity. Chronic Illn 2016;12:272‑80.
12. Rosenthal N, Cao Z, Gundrum J, Sianis J, Safo S. Risk factors
associated with In‑hospital mortality in a US national
sample of patients with COVID‑19. JAMA Netw Open
13. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T,
Davidson KW, et al. Presenting characteristics, comorbidities, and
outcomes among 5700 patients hospitalized with COVID‑19 in
the New York City Area. JAMA 2020;323:2052‑9.
14. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course
and risk factors for mortality of adult inpatients with COVID‑19
in Wuhan, China: A retrospective cohort study. Lancet
15. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell LF,
Chernyak Y, et al. Factors associated with hospitalization and
critical illness among 4,103 patients with COVID‑19 disease in
New York City. MedRxiv 2020.
16. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G,
et al. Risk factors associated with mortality among patients with
COVID‑19 in intensive care units in Lombardy, Italy. JAMA Intern
Med 2020;180:1345‑55.
17. Polverino F, Stern DA, Ruocco G, Balestro E, Bassetti M,
Candelli M, et al. Comorbidities, cardiovascular therapies,
and COVID‑19 mortality: A nationwide, Italian observational
study (ItaliCO). Front Cardiovasc Med 2020; 7:1‑11.
18. Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM.
Association of cardiovascular disease and 10 other pre‑existing
comorbidities with COVID‑19 mortality: A systematic review and
meta‑analysis. PLoS One 2020;15:e0238215.
19. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al.
Predictors of mortality for patients with COVID‑19 pneumonia
caused by SARS‑CoV‑2: A prospective cohort study. Eur
Respirator J 2020;55: 1‑8.
20. Hoffmann M, Kleine‑Weber H, Schroeder S, Krüger N, Herrler T,
Erichsen S, et al. SARS‑CoV‑2 cell entry depends on ACE2 and
TMPRSS2 and is blocked by a clinically proven protease inhibitor.
Cell 2020;181:271‑80.e8.
21. Channappanavar R, Fett C, Mack M, Ten Eyck PP, Meyerholz DK,
Perlman S. Sex‑Based differences in susceptibility to severe
acute respiratory syndrome coronavirus infection. J Immunol
22. Bahl A, van Baalen MN, Ortiz L, Chen NW, Todd C, Milad M,
et al. Early predictors of in‑hospital mortality in patients with
COVID‑19 in a large American cohort. Intern Emerg Med
23. Team CC, Team CC, Team CC, Chow N, Fleming‑Dutra K,
Gierke R, et al. Preliminary estimates of the prevalence of selected
underlying health conditions among patients with coronavirus disease 2019 – United States, February 12 – March 28, 2020. Morb
Mortal Wkly Rep 2020;69:382‑6.
24. Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M, et al.
Age and multimorbidity predict death among COVID‑19 patients:
Results of the SARS‑RAS study of the Italian Society of
Hypertension. Hypertension 2020;76:366‑72.
25. BikdeliB, TalasazAH, RashidiF, Sharif‑KashaniB, FarrokhpourM,
Bakhshandeh H, et al. Intermediate versus standard‑dose
prophylactic anticoagulation and statin therapy versus placebo
in critically‑ill patients with COVID‑19: Rationale and design
of the INSPIRATION/INSPIRATION‑S studies. Thromb Res