Coexisting illness and COVID-19

Background: Coronavirus disease 2019 (COVID-19) has rapidly spread throughout worldwide. Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease were the most common coexisting illness among patients with severe SARS-CoV-2 infection. We aim to analyze the effect of them on the result of laboratory nding in patients with severe or critical SARS-CoV-2 infection. Methods: The date of a total of 49 patients who met the inclusion criteria from January 12 to March 20, 2020, from the rst aliated hospital of Harbin medical university were analyzed in our study. Results: Compared with patients without any coexisting illness, we found that PT levels were decreased in patients with cerebrovascular disease, hypertension or cardiovascular disease, and D-Dimer levels were decreased in patients with cerebrovascular disease, hypertension or diabetes. Similarly, LDH and ALT levels were lower in patients with cerebrovascular disease than that without any coexisting illness. Conclusions: Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease are associated with an increased disease severity and risk of death in patients with COVID-19. Recently study also reported that the levels of PT, D-dimer, and LDH were increased and predicted the deterioration of disease in severe patients with SARS-CoV-2 infection. Interestingly, our results demonstrate that the levels of laboratory indicators such as PT, D-dimer, LDH and ALT were decreased in patients with coexisting illness than without any coexisting illness. It may give us the inaccurate result when we use those laboratory indicators to predict the deterioration of the patients and we need to pay more attention to it. 2019; coronavirus standard deviation; PT: prothrombin time; ALT: Alanine transaminase; LDH: lactate dehydrogenase; CK: creatine kinase; CKMB: creatine phosphokinase BUN: Blood Urea Nitrogen; cTnI: cardiac troponin I; PCT: procalcitonin;

Methods: The date of a total of 49 patients who met the inclusion criteria from January 12 to March 20, 2020, from the rst a liated hospital of Harbin medical university were analyzed in our study.
Results: Compared with patients without any coexisting illness, we found that PT levels were decreased in patients with cerebrovascular disease, hypertension or cardiovascular disease, and D-Dimer levels were decreased in patients with cerebrovascular disease, hypertension or diabetes. Similarly, LDH and ALT levels were lower in patients with cerebrovascular disease than that without any coexisting illness.
Conclusions: Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease are associated with an increased disease severity and risk of death in patients with COVID-19. Recently study also reported that the levels of PT, D-dimer, and LDH were increased and predicted the deterioration of disease in severe patients with SARS-CoV-2 infection. Interestingly, our results demonstrate that the levels of laboratory indicators such as PT, D-dimer, LDH and ALT were decreased in patients with coexisting illness than without any coexisting illness. It may give us the inaccurate result when we use those laboratory indicators to predict the deterioration of the patients and we need to pay more attention to it.

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is an ongoing pandemic. Hypertension, cardiovascular disease, diabetes, and cerebrovascular disease were the most common coexisting illness among patients with severe SARS-CoV-2 infection [1] . However, the clinical characteristics and laboratory ndings in severe or critical SARS-CoV-2 infection patients with coexisting illness is still unclear.

Methods
In this study, we analyze 49 severe or critical patients infected with COVID-19 from January 12 to March 20, 2020 at the rst a liated hospital of Harbin medical university. All the patients were laboratory-con rmed cases and classi cation of the severity of COVID-19 was based on the New Coronavirus Pneumonia Prevention and Control Program (6th edition) published by the National Health Commission of China [2] . Continuous variables are expressed as the mean ± standard deviation (SD). Continuous data with skewed distributions were compared with the Wilcoxon rank sum test. Categorical variables are summarized as counts (percentages). All analyses were performed with SPSS software, version 23. A P value less than 0.05 was considered statistically signi cant.

Results
The total mean age was 64. 3  Interestingly, laboratory data within 3 days of admission demonstrated that the mean PT levels in patients without coexisting illness disease (normal 11-13 sec, n = 19) were 13.5 ± 2.1 sec, but it was only 12.2 ± 1.0 sec in patients with cardiovascular disease(n = 16), 12.3 ± 1.0 sec (n = 18) in patients with hypertension and 12.2 + 0.4 sec (n = 8) in patients with cerebrovascular disease(P < 0.05). Similarly, the mean D-dimer levels in patients without coexisting illness disease were 9.2 ± 13.9 mg/L (n = 19, normal D-dimer < 0.5 mg/L), but it was only 2.7  Table 1). The levels of other laboratory ndings, including white blood cell, Neutrophil count, lymphocyte count, monocyte count, platelet count, activated partial thromboplastin time, aspartate aminotransferase, CK, CKMB, BUN, cTnI, PCT, CRP and IL-6, had no statistic difference between patients with coexisting illness disease and without that.

Conclusion
In summary, our study demonstrates that the levels of laboratory indicators such as PT, D-dimer, LDH and ALT were decreased in patients with coexisting illness than without any coexisting illness. It may give us the inaccurate result when we use those laboratory indicators to predict the deterioration of the patients and we need to pay more attention to it. However, studies with larger sample size and number of events are needed to con rm our ndings.