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Abstract: PO0071

Initial Blood Pressure (BP) and COVID-19 (C19) Mortality

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Yangchen, Tenzin, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States
  • Koraishy, Farrukh M., Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States
  • Rohatgi, Rajeev, Northport VA Medical Center, Northport, New York, United States
Background

For C19 to infect epithelia, serine proteases cleave the spike protein to enhance its binding to ACE2 and entry into the epithelia. Since viral replication highjacks components of the renin-angiotensin system, investigators speculate that hypertension (HTN) is a risk factor for severe infection; however, it is uncertain whether high BP at presentation is a risk factor for mortality in C19 infection. Thus, we tested whether BP at presentation portends mortality in C19 positive (+) vs. negative (-) hospitalized patients.

Methods

Clinical/laboratory data from C19(+) and (-) hospitalized patients at Stony Brook Hospital (SBH) from March 2020 to July 2020 were included. The initial systolic BP (SBP) categorized patients into normotensive (SBP 90-139 mm Hg), stage 1 HTN (SBP 140-159 mm Hg) and stage 2 HTN (>160 mm Hg). Subjects with a mean arterial BP (MABP) <65 (hypotensive) were excluded and the remaining cohort was re-categorized into tertiles (T) of MABP (65-85 [T1], 86-97 [T2] and >98 [T3]).

Results

4436 patients were admitted to SBH and 1591 diagnosed with and 2845 without C19. Mortality of C19(+) was 4.5-fold greater than C19(-) patients. Though the diagnosis of HTN was more prevalent among C19(+) (629/1591; 39.53%) vs. (-) (1014/2845; 35.64%; p<0.05) patients, the average presenting SBP and MABP was significantly lower in the C19(+) cohort (p<0.05). After excluding hypotensive patients, the mortality of stage 1 (33/271; 12.18%) and/or stage 2 (24/150; 16.00%) SBP cohorts did not differ from the normotensives (133/1112; 11.95%) in C19(+) patients. A similar finding was noted in the C19(-) patients. T2 tertile of MABP had the lowest mortality among C19(+) patients (56/562; 9.96%) and the T1 and T3 tertile of MABP had greater mortality at 15.31% (81/529) and 12.75% (58/455), respectively, than T2 (p<0.05). No difference in mortality was noted across the MABP tertiles of C19(-) cohort. Two multivariate (MV) regressions models evaluating mortality were studied each comparing T1 vs T2 or T2 vs. T3. In T1 vs T2 age, gender, albumin and T1 MABP significantly contributed to mortality while in T2 vs T3 age, gender, and first respiratory rate predicted mortality.

Conclusion

Univariate analysis of MABP suggests mortality is greater in T1 and T3 cohorts compared to T2; however, MV analysis implies that a low MABP (T1), but not high MABP (T3) is a significant predictor of mortality in C19 infection.

Funding

  • Veterans Affairs Support