Immunological Implications of Diabetes and Hypertension as Pre-existing Comorbidities in Iraqi Patients with COVID-19

Abstract

Abstract—COVID-19 patients with comorbidities are associated with increased severity of lung injury, intensive care unit and mortality. These comorbidities are commonly hypertension and diabetes. This study investigated the immunological implications of COVID-19 in patients with hypertension and diabetes with the aim of detecting significant implications with the disease severity. Patients between 30 and 65 years, diagnosed as SARS-COV-2 infection admitted to Al-Hussein Teaching Hospital Kerbala, Iraq were recruited. Clinical symptoms were evaluated and laboratory measurement of total and differential leukocyte counts, serum levels of D-dimer, interleukin 6 and C-reactive protein were conducted.

 A total of 150 admitted COVID-19 patients met criteria and were recruited. Evidence of neutrophilia with lymphopenia was observed in patients with comorbidity. Differential neutrophil percentage highest among those with both diabetes and hypertension i.e. 89.58±9.17 % followed by 78.81±9.93 % for diabetic group, then 62.24±14.42 % for hypertensive, and 54.25±11.84 % for patients with no comorbidity. Differential lymphocyte percentage was lowest among those with both diabetes and hypertension i.e. 2.47±1.24 % followed by 14.29±5.29 % for diabetic group, then 26.73±6.53 for hypertensive, and 33.14±9.35 % for patients with no comorbidity, with significant difference with the groups was observed (p < 0.05). Levels of D-dimer, IL-6 and C-reactive protein were significantly higher in patients with comorbidities compared to those without (p < 0.01). D-dimer and C-reactive protein levels were higher in diabetics, IL-6 inclined towards hypertensive. 

The findings indicate a significant immunological implications of the pre-existence of diabetes and hypertension among COVID-19 patients which include aggravation of COVID-19 associated immunopathies.