The interface between SARS-CoV-2 and non-communicable diseases (NCDs) in a high HIV/TB burden district level hospital setting, Cape Town, South Africa

• Published in: PloS one Vol. 18; no. 10; p. e0277995
• Main Authors: Mnguni, Ayanda Trevor, Schietekat, Denzil, Ebrahim, Nabilah, Sonday, Nawhaal, Boliter, Nicholas, Schrueder, Neshaad, Gabriels, Shiraaz, Cois, Annibale, Tamuzi, Jacques L, Tembo, Yamanya, Davies, Mary-Ann, English, Rene, Nyasulu, Peter S
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05-10-2023; Public Library of Science (PLoS)
• Subjects: Abnormalities; Adaptive immunity; Adult; Analysis; Antigens; Biology and Life Sciences; Body mass index; Chronic kidney failure; Chronic obstructive pulmonary disease; Communicable diseases; Comorbidity; Comparative analysis; Congestive heart failure; Coronary artery disease; COVID-19; COVID-19 - epidemiology; COVID-19 vaccines; Death; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diagnosis; Diagnostic imaging; Disease transmission; Distribution; Ethics; Fatalities; Health care policy; Heart diseases; Hemoglobin; HIV; HIV (Viruses); HIV Infections - epidemiology; Hospitals; Hospitals, District; Human immunodeficiency virus; Humans; Hypertension; Hypertension - epidemiology; Infectious diseases; Kidney diseases; Laboratories; Lung diseases; Medical research; Medicine and Health Sciences; Medicine, Experimental; Missing data; Mortality; Noncommunicable Diseases - epidemiology; Obesity; Observational studies; Obstructive lung disease; Oxygen; Pandemics; Patients; Phenotypes; Polymerase chain reaction; Population; Public health; Radiography; Renal Insufficiency, Chronic; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; South Africa - epidemiology; Statistical analysis; Stroke; Stroke (Disease); Tuberculosis; Viral diseases; Wave period; Womens health; South Africa; United Kingdom; Cape Town South Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0277995

COVID-19 experiences on noncommunicable diseases (NCDs) from district-level hospital settings during waves I and II are scarcely documented. The aim of this study is to investigate the NCDs associated with COVID-19 severity and mortality in a district-level hospital with a high HIV/TB burden.
This was a retrospective observational study that compared COVID-19 waves I and II at Khayelitsha District Hospital in Cape Town, South Africa. COVID-19 adult patients with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) or positive antigen test were included. In order to compare the inter wave period, clinical and laboratory parameters on hospital admission of noncommunicable diseases, the Student t-test or Mann-Whitney U for continuous data and the X2 test or Fishers' Exact test for categorical data were used. The role of the NCD subpopulation on COVID-19 mortality was determined using latent class analysis (LCA).
Among 560 patients admitted with COVID-19, patients admitted during wave II were significantly older than those admitted during wave I. The most prevalent comorbidity patterns were hypertension (87%), diabetes mellitus (65%), HIV/AIDS (30%), obesity (19%), Chronic Kidney Disease (CKD) (13%), Congestive Cardiac Failure (CCF) (8.8%), Chronic Obstructive Pulmonary Disease (COPD) (3%), cerebrovascular accidents (CVA)/stroke (3%), with similar prevalence in both waves except HIV status [(23% vs 34% waves II and I, respectively), p = 0.022], obesity [(52% vs 2.5%, waves II and I, respectively), p <0.001], previous stroke [(1% vs 4.1%, waves II and I, respectively), p = 0.046]. In terms of clinical and laboratory findings, our study found that wave I patients had higher haemoglobin and HIV viral loads. Wave II, on the other hand, had statistically significant higher chest radiography abnormalities, fraction of inspired oxygen (FiO2), and uraemia. The adjusted odds ratio for death vs discharge between waves I and II was similar (0.94, 95%CI: 0.84-1.05). Wave I had a longer average survival time (8.0 vs 6.1 days) and a shorter average length of stay among patients discharged alive (9.2 vs 10.7 days). LCA revealed that the cardiovascular phenotype had the highest mortality, followed by diabetes and CKD phenotypes. Only Diabetes and hypertension phenotypes had the lowest mortality.
Even though clinical and laboratory characteristics differed significantly between the two waves, mortality remained constant. According to LCA, the cardiovascular, diabetes, and CKD phenotypes had the highest death probability.