• Komang Pranayoga Prandhana Putra Nartha Universitas Mataram
Keywords: COVID-19, comorbidity, mortality


Coronavirus Disease 2019 (COVID-19) is an infectious respiratory disease caused by a new type of coronavirus that has never been previously identified, namely SARS-CoV-2. The high number of deaths in COVID-19 patients is associated with comorbidities such as hypertension, diabetes mellitus, cardiovascular disease, chronic obstructive pulmonary disease, kidney disease, cancer and liver disease. The pathophysiological mechanisms of comorbidity in exacerbating symptoms and increasing the risk of mortality in COVID-19 patients are complex and diverse. In patients with hypertension, chronic obstructive pulmonary disease, and kidney disease, there is an increase in the expression of ACE-2 receptors, making them very susceptible to COVID-19 infection. The decrease and weakening of the body's immune system plays an important role in the aggravation of the symptoms of COVID-19 in cancer, liver and cardiovascular disease patients. In diabetic patients, impaired T cell function and elevated levels of interleukin-6 (IL-6) play a role in increasing the severity of COVID-19 disease. Meanwhile, in asthmatic patients, IgE cross-linking and decreased interferon production make asthmatic patients more susceptible to viral infections and can worsen asthma symptoms and exacerbations.


1. Kementerian Kesehatan RI. Pedoman Pencegahan dan Pengendalian Corona Virus deases (Covid-19). Kementrian Kesehat [Internet]. 2020;5:178. Available from:
2. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data [Internet]. [cited 2021 Jul 17]. Available from:
3. Hamid S, Mir MY, Rohela GK. Novel coronavirus disease (COVID-19): a pandemic (epidemiology, pathogenesis and potential therapeutics). New Microbes New Infect [Internet]. 2020;35:100679. Available from:
4. Mejía F, Medina C, Cornejo E, Morello E, Vásquez S, Alave J, et al. Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PLoS One. 2020;15(12 December):1–12.
5. Vahidy FS, Pan AP, Ahnstedt H, Munshi Y, Choi HA, Tiruneh Y, et al. Sex differences in susceptibility, severity, and outcomes of coronavirus disease 2019: Cross-sectional analysis from a diverse US metropolitan area. PLoS One [Internet]. 2021;16(1 January):1–14. Available from:
6. Mahmood M. Risk factors associated with mortality in COVID-19 patients?: a retrospective case control study. 2020;1–11.
7. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192–206.
8. Daniel P, Oran. AM EJ. A Narrative Review Annals of Internal Medicine Prevalence of Asymptomatic SARS-CoV-2 Infection. 2020;43(6).
9. Mesquita R, Carlos L, Silva F, Fernanda J, Santos M, Farias T, et al. Clinical manifestations of COVID-19 in the general population?: systematic review. 2021;377–82.
10. Khan MA. Effects of underlying morbidities on the occurrence of deaths in COVID-19 patients?: A systematic review and meta-analysis. 2020;10(2):1–14.
11. Gao Z, Xu Y, Sun C, Wang X, Guo Y, Qiu S. A systematic review of asymptomatic infections with COVID-19. 2020;(January).
12. Fang L, Karakiulakis G, Roth M. Correspondence hypertension and increased risk for. Lancet Respir [Internet]. 2020;2600(20):30116. Available from:
13. Dan S, Pant M, Upadhyay SK. The Case Fatality Rate in COVID-19 Patients With Cardiovascular Disease: Global Health Challenge and Paradigm in the Current Pandemic. Curr Pharmacol Reports. 2020;6(6):315–24.
14. Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020;13(January):1833–9.
15. Leung JM, Niikura M, Yang CWT, Sin DD. COVID-19 and COPD. Eur Respir J [Internet]. 2020;56(2):1–9. Available from:
16. Armaly Z, Kinaneh S, Skorecki K. Renal Manifestations of Covid-19: Physiology and Pathophysiology. J Clin Med. 2021;10(6):1216.
17. PDPI, PERKI, PAPDI, PERDATIN, IDAI. Pedoman tatalaksana COVID-19 Edisi 3 Desember 2020 [Internet]. Pedoman Tatalaksana COVID-19. 2020. 36–37 p. Available from:
18. Ramakrishnan RK, Heialy S Al, Hamid Q. Implications of preexisting asthma on COVID-19 pathogenesis. Am J Physiol - Lung Cell Mol Physiol. 2021;320(5):L880–91.
19. Pathania AS, Prathipati P, Abdul BAA, Chava S, Katta SS, Gupta SC, et al. COVID-19 and cancer comorbidity: Therapeutic opportunities and challenges. Theranostics. 2020;11(2):731–53.
20. Ahmad A, Ishtiaq SM, Khan JA, Aslam R, Ali S, Arshad MI. COVID-19 and comorbidities of hepatic diseases in a global perspective. World J Gastroenterol. 2021;27(13):1296–310.
21. Ge J, Pletcher MJ, Lai JC, Harper JR, Chute CG, Haendel MA. Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study. Gastroenterology. 2021;
22. Martinez MA, Franco S. Impact of COVID?19 in Liver Disease Progression . Hepatol Commun. 2021;5(7):1138–50.
Literature Review