3. Discussion
Underlying comorbidities are major risk factors for progression to critical illness and death in Covid-19 patients 7-9. Amongst them, our patient had history of diabetes and epilepsy, which are associated with altered immune system response and potential poor prognosis in Covid-19 patients 10-12, 14-16. Weakened immune response might be related to mechanism in which these comorbidities modulate host-viral or host-immune system interactions17, 18. Specifically, it has been demonstrated that diabetes is a major risk factor for in-hospital mortality. Moreover, patient’s urinary tract infection was assumed to be due to underlying comorbidities, especially diabetes and gout 19, 20. Development of acute kidney injury (AKI) in hospitalized Covid-19 patients is a negative prognostic factor and ranges between 3% to 29%. Patient’s proteinuria might be due to developed AKI during hospitalization which is highly associated with in hospital mortality21.
The presented case developed multiple organ failure induced by Covid-19. It is confirmed that Covid-19 can cause cytokine storm, in which high pro-inflammatory cytokines, as in the presented case, can lead to heart failure (CPK 340 U/L), liver failure (elevated SGOT, SGPT, and Bilirubin), AKI, as well as respiratory failure (low PO2). Multiple organ failure is the most common cause of death in these patients22, 23.
It is crucial to develop effective treatment regimens for Covid-19 patients with multiple comorbidities, as patients’ past medical history is an essential contributor to possible organ injuries in these patients. Further observations will be required to comprehensively understand the full spectrum of Covid-19 clinical features in patients with multiple comorbidities.