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In this case–control study designed to establish the extent to which periodontitis is associated with COVID-19 complications, after adjusting for potential confounders and comorbidities, multivariate analysis showed an adjusted odds ratio of 3.67 for all COVID-19 complications, 8.81 for death, 3.54 for ICU admission, and a 4.57 for need of assisted ventilation. Concentrations of D-dimer (P < .001), white blood cell count (WBC; P < .001), and C-reactive protein (CRP; P < .001) were significantly higher in COVID-19–deceased patients compared with surviving patients, while concentrations of lymphocytes (P < .005) were significantly lower in deceased patients. Patients admitted to the ICU and patients requiring assisted ventilation also had significantly higher D-dimer, WBC, and CRP serum levels than patients not admitted to the ICU or requiring assisted ventilation.
Even though periodontitis and COVID-19 have both been associated with common comorbidities, there has heretofore been no evidence of a possible direct association between these two diseases. In this study, the risk of COVID-19 complications was significantly higher among patients with moderate to severe periodontitis compared with those with mild or no periodontitis. The authors conclude that these compelling results confirm the association between periodontitis and worse progression of COVID-19.
COVID-19 is associated with an exacerbated inflammatory response that can result in fatal outcomes. Systemic inflammation is also a main characteristic of periodontitis. Therefore, we investigated the association of periodontitis with COVID-19 complications.
MATERIALS AND METHODS
A case-control study was performed using the national electronic health records of the State of Qatar between February and July 2020. Cases were defined as patients who suffered COVID-19 complications (death, ICU admissions or assisted ventilation), and controls were COVID-19 patients discharged without major complications. Periodontal conditions were assessed using dental radiographs from the same database. Associations between periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic, medical and behaviour factors.
In total, 568 patients were included. After adjusting for potential confounders, periodontitis was associated with COVID-19 complication including death (OR = 8.81, 95% CI 1.00-77.7), ICU admission (OR = 3.54, 95% CI 1.39-9.05) and need for assisted ventilation (OR = 4.57, 95% CI 1.19-17.4). Similarly, blood levels of white blood cells, D-dimer and C Reactive Protein were significantly higher in COVID-19 patients with periodontitis.
Periodontitis was associated with higher risk of ICU admission, need for assisted ventilation and death of COVID-19 patients, and with increased blood levels of biomarkers linked to worse disease outcomes.