Publication date: Jul 28, 2025

The impact of chronic medication on COVID-19 outcomes has been a topic of ongoing debate since the onset of the pandemic. Investigating how specific long-term treatments influence infection severity and prognosis is essential for optimising patient management and care. This study aimed to investigate the association between chronic medication and COVID-19 outcomes, using machine learning to identify key medication-related factors. We analysed 137,835 COVID-19 patients in Catalonia (February-September 2020) using eXtreme Gradient Boosting to predict hospitalisation, ICU admission, and mortality. This was complemented by univariate logistic regression analyses and a sensitivity analysis focusing on diabetes, hypertension, and lipid disorders. Participants had a mean age of 53 (SD 20) years, with 57% female. The best model predicted mortality risk in 18 to 65-year-olds (AUCROC 0. 89, CI 0. 85-0. 92). Key features identified included the number of prescribed drugs, systemic corticoids, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, and hypertension drugs. A sensitivity analysis identified that hypertensive participants over 65 taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) had lower mortality risk (OR 0. 78 CI 0. 68-0. 92) compared to those on other antihypertensive medication (OR 0. 8 CI 0. 68-0. 95). Treatment with inhibitors of dipeptidyl peptidase 4 was associated to higher mortality in participants aged 18-65, while metformin showed a protective effect in those over 65 (OR 0. 79, 95% CI 0. 68-0. 92). Machine learning models effectively distinguished COVID-19 outcomes. Patients under ACEi or ARBs or biguanides should continue their prescribed medications, which may offer protection over alternative treatments.

Open Access PDF

Semantics

Original Article