Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study

Yan Zhang, Yanhui Cui, Minxue Shen, Jianchu Zhang, Ben Liu, Minhui Dai, Lingli Chen, Duoduo Han, Yifei Fan, Yanjun Zeng, Wen Li, Fengyu Lin, Sha Li, Xiang Chen, Pinhua Pan, medical team from Xiangya Hospital to support Hubei, China, Yan Zhang, Yanhui Cui, Minxue Shen, Jianchu Zhang, Ben Liu, Minhui Dai, Lingli Chen, Duoduo Han, Yifei Fan, Yanjun Zeng, Wen Li, Fengyu Lin, Sha Li, Xiang Chen, Pinhua Pan, medical team from Xiangya Hospital to support Hubei, China

Abstract

Aims: The 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China, and was characterized as a pandemic by the World Health Organization. Diabetes is an established risk associated with poor clinical outcomes, but the association of diabetes with COVID-19 has not been reported yet.

Methods: In this cohort study, we retrospectively reviewed 258 consecutive hospitalized COVID-19 patients with or without diabetes at the West Court of Union Hospital in Wuhan, China, recruited from January 29 to February 12, 2020. The clinical features, treatment strategies and prognosis data were collected and analyzed. Prognosis was followed up until March 12, 2020.

Results: Of the 258 hospitalized patients (63 with diabetes) with COVID-19, the median age was 64 years (range 23-91), and 138 (53.5%) were male. Common symptoms included fever (82.2%), dry cough (67.1%), polypnea (48.1%), and fatigue (38%). Patients with diabetes had significantly higher leucocyte and neutrophil counts, and higher levels of fasting blood glucose, serum creatinine, urea nitrogen and creatine kinase isoenzyme MB at admission compared with those without diabetes. COVID-19 patients with diabetes were more likely to develop severe or critical disease conditions with more complications, and had higher incidence rates of antibiotic therapy, non-invasive and invasive mechanical ventilation, and death (11.1% vs. 4.1%). Cox proportional hazard model showed that diabetes (adjusted hazard ratio [aHR] = 3.64; 95% confidence interval [CI]: 1.09, 12.21) and fasting blood glucose (aHR = 1.19; 95% CI: 1.08, 1.31) were associated with the fatality due to COVID-19, adjusting for potential confounders.

Conclusions: Diabetes mellitus is associated with increased disease severity and a higher risk of mortality in patients with COVID-19.

Keywords: COVID-19; Diabetes mellitus; Prognosis; SARS-CoV-2.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2020 Elsevier B.V. All rights reserved.

References

    1. Chen N, Zhou M, Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513. doi: 10.1016/S0140-6736(20)30211-7.
    1. Lu R, Zhao X, Li J. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. doi: 10.1016/S0140-6736(20)30251-8.
    1. WHO. Middle East respiratory syndrome coronavirus (MERS-CoV). November, 2019. (accessed February 28, 2020).
    1. Wang L, Gao P, Zhang M. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. JAMA. 2017;317(24):2515–2523. doi: 10.1001/jama.2017.7596.
    1. Xia C, Rao X, Zhong J. Role of T lymphocytes in type 2 diabetes and diabetes-associated inflammation. J Diabetes Res. 2017;2017(4):6494795–6494796. doi: 10.1155/2017/6494795.
    1. Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology. 2015;144(2):171–185. doi: 10.1111/imm.12394.
    1. Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5.
    1. Wang D, Hu B, Hu C. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061. doi: 10.1001/jama.2020.1585.
    1. Guan W, Ni Z, Hu Y et al. Clinical characteristics of 2019 novel coronavirus infection in China. medRxiv 2020:2020.02.06.20020974.
    1. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. Published January 28, 2020. Accessed February 28, 2020. .
    1. Liu Y, Sun W, Li J et al. Clinical features and progression of acute respiratory 1 distress syndrome in coronavirus disease 2019. medRxiv 2020:2020.02.17.20024166.
    1. Chinese Diabetes Society. Guidelines for the prevention and control of type 2 diabetes in China (2017 Edition). Chinese Journal of Diabetes Mellitus 2018; 10(1): 4-67 .
    1. Force ADT., Ranieri VM, Rubenfeld GD. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533.
    1. Shi S, Qin M, Shen B. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;e200950 doi: 10.1001/jamacardio.2020.0950.
    1. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. March, 2012. KDIGO-2012-AKI-Guideline-English.pdf (accessed February 28, 2020).
    1. Zhang JJ, Dong X, Cao YY. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020 doi: 10.1111/all.14238.
    1. Liu J, Liu Y, Xiang P, et al. Neutrophil-to-Lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage. medRxiv 2020:2020.02.10.20021584.
    1. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–982. doi: 10.1210/jcem.87.3.8341.
    1. van den Berghe G, Wouters P, Weekers F. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345(19):1359–1367. doi: 10.1056/NEJMoa011300.
    1. van den Berghe G, Wouters PJ, Bouillon R. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med. 2003;31(2):359–366. doi: 10.1097/01.CCM.0000045568.12881.10.
    1. Klekotka RB, Mizgała E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol. 2015;83(5):401–408. doi: 10.5603/PiAP.2015.0065.
    1. Yang JK, Feng Y, Yuan MY. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med. 2006;23(6):623–628. doi: 10.1111/j.1464-5491.2006.01861.x.
    1. Chen CY, Lee CH, Liu CY, Wang JH, Wang LM, Perng RP. Clinical features and outcomes of severe acute respiratory syndrome and predictive factors for acute respiratory distress syndrome. J Chin Med Assoc. 2005;68(1):4–10. doi: 10.1016/S1726-4901(09)70124-8.
    1. Choi WS, Kang CI, Kim Y. Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea. Infect Chemother. 2016;48(2):118–126. doi: 10.3947/ic.2016.48.2.118.
    1. Banik GR, Alqahtani AS, Booy R, Rashid H. Risk factors for severity and mortality in patients with MERS-CoV: Analysis of publicly available data from Saudi Arabia. Virol Sin. 2016;31(1):81–84. doi: 10.1007/s12250-015-3679-z.
    1. Zhu L, She Z, Cheng X. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab. 2020 doi: 10.1016/j.cmet.2020.04.021.
    1. Reaven PD, Emanuele NV, Wiitala WL. Intensive Glucose Control in Patients with Type 2 Diabetes - 15-Year Follow-up. N Engl J Med. 2019;380(23):2215–2224. doi: 10.1056/NEJMoa1806802.
    1. Diao B, Wang C, Tan Y. Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19) Front Immunol. 2020;11:827. doi: 10.3389/fimmu.2020.00827.
    1. Kulcsar KA, Coleman CM, Beck SE, Frieman MB. Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight. 2019;4(20):e131774. doi: 10.1172/jci.insight.131774.

Source: PubMed

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