Characteristics and outcomes of COVID-19 in hospitalized patients with and without diabetes

Abdallah Al-Salameh, Jean-Philippe Lanoix, Youssef Bennis, Claire Andrejak, Etienne Brochot, Guillaume Deschasse, Hervé Dupont, Vincent Goeb, Maité Jaureguy, Sylvie Lion, Julien Maizel, Julien Moyet, Benoit Vaysse, Rachel Desailloud, Olivier Ganry, Jean-Luc Schmit, Jean-Daniel Lalau, Abdallah Al-Salameh, Jean-Philippe Lanoix, Youssef Bennis, Claire Andrejak, Etienne Brochot, Guillaume Deschasse, Hervé Dupont, Vincent Goeb, Maité Jaureguy, Sylvie Lion, Julien Maizel, Julien Moyet, Benoit Vaysse, Rachel Desailloud, Olivier Ganry, Jean-Luc Schmit, Jean-Daniel Lalau

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a rapidly progressing pandemic, with four million confirmed cases and 280 000 deaths at the time of writing. Some studies have suggested that diabetes is associated with a greater risk of developing severe forms of COVID-19. The primary objective of the present study was to compare the clinical features and outcomes in hospitalized COVID-19 patients with vs without diabetes.

Methods: All consecutive adult patients admitted to Amiens University Hospital (Amiens, France) with confirmed COVID-19 up until April 21st, 2020, were included. The composite primary endpoint comprised admission to the intensive care unit (ICU) and death. Both components were also analysed separately in a logistic regression analysis and a Cox proportional hazards model.

Results: A total of 433 patients (median age: 72; 238 (55%) men; diabetes: 115 (26.6%)) were included. Most of the deaths occurred in non-ICU units and among older adults. Multivariate analyses showed that diabetes was associated neither with the primary endpoint (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.66-1.90) nor with mortality (hazard ratio: 0.73; 95%CI: 0.40-1.34) but was associated with ICU admission (OR: 2.06; 95%CI 1.09-3.92, P = .027) and a longer length of hospital stay. Age was negatively associated with ICU admission and positively associated with death.

Conclusions: Diabetes was prevalent in a quarter of the patients hospitalized with COVID-19; it was associated with a greater risk of ICU admission but not with a significant elevation in mortality. Further investigation of the relationship between COVID-19 severity and diabetes is warranted.

Keywords: acute respiratory distress syndrome; coronavirus disease 2019 (COVID-19); diabetes; intensive care; mortality; outcome.

Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

© 2020 John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Factors significantly associated with the composite endpoint (death or admission to the ICU) in a multivariable logistic regression analysis. Diabetes (yes, no); age (years); sex (female vs male); obesity (yes if BMI ≥30 kg/m2, no); cardiac disease (coronary heart disease, arrhythmia or heart failure); and serum C‐reactive protein (CRP) on admission (per 10 mg/L). The ORs [95%CI] were obtained in multivariable logistic regressions
FIGURE 2
FIGURE 2
Factors significantly associated with admission to the ICU in a multivariable logistic regression analysis. Diabetes (yes, no); age (per 10 years); sex (female vs male); BMI, body mass index as a numerical variable (per 5 kg/m²); and serum C‐reactive protein (CRP) on admission (per 10 mg/L). The ORs [95%CI] were obtained in multivariable logistic regressions
FIGURE 3
FIGURE 3
Factors significantly associated with death in a multivariable Cox proportional hazards analysis. Age (per 10 years); sex (female vs male); total cardiovascular disease (TCVD: yes, no); abnormal liver function tests (Abnormal LFTs: no abnormal tests, one abnormal test, two abnormal tests, or three abnormal tests). The HRs [95%CI] were obtained in multivariable Cox's proportional hazards analyses

References

    1. Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. 10.1016/j.diabres.2019.107843.
    1. Guan W‐J, Ni Z‐Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708‐1720. 10.1056/NEJMoa2002032.
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Lond Engl. 2020;395(10223):497‐506. 10.1016/S0140-6736(20)30183-5.
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID‐19 in the New York City area. JAMA Published online. 2020;323(20):2052‐2059. 10.1001/jama.2020.6775.
    1. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS‐CoV‐2 pneumonia in Wuhan, China: a single‐centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475‐481. 10.1016/S2213-2600(20)30079-5.
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID‐19 in Wuhan, China: a retrospective cohort study. Lancet Lond Engl Published online. 2020;395(10229):1054‐1062. 10.1016/S0140-6736(20)30566-3.
    1. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS‐CoV‐2 admitted to ICUs of the Lombardy region, Italy. JAMA Published online. 2020;323(16):1574‐1581. 10.1001/jama.2020.5394.
    1. Garg S, Kim L, Whitaker M, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory‐confirmed coronavirus disease 2019 ‐ COVID‐NET, 14 states, march January 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458‐464. 10.15585/mmwr.mm6915e3.
    1. Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obes Silver Spring Md. Published online. 2020;28(7):1195‐1199. 10.1002/oby.22831.
    1. Drucker DJ. Coronavirus infections and type 2 diabetes‐shared pathways with therapeutic implications. Endocr Rev. 2020;41(3):457‐470. 10.1210/endrev/bnaa011.
    1. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid‐19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. 10.1136/bmj.m1985.
    1. Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID‐19. Diabetes Metab Res Rev Published online. 2020;e3319. 10.1002/dmrr.3319.
    1. Patel AB, Verma A. COVID‐19 and angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers: what is the evidence? JAMA. Published online. 2020;323(18):1769‐1770. 10.1001/jama.2020.4812.
    1. ARDS Definition Task Force , Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526‐2533. 10.1001/jama.2012.5669.
    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‐19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA Published online. 2020;323(13):1239‐1242. 10.1001/jama.2020.2648.
    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):18. 10.1172/jci.insight.131774.
    1. Gutta S, Grobe N, Kumbaji M, et al. Increased urinary angiotensin converting enzyme 2 and neprilysin in patients with type 2 diabetes. Am J Physiol Renal Physiol. 2018;315(2):F263‐F274. 10.1152/ajprenal.00565.2017.
    1. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60years is a risk factor for Covid‐19 hospital admission. Clin Infect Dis off Publ Infect Dis Soc Am Published online. 2020;71(15):896‐897. 10.1093/cid/ciaa415.
    1. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in‐hospital outcomes, and higher in‐hospital mortality, in a cohort of patients with COVID‐19 in the Bronx, New York. Metabolism. 2020;108:154262. 10.1016/j.metabol.2020.154262.
    1. Klang E, Kassim G, Soffer S, Freeman R, Levin MA, Reich DL. Morbid obesity as an independent risk factor for COVID‐19 mortality in hospitalized patients younger than 50. Obes Silver Spring Md. Published online. 2020. 10.1002/oby.22913.
    1. Watanabe M, Risi R, Tuccinardi D, Baquero CJ, Manfrini S, Gnessi L. Obesity and SARS‐CoV‐2: a population to safeguard. Diabetes Metab Res Rev Published online. 2020;e3325. 10.1002/dmrr.3325.
    1. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID‐19 pneumonia—a systematic review, meta‐analysis, and meta‐regression. Diabetes Metab Syndr. 2020;14(4):395‐403. 10.1016/j.dsx.2020.04.018.
    1. Prospective Studies Collaboration and Asia Pacific Cohort Studies Collaboration . Sex‐specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta‐analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol. 2018;6(7):538‐546. 10.1016/S2213-8587(18)30079-2.
    1. Tancredi M, Rosengren A, Svensson A‐M, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015;373(18):1720‐1732. 10.1056/NEJMoa1504347.
    1. Di Bella S, Cesareo R, De Cristofaro P, et al. Neck circumference as reliable predictor of mechanical ventilation support in adult inpatients with COVID‐19: a multicentric prospective evaluation. Diabetes Metab Res Rev Published online. 2020;e3354. 10.1002/dmrr.3354.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren