Assessment of Mortality Rate, Need for ICU Admission and Ventilation in COVID-19 Patients with Diabetes Mellitus

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) has become a threat to public health. People with chronic diseases, such as diabetes, are at a greater risk of severe diseases and death upon contracting this new disease. Due to the novelty of COVID-19, no specific information is available about the degree of its mortality and risk factors among diabetic patients. Therefore, this study aims to compare diabetic and nondiabetic COVID-19 patients regarding mortality rate, the need for intensive care unit (ICU) admission, invasive and noninvasive ventilation, and the associated risk factors. Methods: This was a cross-sectional study performed on the medical records of 650 adult COVID-19 patients (325 diabetics and 325 nondiabetics) admitted to Razi Hospital in Ahvaz from March 2020 to September 2020. Results: The mean age of the patients was 61.3 years in the diabetic group and 52.3 years in the nondiabetic group. Men comprised 48.3% of the diabetic group and 59.7% of the nondiabetic group. Diabetic patients suffered from significantly more underlying diseases, such as ischemic heart disease (IHD), hypertension (HTN), chronic kidney disease (CKD), and acute renal failure (ARF) compared to the nondiabetic group ( p < 0.0001). Also, when compared with the nondiabetic group, the diabetic group had a significantly higher mortality rate (17.5% vs. 12%; p = 0.047, respectively), more ICU admissions (35.4% vs. 27.7%; p = 0.035, respectively), and a greater need for invasive ventilation (17.5% vs. 11.4%; p = 0.026, respectively). Conclusion: In diabetic patients, the mortality rate, need for ICU admission, and need for invasive ventilation were significantly higher than nondiabetic patients. Our logistic regression analysis in diabetic patients with COVID-19 showed that age, CKD, and ARF were the risk factors affecting mortality. In contrast, age and CKD were the risk factors affecting the rate of ICU admission, and CKD and ARF were the risk factors affecting the need for invasive ventilation.

The impact of type 2 diabetes and glycaemic control on mortality and clinical outcomes in hospitalized patients with COVID‐19 in the capital region of Denmark

“…In contrast to our results, other studies have with variable certainty reported that T2D is a risk factor for both death from COVID‐19 and admission to an ICU because of COVID‐19 3–11,22 . The discrepancy compared with our results could partly be explained by the higher number of covariates we adjusted for, that could potentially explain the higher risk in patients with T2D.…”

“…1,2 Since then, studies have found that hospitalized patients with T2D have a higher risk of dying from COVID-19 than patients without T2D. [3][4][5][6][7][8][9][10][11] This has encouraged researchers to explore possible T2Drelated predictors for poor outcomes in COVID-19, such as plasma glucose levels and glucose-lowering medications. [5][6][7]12 Hyperglycaemia in T2D is known to have detrimental effects on immune function, and, to increase inflammatory responses and oxidative stress, ultimately causing microvascular complications.…”

“…During the earliest stage of the coronavirus disease 2019 (COVID‐19) pandemic, it became clear that people with type 2 diabetes (T2D) were overrepresented among COVID‐19‐related hospitalizations 1,2 . Since then, studies have found that hospitalized patients with T2D have a higher risk of dying from COVID‐19 than patients without T2D 3–11 . This has encouraged researchers to explore possible T2D‐related predictors for poor outcomes in COVID‐19, such as plasma glucose levels and glucose‐lowering medications 5–7,12 …”

Predicting Intensive Care Unit Admission for COVID-19 Patients from Laboratory Results

“…In addition, COVID-19 patients who were male, at least 55 years old or had a comorbidity (diabetes mellitus or hypertension), had increased risk of ICU admission. Similar correlations between these factors and ICU admission have been reported [ 5 , 14 – 16 ]. To date, there is no clear explanation why age is an independent risk factor.…”

“…Comorbidities, such as hypertension and diabetes, have been reported previously to affect the severity of the disease and the prognosis of COVID-19 patients [ 14 , 26 – 28 ]. Several mechanisms have been discussed for the effect of hypertension, one of which is related to distribution of ACE2 enzyme/receptor, expressed in different tissues, such as lung alveolar epithelial cells, cardiovascular, arterial smooth muscle, arterial and venous endothelial cells, and enterocytes of the small intestine [ 29 ].…”