Clinical characteristics and outcomes of patients with severe covid-19 with diabetes

Yan, Yongli; Yang, Yan; Wang, Fen; Ren, Huihui; Zhang, Shujun; Shi, Xiaoli; Yu, Xuefeng; Dong, Kun

doi:10.1136/bmjdrc-2020-001343

Cited by 495 publications

(626 citation statements)

References 34 publications

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“…According to the laboratory ndings, non-survivors had lower lymphocyte count and higher counts of WBC and neutrophil besides higher concentration of serum creatinine, CRP, LDH, CPK and CPK-MB, but lower concentration of Hb compared to survivors, re ecting severe in ammatory response and cardiac and renal impairments in nonsurvivors. Our ndings were in agreement with previous observations in COVID-19 patients [11,[15][16][17]. These biochemical abnormalities point to that covid-19 infection may be lead to progressive systemic injuries and consequently death in diabetic patients.…”

Section: Discussionsupporting

confidence: 93%

“…These biochemical abnormalities point to that covid-19 infection may be lead to progressive systemic injuries and consequently death in diabetic patients. The mechanisms linking diabetes with high risk of mortality were pulmonary dysfunction and deleterious in ammation which has been indicated in results of comparison between survivors and non-survivors [15,18]. Chen et al indicated CRP as the only risk factor for mortality in diabetic patients with COVID-19 as a clinical manifestation of systemic in ammation [19].…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated with the Poor Outcomes in Diabetic Patients with COVID-19

Rastad

Ejtahed

Ghorabi

et al. 2020

Preprint

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Abstract Background: Diabetic’s patients are supposed to experience higher rates of COVID-19 related poor outcomes. We aimed to determined factors predicting poor outcomes in hospitalized diabetic patients with COVID-19. Methods: This retrospective cohort study included all adult diabetic patients with radiological or laboratory confirmed COVID-19 who hospitalized between 20 February 2020 and 27 April 2020 in Alborz province, Iran. Data on demographic, medical history, and laboratory test at presentation were obtained from electronic medical records. Diagnosis of diabetes mellitus was self-reported. Comorbidities including cancer, rheumatism, immunodeficiency, or chronic diseases of respiratory, liver, and blood were classified as “other comorbidities” due to low frequency. The assessed poor outcomes were in-hospital mortality, need to ICU care, and receiving invasive mechanical ventilation. Self-reported. Multivariate logistic regression models were fitted to quantify the predictors of in-hospital mortality from COVID-19 in patients with DM. Results: Of 455 included patients, 98(21.5%) received ICU care, 65(14.3%) required invasive mechanical ventilation, and 79 (17.4%) dead. In the multivariate model, significant predictors of “death of COVID-19” were age 65 years or older (OR (95% CI): 2.0 (1.16-3.44), chronic kidney disease (CKD) (2.05 (1.16 -3.62), presence of “other comorbidities” (2.20 (1.04-4.63)), neutrophil count ≥ 8.0 × 10⁹/L )6.62 (3.73-11.7 ((, Hb level <12.5 g/dl (2.05 (1.13-3.72)(, and creatinine level ≥1.36 mg/dl (3.10 (1.38-6.98)). (All p –values < 0.05). Some of these factors were also associated with other assessed poor outcomes, e.g., need to ICU care or invasive mechanical ventilation.Conclusions: Diabetic patients with age 65 years or older, comorbidity CKD, “other comorbidities”, as well as neutrophil count ≥ 8.0 × 10⁹/L, Hb level <12.5 g/dl, and creatinine level ≥1.36 mg/dl, were more likely to dead after COVID-19. Presence of hypertension and cardiovascular disease were associated with none of the poor outcomes.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Poor Outcomes in Diabetic Patients with COVID-19

Rastad

Ejtahed

Ghorabi

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In this study which had relatively rich clinical data, we found that diabetes alone was not the independent risk factors for in-hospital mortality of COVID-19, but comorbidities such as hypertension, CKD were risk factors, this result was consistent with the previous study [13]. Partially consistent with the previous studies, our study found that, compared with non-diabetic patients, diabetic COVID-19 patients were older, had worse outcome including higher rate of mortality, severe cases and ARDS, presented severe in ammation response, lung and coagulation dysfunction [2,11,12,14]. Additionally, diabetic patients had increased level of urea nitrogen and decreased level of albumin.…”

Section: Discussionsupporting

confidence: 91%

“…Lots of studies had demonstrated that diabetic patients had higher risk of mortality in COVID, as well as developing more severe cases [2,4,11,12]. Guo et al [12] reported that diabetes was a risk factor for the progression and prognosis of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Patients with Comorbidities had Worse Outcomes When Suffered with COVID-19 and Acarbose might have Protective Effects

Luo

et al. 2020

Preprint

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Background: Previous studies showed that diabetes was a common comorbidity of COVID-19, but the effects of diabetes or anti-diabetic drugs on the mortality of COVID-19 have not been well described. To investigate the outcome of different status (with or without comorbidity) and anti-diabetic medication before admission of diabetic patients after SARS-CoV-2 infected, we collected clinical data of COVID-19 patients from Hubei Province and compared between diabetes and non-diabetes.Methods: In this multicenter and retrospective study, we enrolled 1,422 cases of consecutive hospitalized patients from January 21, 2020 to March 25, 2020 at six hospitals in Hubei Province, China. The primary endpoint was in-hospital mortality.Results: Diabetes patients were 10-years older than non-diabetes (p<0.001), had higher prevalence of comorbidities such as hypertension (p<0.001), coronary heart disease (p<0.001), cerebrovascular disease (CVD) (p<0.001), chronic kidney disease (CKD) (p=0.007). The incidence of mortality (p=0.003) were more prevalent among the diabetes group. Further analysis revealed that diabetes patients who took alpha-glucosidase inhibitor (AGI) had lower mortality rate(p<0.01). Multivariable Cox regression showed that male sex, hypertension, CKD, CVD, age were risk factors for the mortality of COVID-19. Survival curve revealed that, compared with diabetes only group, the mortality was increased in diabetes with comorbidities (p=0.009), but had no significant difference in the non-comorbidity group, p=0.59).Conclusions: Patients with diabetes had worse outcome when suffered with COVID-19, however, it was not associated with diabetes itself but the comorbidities. Furthermore, the administration of AGI could reduce the risk of death in patients with diabetes.

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“…Why is diabetes associated with severe covid-19 lung disease requiring admission to the ICU? In a report in this journal, Yan et al 13 Editorial with severe covid-19 without diabetes hospitalized in China in a retrospective single center observational study. The authors demonstrate that compared with non-diabetics, patients with diabetes and severe covid-19 exhibited a severe inflammatory response and were more likely to receive mechanical ventilation and have a higher mortality (and a reduced survival duration).…”

mentioning

confidence: 99%