Covid-19 fatality prediction in people with diabetes and prediabetes using a simple score at hospital admission

Abstract

AIM We assessed predictors of inhospital mortality in people with prediabetes and diabetes hospitalized for COVID19 infection and developed a risk score for identifying those at the highest risk of a fatal outcome. MATERIALS AND METHODS A combined prospective and retrospective multicenter cohort study was conducted in 10 sites in Austria on 247 people with diabetes or newly diagnosed prediabetes, who were hospitalised for COVID19. The primary outcome was inhospital mortality and predictor variables at the time of admission included clinical data, comorbidities of diabetes or laboratory data. Logistic regression analyses were performed to identify significant predictors and develop a risk score for inhospital mortality. RESULTS The mean age of people hospitalized (n=238) for COVID−19 was 71.1±12.9 years, 63.6% were males, 75.6% had type 2 diabetes, 4.6% had type 1 diabetes, and 19.8% had prediabetes. The mean duration of hospital stay was 18±16 days, 23.9% required ventilation therapy, and 24.4% died in the hospital. Mortality rate in people with diabetes was numerically higher (26.7%) as compared to those with prediabetes (14.9%) but without statistical significance (p=0.128). A score including age, arterial occlusive disease, CRP, eGFR and AST levels at admission predicted inhospital mortality with a Cstatistics of 0.889 (95%CI: 0.837−0.941) and calibration of 1.000 (p=0.909). CONCLUSIONS The inhospital mortality for COVID−19 was high in people with diabetes and not significantly different to the risk in people with prediabetes. A risk score using five routinely available patient parameters demonstrated excellent predictive performance for assessing inhospital mortality.

Diabetes predicts severity of COVID‐19 infection in a retrospective cohort: A mediatory role of the inflammatory biomarker C‐reactive protein

“…However, our study suggested that prediabetes was not associated with a higher baseline CRP level or increased incidence of severe COVID‐19 disease. This supports the findings from a recent study 36 . Even though primary outcome event numbers were small in this group to draw a definitive conclusion, there was no trend towards poorer outcomes, even with baseline CRP level.…”

Determinants of COVID-19 outcomes: A systematic review

“…Age and sex were the common demographic risk factors. Of the 20 studies on age and COVID-19 mortality, 16 identified increasing age as a significant determinant of COVID-19 mortality, with effect sizes ranging from 1.04 to 20.6 and 95% CI from 1.01 to 22.68 (9, 10, 11, 16, 17, 18, 24, 25, 26, 27, 28, 29, 30, 32, 33, 35). Also, 8 of the 20 studies on gender/sex and COVID-19 found men to have a higher risk of COVID-19 mortality than women (10, 11, 16, 17, 24, 26, 28, 32).…”

“…Of the 10 studies that included CKD in their analysis, 5 found it a significant determinant of COVID-19 mortality (18, 25, 26, 30, 35). Additionally, out of the 5 studies that investigated the influence of CRP on COVID-19 mortality, 4 showed that elevated CRP in the blood (at least >5mg/L) increases the risk of COVID-19 death (11, 24, 26, 29). Also, people with diabetes were found to have a higher risk of COVID-19 mortality in 6 of the 18 studies on diabetes and COVID-19 mortality (16, 17, 18, 26, 30, 32)…”

Knowledge, attitudes and practice among primary care physicians in Sudan regarding prediabetes: A cross-sectional survey

“…[ 23 24 ] Prediabetes is also a condition that associated with an increase in different comorbidities like hypertension, fatty liver polycystic ovary syndrome, hyperlipideamia, metabolic syndrome, an increase risk of cardiovascular disease, decrease in chromium and an increase in oral lesions. Importantly, diabetes was significantly associated with high hospital mortality with COVID-19, but prediabetes was not statistically associated with high hospital mortality[ 25 26 27 28 29 ]…”