Distinguishable Immunologic Characteristics of COVID-19 Patients with Comorbid Type 2 Diabetes Compared with Nondiabetic Individuals

Zhao, Ruxing; Sun, Yujing; Zhang, Yongyuan; Wang, Weili; Wang, Shouyu; Wang, Chuang; Wang, Zhibin; Gao, Ling; Hu, Zhao; Fei, Jianchun; Hou, Xinguo; Zheng, Huizhen; Chen, Li; Migliorini, Paola

doi:10.1155/2020/6914878

Cited by 23 publications

(33 citation statements)

References 44 publications

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“…We also found that lymphocytes in general as well as lymphocyte subset were significantly reduced in COVID-19 patients, especially those with DM. Moreover, the rate of severity was the highest in those with DM, the prognosis was worse, and the lymphocyte counts and lymphocyte subset counts, especially CD4+ T cells, CD8+ T cells and B cells were the lowest in those with severe COVID-19 and DM, these findings were consistent with the literature [ 13 , 25 , 26 ]. However, in the literature, no hierarchical analysis was performed between COVID-19 patients with and without DM, [ 13 , 25 ] and no hierarchical analysis was performed between non-severe and severe COVID-19 patients with or without DM [ 26 ].…”

Section: Discussionsupporting

confidence: 90%

Overall reduced lymphocyte especially T and B subsets closely related to the poor prognosis and the disease severity in severe patients with COVID-19 and diabetes mellitus

Liu

Wang

Zhao

et al. 2021

Diabetol Metab Syndr

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Background A dysregulated host immune response is common in patients with COVID-19. Aim In this study, we aimed to define the characteristics of lymphocyte subsets and their relationship with disease progression in COVID-19 patients with or without diabetes mellitus (DM). Methods The baseline peripheral lymphocyte subsets were compared between 55 healthy controls and 95 patients with confirmed COVID-19, and between severe and non-severe COVID-19 patients with or without DM. Results The prevalence of DM in the COVID-19 group was 20%, and patients with severe COVID-19 had a higher prevalence of DM than those with non-severe disease (P = 0.006). Moreover, a significantly poor prognosis and a higher rate of severity were found in those with DM relative to those without DM (P = 0.001, 0.003). Generally, all lymphocytes and subsets of lymphocytes, especially B and T cells, were significant reduced in COVID-19 patients, particularly in those with DM. Patients with severe COVID-19 and DM had the lowest lymphocyte counts compared with those with severe COVID-19 without DM, and those with non-severe COVID-19 with or without DM. Partially decreased lymphocyte subsets, age and DM were closely related to disease progression and prognosis. Conclusions These findings provide a reference for clinicians that immunomodulatory treatment may improve disease progression and prognosis of COVID-19 patients, especially those with severe disease with DM. Trial registration Chinese Clinical Trial Register ChiCTR2000034563

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Section: Discussionsupporting

confidence: 90%

Overall reduced lymphocyte especially T and B subsets closely related to the poor prognosis and the disease severity in severe patients with COVID-19 and diabetes mellitus

Liu

Wang

Zhao

et al. 2021

Diabetol Metab Syndr

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“…A previous study found Th1 cytokines including IFN-γ, TNF-α, and CRP but not Th2 cytokines appeared significantly higher in the T2DM group than in the non-T2DM group. Unlike the above study, we found both Th1 and Th2 cytokines were greatly elevated in T2DM compared with non-T2DM when infected with SARS-CoV-2 ( 52 ).…”

Section: Discussioncontrasting

confidence: 79%

Immunological Characteristics in Type 2 Diabetes Mellitus Among COVID-19 Patients

Han

Wang

et al. 2021

Front. Endocrinol.

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Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT04365634.ContextDiabetes mellitus was associated with increased severity and mortality of disease in COVID-19 pneumonia. So far the effect of type 2 diabetes (T2DM) or hyperglycemia on the immune system among COVID-19 disease has remained unclear.ObjectiveWe aim to explore the clinical and immunological features of type 2 diabetes mellitus (T2DM) among COVID-19 patients.Design and MethodsIn this retrospective study, the clinical and immunological characteristics of 306 hospitalized confirmed COVID-19 patients (including 129 diabetic and 177 non-diabetic patients) were analyzed. The serum concentrations of laboratory parameters including cytokines and numbers of immune cells were measured and compared between diabetic and non-diabetic groups.ResultsCompared with non-diabetic group, diabetic cases more frequently had lymphopenia and hyperglycemia, with higher levels of urea nitrogen, myoglobin, D-dimer and ferritin. Diabetic cases indicated the obviously elevated mortality and the higher levels of cytokines IL‐2R, IL‐6, IL‐8, IL‐10, and TNF‐α, as well as the distinctly reduced Th1/Th2 cytokines ratios compared with non-diabetic cases. The longitudinal assays showed that compared to that at week 1, the levels of IL-6 and IL-8 were significantly elevated at week 2 after admission in non-survivors of diabetic cases, whereas there were greatly reductions from week 1 to week 2 in survivors of diabetic cases. Compared with survival diabetic patients, non-survival diabetic cases displayed distinct higher serum concentrations of IL-2R, IL-6, IL-8, IL-10, TNF‐α, and lower Th1/Th2 cytokines ratios at week 2. Samples from a subset of participants were evaluated by flow cytometry for the immune cells. The counts of peripheral total T lymphocytes, CD4+ T cells, CD8+ T cells and NK cells were markedly lower in diabetic cases than in non-diabetic cases. The non-survivors showed the markedly declined counts of CD8+ T cells and NK cells than survivors.ConclusionThe elevated cytokines, imbalance of Th1/Th2 cytokines ratios and reduced of peripheral numbers of CD8+ T cells and NK cells might contribute to the pathogenic mechanisms of high mortality of COVID-19 patients with T2DM.

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“… 39 Patients with diabetes have a high risk of immune dysregulation noted previously during the viral epidemic of MERS (middle east respiratory syndrome). 40 Similarly, also in COVID-19, when the inflammatory markers were studied in two sub cohorts of sex- and age-matched participants, diabetic patients (n-33) had higher CRP levels than non-diabetics patients 41 (n-37). In PROSPERO-based pooled analysis, the diabetic patients had higher CRP levels than non-diabetic.…”

Section: Discussionmentioning

confidence: 95%

Prevalence of Symptoms in Patients Discharged from COVID Care Facility of NIMS Hospital: Is RT PCR Negativity Truly Reflecting Recovery? A Single-Centre Observational Study

Tomar¹,

Singh²,

Nathiya³

et al. 2021

IJGM

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Purpose: To assess the prevalence of post-COVID symptoms in patients with recovered COVID-19 (nasopharyngeal RT PCR negative) who were discharged from an acute COVID care facility at a tertiary care teaching hospital in North India. Methods: This study was an observational study with retrospective data collection, conducted in the COVID follow-up clinic, a combined clinic of medicine and endocrinology. Patients discharged from the acute COVID care facility were recruited after 14 days of discharge if they fulfilled inclusion and exclusion criteria. The retrospective data was collected from the hospital records/EMR and analysed by the SPSSv23. Results: Fifty patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The Mean age of patients was 53.4±13.8 years (range 28-77). Seventy six percent were male, and 38% had type 2 diabetes. Fever (94%), cough (78%) and breathlessness (68%), were the most common symptoms at presentation to acute care facility. Oxygen saturation at presentation had a negative correlation with D-Dimer, age, and C reactive protein. When patients were evaluated clinically, after 14 days (range 15 to 50 days) of the discharge, 82% of patients had at least one persistent symptom. Fatigue (74%) was the most common symptoms in follow-up followed by breathlessness (44%), and muscle weakness (36%). Two patients had persistent fever, even after negative RT PCR status. Conclusion: Patients discharged from the acute COVID care facility had a high prevalence of post-COVID symptoms even after 14 days.

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Distinguishable Immunologic Characteristics of COVID-19 Patients with Comorbid Type 2 Diabetes Compared with Nondiabetic Individuals

Cited by 23 publications

References 44 publications

Overall reduced lymphocyte especially T and B subsets closely related to the poor prognosis and the disease severity in severe patients with COVID-19 and diabetes mellitus

Overall reduced lymphocyte especially T and B subsets closely related to the poor prognosis and the disease severity in severe patients with COVID-19 and diabetes mellitus

Immunological Characteristics in Type 2 Diabetes Mellitus Among COVID-19 Patients

Prevalence of Symptoms in Patients Discharged from COVID Care Facility of NIMS Hospital: Is RT PCR Negativity Truly Reflecting Recovery? A Single-Centre Observational Study

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