Predictors of mortality in critically ill patients with COVID-19 and diabetes

Abstract

The COVID-19 pandemic has challenged the entire world, and patients with diabetes mellitus (DM) have been particularly affected. We aimed to evaluate predictors of mortality during the first 30 days of hospitalization in critically ill patients with COVID-19 and comorbid DM. This prospective study included 110 critically ill patients admitted with COVID-19 infection. Thirty-two (29%) patients had a previous diagnosis of DM. Clinical variables, laboratory tests, and vascular biomarkers, such as VCAM-1, syndecan-1, ICAM-1, angiopoietin-1, and angiopoeitin-2, were evaluated after intensive care unit (ICU) admission. A comparison was made between patients with and without DM. No difference in mortality was observed between the groups (48.7 vs 46.9%, P=0.861). In the multivariate Cox regression analysis, VCAM-1 levels at ICU admission (HR: 1 [1-1.001], P<0.006) were associated with death in patients with DM. Among patients with DM, advanced age (HR 1.063 [1.031-1.096], P<0.001), increased Ang-2/Ang-1 ratio (HR: 4.515 [1.803-11.308] P=0.001), and need for dialysis (HR: 3.489 [1.409-8.642], P=0.007) were independent predictors of death. Higher levels of VCAM-1 in patients with DM was better at predicting death of patients with severe COVID-19 and comorbid DM, and their cut-off values were useful for stratifying patients with a worse prognosis. Vascular biomarkers VCAM-1 and Ang-2/Ang-1 ratio were predictors of death in patients with severe COVID-19 and comorbid DM and those without DM. Additionally, kidney injury was associated with an increased risk of death.

Angiopoietins as Predictor Indexes in COVID-19 Patients in Delta and Omicron Waves

“…Also, in the Gouzi et al survey, the Ang-2/Ang-1 ratio is a potential marker of vascular impairment in chronic obstructive pulmonary disease (COPD) patients. Moreover, according to the findings of Fang et al, Angiopoietin-2/Angiopoietin-1 and ratios could have a predictive value for early sepsis in an emergency department [31].In the study of Lázaro et al, the Ang2/Ang1 ratio was shown to be a predictor of severity among critically ill patients [33]. According to our research, the Ang-2/Ang-1 ratio is a potent severity indicator considerably higher in the critical group of COVID-19 patients, consistent with the findings of Abou-Arab et al research.…”

“…Different conditions such as diabetes mellitus, atherosclerosis, hypertension, endothelial dysfunction, and impaired angiogenesis contribute to microvascular dysfunction [11], [19]. It has been demonstrated that markers of endothelial dysfunction and angiogenesis markers have been predictors of disease severity in heart failure, renal failure, and after cardiac surgery [20], [21].…”

“…Originating in Wuhan, China, in early December 2019, coronavirus disease 19 (COVID-19) has spread rapidly, with cases confirmed in every country. Coronavirus disease 2019 (COVID- 19), caused by the SARS-CoV-2 infection, belongs to the subfamily Coronavirinae in the family Coronaviridae [1]. It is still a persistent threat to global public health, resulting in widespread morbidity and mortality and highly intensive care unit use.…”

“…Many studies have suggested that an increase in Ang-2 and a decrease in Ang-1 may be indicative of a pro-inflammatory state that is best described by the Ang-2 to Ang-1 ratio [16,17]. Considering these findings, our primary objective was to examine the relationship between decreased Ang-1 and increased Ang-2 concentrations and the Ang-2/Ang-1 ratio with clinical outcomes [18,19]. They may appear valid as disease severity and survival biomarkers and a prospective and promising therapeutic target.…”

Comparison of Different Vascular Biomarkers for Predicting In-Hospital Mortality in Severe SARS-CoV-2 Infection

“…In parallel, increased serum levels of VCAM-1 were described in COVID-19 patients with distinct severity under dexamethasone treatment in correlation with classic sepsis biomarkers soluble urokinase-type plasminogen activator receptor and presepsin [ 52 ]. Recently, Lázaro et al proved that an even more augmented concentration of VCAM-1, with a high acute-lung-injury-specific angiopoeitin-2/angiopoietin-1 ratio, predicted unfavourable outcomes with a good efficacy in critically ill COVID-19 patients with diabetes mellitus [ 53 ]. In our current study, serum VCAM-1 showed a significant elevation in both survivors and non-survivors vs. controls and effectively distinguished these two COVID-19 subgroups from each other.…”