Proportion and mortality of Iranian diabetes mellitus, chronic kidney disease, hypertension and cardiovascular disease patients with COVID-19: a meta-analysis

Abstract

Background Currently, the number of patients with SARS-COV-2 infection has increased rapidly in Iran, but the risk and mortality of SARS-COV-2 infection in Iranian patients with diabetes mellitus (DM), chronic kidney disease (CKD), hypertension and cardiovascular diseases (CVDs) still not clear. The aim of this meta-analysis was to estimate the proportion and mortality of SARS-COV-2 in these patients. Methods A comprehensive literature search was carried out in PubMed, Web of Sciences, Cochrane Library, EMBASE, CNKI, SciELO, and other databases to identify all relevant studies published up to 10 January, 2020. The proportion and mortality in the patients were assessed by odd ratio (OR) and the corresponding 95 % confidence interval (95 % CI). Results A total of ten case-series including 11,755 cases with SARS-COV-2 infection and 942 deaths were selected. Among them, there were total of 791 DM patients with 186 deaths, 225 CKD patients with 45 deaths, 790 hypertension cases with 86 deaths, and 471 CVDs cases with 60 deaths. Pooled data revealed that the proportion of SARS-COV-2 infection in the patients with hypertension, DM, CVDs and CKD were 21.1 %, 16.3 %, 14.0 % and 5.0 %, respectively. Moreover, the SARS-COV-2 infection were associated with an increased risk of mortality in DM (OR = 0.549, CI 95 % 0.448-0.671, p ≤ 0.001) and CKD (OR = 0.552, 95 % CI 0.367-0.829, p = 0.004) patients, but not hypertension and CVDs. There was no publication bias. Conclusions Our pooled data showed that the proportion of SARS-COV-2 infection was the highest in the Iranian patients with hypertension (21.1 %) followed by DM (16.3 %), CVDs (14.0 %) and CKD (5.0 %). Moreover, DM and CKD in patients with SARS-COV-2 infection were associated with a 0.549 and 0.552-fold increase in mortality, respectively. Clinicians in Iran should be aware of these findings, to identifying patients at higher risk and inform interventions to reduce the risk of death. Moreover, well-designed, large-scale and multicenter studies are needed to improve and validate our findings.

Impact of Kidney Failure on the Severity of COVID-19

“…Among patients with COVID-19 hospitalized in 30 Polish centers included in the current analysis, nearly 20% were diagnosed with CKD, of which 18% presented severe renal failure. In addition to the worse patient’s status regarding the severity of COVID-19 when admitted to the hospital, we found the pre-existing renal disease to be independently associated with higher in-hospital mortality, especially in those with severe kidney failure, and our findings are in line with the results of previous studies [ 13 , 14 , 22 , 23 , 24 , 25 , 26 ]. The Global Burden of Disease (GBD) collaboration recently estimated the risk factors for severe COVID-19 worldwide using results from international databases and large multimorbidity studies from different countries, and determined that CKD is a condition conveying the highest risk for the severe presentation of the disease and COVID-19-related death [ 27 ].…”

“…The impact of coexisting diseases was investigated in many studies and results are divergent depending on the analyzed population, sample size, and the nature of the study. Meta-analysis performed among Iranian patients by Merjalili et al revealed that diabetes was associated with higher mortality, while arterial hypertension was not [ 26 ]. Park et al analyzed the Korean population and found both diabetes and hypertension to be risk factors for death in the course of COVID-19 [ 34 ].…”

Coronavirus Disease (COVID)-19 and Diabetic Kidney Disease

“…Persistent renin-angiotensin-aldosterone system (RAAS) activation and disruption in central metabolism encourage proteinuria and renal fibrosis [ 38 , 39 , 40 ]. There are recent reports of SARS-CoV-2 infections in diabetes and DKD [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Figure 1 demonstrates the role of RAAS in the understanding of SARS-CoV-2 in diabetes.…”

New onset of diabetes in a child infected with COVID-19: a case report

“…The patient was admitted under the impression of diabetic ketoacidosis (DKA). The initial laboratory data (with normal range in parenthesis) showed a high Blood Sugar level (BS): 487 mg/dL (< 140), HbA1c: 7.2% (< 6.5%), pH: 6.7 (7.35-7.45), Bicarbonate (HCO 3 ): 4.2 mEq/L (22-26), Anti GAD65: negative, Insulin Antibody (Ab): negative, Carbon Dioxide (pCO 2 ): 21.7 mmHg (30-50), Urine Ketone: 1 + , Sodium (Na): 128 mEq/L (134-145), Potassium (K): 2.5 mEq/L (3.5-5.5), WBC: 11,400 /µL (3500-10,000), RBC: 6,100,000 /µL (3,600,000-6,100,000), Hemoglobin: 15 gr/dL (11.5-18.8), PLT: 354 /mL (150-450), CRP: negative, Magnesium (Mg): 2.2 mg/dL (1.5-2.3), Phosphorus (P): 1.7 mg/dL (3.9-7.7), Blood Urea Nitrogen (BUN): 90 mg/dL (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), and Creatinine (Cr): 0.6 mg/dL (0.7-1.4). Additionally, due to the patient's contact with his mother, all the laboratory workups related to COVID-19 were done.…”

“…Recently, evidence showed that an association may exist between diabetes and higher risk of COVID-19 infection and the increased mortality rate [6]. On the other hand, in some people infected with COVID-19, new-onset diabetes has been reported and in some others, severe metabolic complications occurring in PWD have been observed [7][8][9].…”