Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease

Abstract

Background: Diabetes mellitus (DM) and cardiovascular disease (CVD) are present in a large number of patients with novel Coronavirus disease 2019 (COVID-19). We aimed to determine the risk and predictors of in-hospital mortality from COVID-19 in patients with DM and CVD. Methods: This retrospective cohort study included hospitalized patients aged ≥ 18 years with confirmed COVID-19 in Alborz province, Iran, from 20 February 2020 to 25 March 2020. Data on demographic, clinical and outcome (in-hospital mortality) data were obtained from electronic medical records. Self-reported comorbidities were classified into the following groups: "DM" (having DM with or without other comorbidities), "only DM" (having DM without other comorbidities), "CVD" (having CVD with or without other comorbidities), "only CVD" (having CVD without other comorbidities), and "having any comorbidity". Multivariate logistic regression models were fitted to quantify the risk and predictors of in-hospital mortality from COVID-19 in patients with these comorbidities. Results: Among 2957 patients with COVID-19, 2656 were discharged as cured, and 301 died. In multivariate model, DM (OR: 1.62 (95% CI 1.14-2.30)) and only DM (1.69 (1.05-2.74)) increased the risk of death from COVID-19; but, both CVD and only CVD showed non-significant associations (p > 0.05). Moreover, "having any comorbidities" increased the risk of in-hospital mortality from COVID-19 (OR: 2.66 (95% CI 2.09-3.40)). Significant predictors of mortality from COVID-19 in patients with DM were lymphocyte count, creatinine and C-reactive protein (CRP) level (all P-values < 0.05). Conclusions: Our findings suggest that diabetic patients have an increased risk of in-hospital mortality following COVID-19; also, lymphocyte count, creatinine and CRP concentrations could be considered as significant predictors for the death of COVID-19 in these patients.

An investigation of risk factors of in-hospital death due to COVID-19: a case-control study in Rasht, Iran

“…The majority of prior research has focused on the association between having diabetes history instead of blood sugar levels and COVID-19 fatality risk. Therefore, almost similar to our findings, some research and review articles found a negative association between hyperglycemia, weak glycemic control, and diabetes with COVID-19 fatality [3,7,12,[20][21][22][23][24][25]. As such, a recent systematic review recommended that health care providers consider monitoring blood glucose levels to be lower than 180 mg/dl (without triggering hypoglycemia) in most diabetic patients who have COVID-19 [7].…”

“…On the other hand, COVID-19 intensifies the complications and prognosis of diabetes, such as diabetic ketoacidosis. However, it is not well-understood whether blood sugar directly affects SARS-CoV-2 infection progression or the virus changes carbohydrates' metabolism [9,12,13,20,26].…”

“…Additionally, in a retrospective cohort study comprised of 2957 hospitalized Iranian COVID-19 cases (2656 were cured, and 301 died), consistent with our findings, it was demonstrated that cured or discharged subjects had significantly lower serum CRP levels (median = 16 mg/l) than the patients who died (median = 45 mg/l). Also, after considering confounding factors including sex, age, and laboratory values in the multivariable model, it was revealed that CRP levels raised the risk of death from SARS-CoV-2 infection among those who had diabetes with or without other comorbidities (n = 267) (OR = 1.02; 95% = 1.0-1.04), or CVDs with or without other comorbidities (n = 168) (OR = 1.09; 95% CI = 1.04-1.14) [12]. The positive correlation between disease severity and serum CRP concentrations and the value of this inflammatory marker as a predictor of CIVID-19 progression and its complications, including respiratory failure and requiring ventilator support, have additionally been confirmed in further studies [26,[28][29][30][31].…”

“…morbidity, there is no clearly defined risk factor. Advance ages (≥ 65 years), using immunosuppressive medications, smoking, having a history of type 2 diabetes mellitus, dyslipidemia, obesity or increased body weight (body mass index (BMI) ≥ 40 kg/m 2 ), cardiovascular disease (CVD), particularly hypertension (HTN), and ischemic heart diseases and renal disorders are among the most known risk factors for increasing the severity and death rates related to the novel RNA coronavirus (acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) [1,[3][4][5][6][7][8][9][10][11][12].…”

Shelter from the cytokine storm: pitfalls and prospects in the development of SARS-CoV-2 vaccines for an elderly population

“…It is widely reported that most deaths occurred among patients with at least one underlying disease, such as hypertension [4] and diabetes mellitus [5]. A meta-analysis of seven clinical studies performed in China identified chronic obstructive pulmonary disease (COPD), cardiovascular disease, and hypertension as risk factors for severe disease and intensity care unit (ICU) admission [6].…”