Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study

Aims/hypothesis Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVI...

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Vydáno v:	Diabetologia Ročník 63; číslo 8; s. 1500 - 1515
Hlavní autoři:	Cariou, Bertrand, Hadjadj, Samy, Wargny, Matthieu, Pichelin, Matthieu, Al-Salameh, Abdallah, Allix, Ingrid, Amadou, Coralie, Arnault, Gwénaëlle, Baudoux, Florence, Bauduceau, Bernard, Borot, Sophie, Bourgeon-Ghittori, Muriel, Bourron, Olivier, Boutoille, David, Cazenave-Roblot, France, Chaumeil, Claude, Cosson, Emmanuel, Coudol, Sandrine, Darmon, Patrice, Disse, Emmanuel, Ducet-Boiffard, Amélie, Gaborit, Bénédicte, Joubert, Michael, Kerlan, Véronique, Laviolle, Bruno, Marchand, Lucien, Meyer, Laurent, Potier, Louis, Prevost, Gaëtan, Riveline, Jean-Pierre, Robert, René, Saulnier, Pierre-Jean, Sultan, Ariane, Thébaut, Jean-François, Thivolet, Charles, Tramunt, Blandine, Vatier, Camille, Roussel, Ronan, Gautier, Jean-François, Gourdy, Pierre
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2020 Springer Nature B.V Springer Verlag
Témata:	Age Aged Aged, 80 and over Aldosterone Angiotensin Apnea Body mass index C-reactive protein Cell number Coronavirus Infections - complications Coronavirus Infections - metabolism Coronavirus Infections - pathology Coronavirus Infections - therapy Coronaviruses COVID-19 Death Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - metabolism Diabetes Mellitus, Type 2 - pathology Diabetes Mellitus, Type 2 - virology Dyspnea Emerging diseases Endocrinology and metabolism Female Genotype & phenotype Glucose Glycated Hemoglobin A - metabolism Hemoglobin Human health and pathology Human Physiology Humans Hypertension Hypertension - pathology Infectious diseases Inpatients - statistics & numerical data Internal Medicine Intubation Life Sciences Lymphocytes Male Mechanical ventilation Medical prognosis Medicine Medicine & Public Health Metabolic Diseases Microvasculature Middle Aged Pandemics Pathophysiology Pneumonia, Viral - complications Pneumonia, Viral - metabolism Pneumonia, Viral - pathology Pneumonia, Viral - therapy Prognosis Renin Respiration, Artificial - statistics & numerical data Risk Factors Santé publique et épidémiologie Severe acute respiratory syndrome coronavirus 2 Sleep Sleep apnea Sleep disorders France COVID-19 Hypertension HbA Death Diabetes Mechanical ventilation BMI HbA1c
ISSN:	0012-186X, 1432-0428, 1432-0428
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Shrnutí:	Aims/hypothesis Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown. Methods We conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 French centres in the period 10–31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission. Age- and sex-adjusted multivariable logistic regressions were performed to assess the prognostic value of clinical and biological features with the endpoint. ORs are reported for a 1 SD increase after standardisation. Results The current analysis focused on 1317 participants: 64.9% men, mean age 69.8 ± 13.0 years, median BMI 28.4 (25th–75th percentile: 25.0–32.7) kg/m 2 ; with a predominance of type 2 diabetes (88.5%). Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively. The primary outcome was encountered in 29.0% (95% CI 26.6, 31.5) of participants, while 10.6% (9.0, 12.4) died and 18.0% (16.0, 20.2) were discharged on day 7. In univariate analysis, characteristics prior to admission significantly associated with the primary outcome were sex, BMI and previous treatment with renin–angiotensin–aldosterone system (RAAS) blockers, but not age, type of diabetes, HbA 1c , diabetic complications or glucose-lowering therapies. In multivariable analyses with covariates prior to admission, only BMI remained positively associated with the primary outcome (OR 1.28 [1.10, 1.47]). On admission, dyspnoea (OR 2.10 [1.31, 3.35]), as well as lymphocyte count (OR 0.67 [0.50, 0.88]), C-reactive protein (OR 1.93 [1.43, 2.59]) and AST (OR 2.23 [1.70, 2.93]) levels were independent predictors of the primary outcome. Finally, age (OR 2.48 [1.74, 3.53]), treated obstructive sleep apnoea (OR 2.80 [1.46, 5.38]), and microvascular (OR 2.14 [1.16, 3.94]) and macrovascular complications (OR 2.54 [1.44, 4.50]) were independently associated with the risk of death on day 7. Conclusions/interpretations In people with diabetes hospitalised for COVID-19, BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days. Trial registration clinicaltrials.gov NCT04324736.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0012-186X 1432-0428 1432-0428
DOI:	10.1007/s00125-020-05180-x