tetano
Editor, Senior Moderator
Diabetologia
. 2020 May 29.
doi: 10.1007/s00125-020-05180-x. Online ahead of print.
Phenotypic Characteristics and Prognosis of Inpatients With COVID-19 and Diabetes: The CORONADO Study
Bertrand Cariou[SUP] 1 [/SUP], Samy Hadjadj[SUP] 2 [/SUP], Matthieu Wargny[SUP] 3 4 [/SUP], Matthieu Pichelin[SUP] 3 [/SUP], Abdallah Al-Salameh[SUP] 5 [/SUP], Ingrid Allix[SUP] 6 [/SUP], Coralie Amadou[SUP] 7 [/SUP], Gw?na?lle Arnault[SUP] 8 [/SUP], Florence Baudoux[SUP] 9 [/SUP], Bernard Bauduceau[SUP] 10 11 [/SUP], Sophie Borot[SUP] 12 [/SUP], Muriel Bourgeon-Ghittori[SUP] 13 [/SUP], Olivier Bourron[SUP] 14 [/SUP], David Boutoille[SUP] 15 [/SUP], France Cazenave-Roblot[SUP] 16 17 [/SUP], Claude Chaumeil[SUP] 18 [/SUP], Emmanuel Cosson[SUP] 19 20 [/SUP], Sandrine Coudol[SUP] 4 [/SUP], Patrice Darmon[SUP] 21 [/SUP], Emmanuel Disse[SUP] 22 [/SUP], Am?lie Ducet-Boiffard[SUP] 23 [/SUP], B?n?dicte Gaborit[SUP] 24 [/SUP], Michael Joubert[SUP] 25 [/SUP], V?ronique Kerlan[SUP] 26 [/SUP], Bruno Laviolle[SUP] 27 [/SUP], Lucien Marchand[SUP] 28 [/SUP], Laurent Meyer[SUP] 29 [/SUP], Louis Potier[SUP] 30 [/SUP], Ga?tan Prevost[SUP] 31 [/SUP], Jean-Pierre Riveline[SUP] 32 33 34 [/SUP], Ren? Robert[SUP] 35 [/SUP], Pierre-Jean Saulnier[SUP] 36 [/SUP], Ariane Sultan[SUP] 37 [/SUP], Jean-Fran?ois Th?baut[SUP] 18 [/SUP], Charles Thivolet[SUP] 38 39 [/SUP], Blandine Tramunt[SUP] 40 [/SUP], Camille Vatier[SUP] 41 42 [/SUP], Ronan Roussel[SUP] 30 [/SUP], Jean-Fran?ois Gautier[SUP] 32 34 [/SUP], Pierre Gourdy[SUP] 40 [/SUP], CORONADO investigators
Affiliations
Abstract
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[SUP]2[/SUP]; 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[SUB]1c[/SUB], 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.
Keywords: BMI; COVID-19; Death; Diabetes; HbA1c; Hypertension; Mechanical ventilation.
. 2020 May 29.
doi: 10.1007/s00125-020-05180-x. Online ahead of print.
Phenotypic Characteristics and Prognosis of Inpatients With COVID-19 and Diabetes: The CORONADO Study
Bertrand Cariou[SUP] 1 [/SUP], Samy Hadjadj[SUP] 2 [/SUP], Matthieu Wargny[SUP] 3 4 [/SUP], Matthieu Pichelin[SUP] 3 [/SUP], Abdallah Al-Salameh[SUP] 5 [/SUP], Ingrid Allix[SUP] 6 [/SUP], Coralie Amadou[SUP] 7 [/SUP], Gw?na?lle Arnault[SUP] 8 [/SUP], Florence Baudoux[SUP] 9 [/SUP], Bernard Bauduceau[SUP] 10 11 [/SUP], Sophie Borot[SUP] 12 [/SUP], Muriel Bourgeon-Ghittori[SUP] 13 [/SUP], Olivier Bourron[SUP] 14 [/SUP], David Boutoille[SUP] 15 [/SUP], France Cazenave-Roblot[SUP] 16 17 [/SUP], Claude Chaumeil[SUP] 18 [/SUP], Emmanuel Cosson[SUP] 19 20 [/SUP], Sandrine Coudol[SUP] 4 [/SUP], Patrice Darmon[SUP] 21 [/SUP], Emmanuel Disse[SUP] 22 [/SUP], Am?lie Ducet-Boiffard[SUP] 23 [/SUP], B?n?dicte Gaborit[SUP] 24 [/SUP], Michael Joubert[SUP] 25 [/SUP], V?ronique Kerlan[SUP] 26 [/SUP], Bruno Laviolle[SUP] 27 [/SUP], Lucien Marchand[SUP] 28 [/SUP], Laurent Meyer[SUP] 29 [/SUP], Louis Potier[SUP] 30 [/SUP], Ga?tan Prevost[SUP] 31 [/SUP], Jean-Pierre Riveline[SUP] 32 33 34 [/SUP], Ren? Robert[SUP] 35 [/SUP], Pierre-Jean Saulnier[SUP] 36 [/SUP], Ariane Sultan[SUP] 37 [/SUP], Jean-Fran?ois Th?baut[SUP] 18 [/SUP], Charles Thivolet[SUP] 38 39 [/SUP], Blandine Tramunt[SUP] 40 [/SUP], Camille Vatier[SUP] 41 42 [/SUP], Ronan Roussel[SUP] 30 [/SUP], Jean-Fran?ois Gautier[SUP] 32 34 [/SUP], Pierre Gourdy[SUP] 40 [/SUP], CORONADO investigators
Affiliations
- PMID: 32472191
- DOI: 10.1007/s00125-020-05180-x
Abstract
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[SUP]2[/SUP]; 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[SUB]1c[/SUB], 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.
Keywords: BMI; COVID-19; Death; Diabetes; HbA1c; Hypertension; Mechanical ventilation.