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1 . 2022

Risk factors for fatal outcome in patients with type 2 diabetes mellitus and a new coronavirus infection

Abstract

Diabetes mellitus (DM) is one of the most common pathologies that aggravates the course of COVID-19 (COronaVIrus Disease 2019) and Leads to a fatal outcome. Therefore, it is important to identify factors that can predict the features of development and risk in patients with type 2 diabetes mellitus (T2DM) and COVID-19.

The aim - to evaluate the features of the course and prognostic risk factors of clinical outcomes in patients with a new coronavirus infection and T2DM.

Material and methods. A retrospective study of patients hospitalized in the City Clinical Hospital 52 with a polymerase chain reaction (PCR) confirmed diagnosis of COVID-19 and Lung tissue damage according to computed tomography (CT) data in the «first» (n=1460) and «second wave» (n=1754) of the pandemic was conducted. The participants from the «first wave» of the pandemic were divided into two groups: the first one consisted of patients with established T2DM (n=303), and the second - peopLe without diabetes (n=1144). Then from the group of patients without diabetes, patients comparable in gender and age to the group with T2DM (n=415) were selected by propensity score matching. In these groups, the presence of concomitant pathology, clinical and laboratory parameters and the degree of lung damage were assessed according to CT data at admission and on the seventh day.

Results and discussion. The prevalence of T2DM among patients with COVID-19 was 19.5%. The proportion of deaths in patients with T2DM prevailed compared to patients without diabetes: 18.8 vs 10,8% in the «first wave» (p<0.001) and 16.1 vs 6.9% in the «second wave» (p<0.001). There was a higher prevalence of concomitant diseases in the T2DM group compared to the group without DM: by the presence of arterial hypertension (AH) (87.5 vs 60.2%, p<0.001), coronary heart disease (CHD) (32.7 vs 17.4%, p<0.001), chronic heart failure (CHF) (29.4 vs 12.3%, p<0.001), obesity (55.1 vs 20.2%, p<0.001), chronic kidney disease (CKD) C 3a (52.2 vs 39.8%, p=0.001). The severe course of COVID-19 in the T2DM group prevailed - 60.1 vs 47.0% (p=0.001), as well as the number of patients transferred to the intensive care unit (29.4 vs 18.8%, p=0.001). The frequency of fatal outcomes in the T2DM group, compared with the group without DM, is 1.5 times higher (18.8 vs 12.5%, p=0.021). There were no gender differences in mortality in the group of patients with T2DM (50.9% of men and 49.1% of women, p=0.286). Upon admission, patients with T2DM had brighter disease manifestations reflecting the severity of COVID-19: reduced SpO2, higher markers of inflammation (leukocytes, C-reactive protein, fibrinogen), lower glomerular filtration rate (GFR) and left ventricular ejection fraction (LVEF).

In the T2DM group, the presence of AH increased the risk of death by 9.9 times [95% confidence interval (CI) 1.33-73.85, p=0.003)]. In the group without DM, hypertension increased the risk of death by 3,6 times (95% CI 1.7-7.6, p<0.001). In this group the presence of CHF significantly increased the risk of death by 2.5 times (95% CI 1.21-5.15, p=0.021), CHD - by 2.4 times (95% CI 1.28-4.69, p=0.01), male sex - by 1.9 times (95% CI 1.07-3.5, p=0.027), whereas in the group of patients with T2DM no reliable results were obtained for these risk factors. Obesity didn't affect the fatal outcome in both groups.

In the T2DM group, with lower levels of lactate dehydrogenase (LDH) (302.7 vs 329.5 U/l), D-dimer (394 vs 471.5 ng/ml), interleukin-6 (IL-6) (47.9 vs 52.3 pg/ml), as well as at a younger age (66 years vs 71 years), the risk of death is higher than in the control group. Fasting plasma glucose >6.3 mmol/l is a significant risk factor for death in patients without T2DM.

Conclusion. T2DM is a significant risk factor for death in patients with COVID-19. The presence of AH, younger age (66 years vs 71 years), as well as lower indicators of markers of inflammation (LDH, IL-6) and coagulation (D-dimer) in patients with T2DM, compared with patients without diabetes, lead to the development of a fatal outcome. These parameters can serve as risk assessment factors for the predicted outcome.

Keywords:COVID 19; diabetes mellitus; risk factors; fatal outcome; markers of inflammation; pandemic

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Markova T.N., Ponomareva A.A., Samsonova I.V., Kichigin V.A., Arefieva N.A. Risk factors for fatal outcome in patients with type 2 diabetes mellitus and a new coronavirus infection. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2022; 11 (1): 8-16. DOI: https://doi.org/10.33029/2304-9529-2022-11-1-8-16 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
Конгресс, посвященный Всемирному дню борьбы с ожирением
Эндокринология столицы - Московский городской съезд эндокринологов
РОСМЕДОБР 2021
Вскрытие
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