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3 . 2022

Predictors of mortality in severe cases of coronavirus infection in patients with type 2 diabetes mellitus

Abstract

Diabetes mellitus (DM) worsens the outcome of almost any acute or chronic disease, leading to a reduction in life expectancy. According to scientific data, diabetes mellitus leads to a 2–3-fold increase in the incidence of adverse disease outcomes. Mortality from COVID‑19 throughout the world remains high, so the study of predictors of mortality in patients with COVID‑19 is an urgent and not fully understood problem.

The aim – to conduct a comparative analysis of predictors of death in patients with type 2 diabetes mellitus (T2DM).

Material and methods. The analysis of clinical and laboratory parameters in patients with COVID‑19 and T2DM hospitalized in the intensive care unit in groups with a fatal and a favorable outcome of the disease was carried out.

Results and discussion. The levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), aspartate aminotransferase (AST) during hospitalization were significantly higher in the fatal group compared with the control group: 14.15 mg/l [5.56; 44.63] vs 4,6 mg/l [3.82; 8,22] at p=0,0251, 324.05 U/l [261.35; 406.45] vs 194,6 U/l [166.20; 258.72] at p=0.0199 and 44.27 U/L [23.94; 88.34] vs 24,1 U/L [19.81; 31.72] at p=0,0092, respectively. An increase in alanine aminotransferase (ALT) levels in dynamics was revealed: in the group with a fatal outcome, it increased from 25.2 U/l at admission to 44.34 U/l before discharge/death (p=0.0273) and in the control group – from 24.4 to 37.7 U/l at p<0.0001. The levels of fasting plasma glucose (FPG) and creatinine in dynamics increased from 6.3 to 13.9 mmol/l at p=0.0078 and from 104.4 to 111.6 µmol/l at p<0,0001, respectively, in fatal patients. An increase in the level of creatinine, urea, CRP, AST, LDH, a decrease in glomerular filtration rate and blood albumin, proteinuria significantly increases the risk of hospital death in patients with T2DM complicated by coronavirus infection, which was also confirmed during the Receiver operating characteristic (ROC analysis).

Conclusion. The risk of death from coronavirus infection in people with diabetes increases with age. C-reactive protein is a non-specific, relevant, and clinically significant predictor of mortality in T2DM and COVID‑19. T2DM is a comorbid disease and acute multiple organ disorders develop with the addition of a coronavirus infection.

Keywords:coronavirus infection; diabetes mellitus; predictors; clinical and laboratory indicators; fatal outcome

Funding. The study had no sponsor support.

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

For citation: Khamidullina Z.Z., Nagaev I.R., Bobrik A.G., Avzaletdinova D.Sh., Morugova T.V., Zagidullin N.Sh., Gareeva D.F. Predictors of mortality in severe cases of coronavirus infection in patients with type 2 diabetes mellitus. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2022; 11 (3): 15–26. DOI: https://doi.org/10.33029/2304-9529-2022-11-3-15-26 (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)
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