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 1 , Samy Hadjadj 2 , Matthieu Wargny 3 4 , Matthieu Pichelin 3 , Abdallah Al-Salameh 5 , Ingrid Allix 6 , Coralie Amadou 7 , Gw?na?lle Arnault 8 , Florence Baudoux 9 , Bernard Bauduceau 10 11 , Sophie Borot 12 , Muriel Bourgeon-Ghittori 13 , Olivier Bourron 14 , David Boutoille 15 , France Cazenave-Roblot 16 17 , Claude Chaumeil 18 , Emmanuel Cosson 19 20 , Sandrine Coudol 4 , Patrice Darmon 21 , Emmanuel Disse 22 , Am?lie Ducet-Boiffard 23 , B?n?dicte Gaborit 24 , Michael Joubert 25 , V?ronique Kerlan 26 , Bruno Laviolle 27 , Lucien Marchand 28 , Laurent Meyer 29 , Louis Potier 30 , Ga?tan Prevost 31 , Jean-Pierre Riveline 32 33 34 , Ren? Robert 35 , Pierre-Jean Saulnier 36 , Ariane Sultan 37 , Jean-Fran?ois Th?baut 18 , Charles Thivolet 38 39 , Blandine Tramunt 40 , Camille Vatier 41 42 , Ronan Roussel 30 , Jean-Fran?ois Gautier 32 34 , Pierre Gourdy 40 , 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/m2; 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, HbA1c, 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.