Jesna Jose1,2, Hasan M Al-Dorzi3, Awad Al-Omari4, Yasser Mandourah5, Fahad Al-Hameed6, Musharaf Sadat3, Eman Al Qasim3, Basem Alraddadi7,8, Abdulrahman Al Harthy9, Ghaleb A Al Mekhlafi10, Abdullah Almotairi11, Kasim Al Khatib12, Ahmed Abdulmomen13, Ismael Qushmaq14, Anees A Sindi15, Ahmed Mady9,16, Othman Solaiman17, Rajaa Al-Raddadi18, Khalid Maghrabi17, Ahmed Ragab19, Ayman Kharaba20, Sarah Shalhoub21,22, Abdulsalam M Al-Aithan23, Gajendra K Vishwakarma2, Atanu Bhattacharjee24, Yaseen M Arabi25. 1. Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. 2. Department of Mathematics & Computing, Indian Institute of Technology (ISM), Dhanbad, Jharkhand, 826004, India. 3. Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 4. Department of Intensive Care, College of Medicine, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia. 5. Military Medical Services, Ministry of Defense, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. 6. Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia. 7. Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. 8. Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia. 9. Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia. 10. Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. 11. Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. 12. Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia. 13. Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia. 14. Section of Critical Care Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. 15. Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 16. Tanta University Hospitals, Tanta, Egypt. 17. Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 18. Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 19. Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia. 20. Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah, Saudi Arabia. 21. Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada. 22. King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. 23. Department of Medicine, Critical Care Division, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia. 24. Homi Bhaba National Institute, Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India. 25. Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. arabi@ngha.med.sa.
Abstract
BACKGROUND: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS). METHODS: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012-January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality. RESULTS: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p < 0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72). CONCLUSIONS: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.
BACKGROUND:Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically illpatients with diabetes and Middle East Respiratory Syndrome (MERS). METHODS: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012-January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically illpatients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality. RESULTS: Of the 350 critically illpatients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p < 0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72). CONCLUSIONS: Half of the critically illpatients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.
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