Gemma Llauradó1,2, Bogdan Vlacho3,4, Matthieu Wargny5,6, Yue Ruan7,8, Dídac Mauricio9,10, Josep Franch-Nadal2,3,11, Pere Domingo12, Pierre Gourdy13, Pierre-Jean Saulnier14, Samy Hadjadj5, Sarah H Wild15, Rustam Rea7,8, Bertrand Cariou5, Kamlesh Khunti16. 1. Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain. 2. Department of Endocrinology and Nutrition, Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain. 3. DAP_CAT Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari Per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGol), Barcelona, Spain. 4. Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 5. L'Institut du Thorax, Université de Nantes, CHU Nantes, CNRS, Nantes, Inserm, France. 6. CHU de Nantes, CIC Inserm 1413, Clinique Des Données, Nantes, France. 7. Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 8. Oxford NIHR Biomedical Research Centre, Oxford, UK. 9. Department of Endocrinology and Nutrition, Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain. didacmauricio@gmail.com. 10. Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain. didacmauricio@gmail.com. 11. Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain. 12. Infectious Diseases, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain. 13. CHU de Toulouse & UMR1297/I2MC, Inserm, Université de Toulouse, Toulouse, France. 14. Centre d'Investigation Clinique CIC 1402, Université de Poitiers, Inserm, CHU de Poitiers, Poitiers, France. 15. Usher Institute, University of Edinburgh, Edinburgh, UK. 16. Diabetes Research Centre, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Abstract
BACKGROUND: It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS: We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020-October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS: Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83-2.45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29-1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31-0.75], I2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40-0.68], I2 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS: This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.
BACKGROUND: It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS: We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020-October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS: Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83-2.45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29-1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31-0.75], I2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40-0.68], I2 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS: This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.
Authors: Robert Verity; Lucy C Okell; Ilaria Dorigatti; Peter Winskill; Charles Whittaker; Natsuko Imai; Gina Cuomo-Dannenburg; Hayley Thompson; Patrick G T Walker; Han Fu; Amy Dighe; Jamie T Griffin; Marc Baguelin; Sangeeta Bhatia; Adhiratha Boonyasiri; Anne Cori; Zulma Cucunubá; Rich FitzJohn; Katy Gaythorpe; Will Green; Arran Hamlet; Wes Hinsley; Daniel Laydon; Gemma Nedjati-Gilani; Steven Riley; Sabine van Elsland; Erik Volz; Haowei Wang; Yuanrong Wang; Xiaoyue Xi; Christl A Donnelly; Azra C Ghani; Neil M Ferguson Journal: Lancet Infect Dis Date: 2020-03-30 Impact factor: 25.071
Authors: Elizabeth J Williamson; Alex J Walker; Krishnan Bhaskaran; Seb Bacon; Chris Bates; Caroline E Morton; Helen J Curtis; Amir Mehrkar; David Evans; Peter Inglesby; Jonathan Cockburn; Helen I McDonald; Brian MacKenna; Laurie Tomlinson; Ian J Douglas; Christopher T Rentsch; Rohini Mathur; Angel Y S Wong; Richard Grieve; David Harrison; Harriet Forbes; Anna Schultze; Richard Croker; John Parry; Frank Hester; Sam Harper; Rafael Perera; Stephen J W Evans; Liam Smeeth; Ben Goldacre Journal: Nature Date: 2020-07-08 Impact factor: 49.962
Authors: Javier Perez-Saez; Stephen A Lauer; Laurent Kaiser; Simon Regard; Elisabeth Delaporte; Idris Guessous; Silvia Stringhini; Andrew S Azman Journal: Lancet Infect Dis Date: 2020-07-14 Impact factor: 25.071