Updated results from a study of hospitalised COVID-19 patients with diabetes shows 1 in 5 died within 28 days of hospitalisation, French researchers at Inserm, CNRS, University of Nantes, CHU Nantes, have reported. The updated results from the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which evaluated outcomes in diabetic French patients hospitalised for COVID-19 from 10 March through 10 April, 2020, show that among 2,796 patients, 577 (20.6%; 95% confidence interval [CI], 19.2% to 22.2%) died within 28 days of hospitalisation and 1,404 (50.2%; 95% CI, 48.3% to 52.1%) were discharged from the hospital. Results presented in May 2020 showed that 10% of patients who had diabetes and COVID-19 died within 7 days of hospitalisation.
The patients were mostly male (63.7%), with a mean age of 69.7 years, and the vast majority had type 2 diabetes (88.2%). Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of patients, respectively.
In multivariable models, younger age, routine metformin therapy, and longer symptom duration were positively associated with hospital discharge, while history of microvascular complications, anticoagulant routine therapy, shortness of breath on admission, abnormal levels of liver enzymes, and higher white blood cell counts and C-reactive protein levels were associated with a lower chance of discharge and a higher risk of death. Patients receiving routine treatment with insulin and statins also had a higher risk of death.
The study authors said establishing prognostic factors for hospital discharge and death in diabetic COVID-19 patients could help clinicians better manage this population and use hospital resources accordingly.
Study details
Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study
Matthieu Wargny, Louis Potier, Pierre Gourdy, Matthieu Pichelin, Coralie Amadou, Pierre-Yves Benhamou, Jean-Baptiste Bonnet, Lyse Bordier, Olivier Bourron, Claude Chaumeil, Nicolas Chevalier, Patrice Darmon, Blandine Delenne, Delphine Demarsy, Marie Dumas, Olivier Dupuy, Anna Flaus-Furmaniuk, Jean-François Gautier, Anne-Marie Guedj, Nathalie Jeandidier, Etienne Larger, Jean-Philippe Le Berre, Myriam Lungo, Nathanaëlle Montanier, Philippe Moulin, Françoise Plat, Vincent Rigalleau, René Robert, Dominique Seret-Bégué, Pierre Sérusclat, Sarra Smati, Jean-François Thébaut, Blandine Tramunt, Camille Vatier, Fritz-Line Velayoudom, Bruno Vergès, Patrice Winiszewski, Audrey Zabulon, Pierre-Antoine Gourraud, Ronan Roussel, Bertrand Cariou, Samy Hadjadj for the CORONADO investigators
Published in Diabetologia on 17 February 2021
Abstract
Aims/hypothesis
This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19).
Methods
The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days.
Results
We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors.
Conclusions/interpretation
In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period.
[link url="https://www.cidrap.umn.edu/news-perspective/2021/02/covid-19-scan-feb-18-2021"]CIDRAP material[/link]
[link url="https://link.springer.com/article/10.1007/s00125-020-05351-w#Abs1"]Diabetologia study (Open access)[/link]
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