Subject(s)
Anticoagulants/therapeutic use , COVID-19/blood , Enoxaparin/therapeutic use , Fibrin Fibrinogen Degradation Products/analysis , Kidney/physiopathology , SARS-CoV-2 , Thrombophilia/drug therapy , Thrombosis/prevention & control , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Body Weight , C-Reactive Protein/analysis , COVID-19/complications , Dose-Response Relationship, Drug , Enoxaparin/administration & dosage , Female , Guideline Adherence , Humans , Incidence , Intensive Care Units/statistics & numerical data , Male , Mean Platelet Volume , Middle Aged , Oxygen/blood , Practice Guidelines as Topic , Proportional Hazards Models , Retrospective Studies , Risk Factors , Thrombophilia/etiology , Thrombosis/epidemiology , Thrombosis/etiologyABSTRACT
INTRODUCTION: Patients with diabetes mellitus admitted to hospital with COVID-19 have poorer outcomes. However, the drivers of poorer outcomes are not fully elucidated. We performed detailed characterization of patients with COVID-19 to determine the clinical and biochemical factors that may be drivers of poorer outcomes. RESEARCH DESIGN AND METHODS: This is a retrospective cohort study of 889 consecutive inpatients diagnosed with COVID-19 between March 9 and April 22, 2020 in a large London National Health Service Trust. Unbiased multivariate logistic regression analysis was performed to determine variables that were independently and significantly associated with increased risk of death and/or intensive care unit (ICU) admission within 30 days of COVID-19 diagnosis. RESULTS: 62% of patients in our cohort were of non-white ethnic background and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death/admission to the ICU within 30 days of COVID-19 diagnosis. Male gender, lower platelet count, advancing age and higher Clinical Frailty Scale (CFS) score (but not diabetes) independently predicted poor outcomes on multivariate analysis. Antiplatelet medication was associated with a lower risk of death/ICU admission. Factors that were significantly and independently associated with poorer outcomes in patients with diabetes were coexisting ischemic heart disease, increasing age and lower platelet count. CONCLUSIONS: In this large study of a diverse patient population, comorbidity (ie, diabetes with ischemic heart disease; increasing CFS score in older patients) was a major determinant of poor outcomes with COVID-19. Antiplatelet medication should be evaluated in randomized clinical trials among high-risk patient groups.