Predictors for COVID-Severity among Hospitalized Patients with Diabetes in Japan

ABSTRACT

Background: COVID-is a pandemic disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) . Diabetes is a major risk factor for the severe progression and outcome of COVID-infection. Although some risk factors have been revealed, determining undetected risk factors for severe infection would enable identifying patients who may benefit from aggressive supportive care and early intervention. Methods: A retrospective observational study of 100 diabetes patients who were admitted with confirmed COVID-infection was conducted. The patients were divided into two groups - severe and moderate - based on intensive care unit (ICU) admission. The differences between the groups were analyzed with multivariable logistic regression to reveal the risk factors. Results: Of 100 patients, the mean (SD) age was 62.1 (13.0) years, 70 (70.0%) were male, and 48 (48.0%) were ≥ 65 years. Among patients with severe COVID-infection, 25 (25%) were admitted to ICU, and one patient died. Patients with severe infection had a significantly lower albumin level (severe 2.81 ± 0.37 g/dL vs. moderate 3.39 ± 0.50, p<0.01) , and a higher blood glucose (221.5 ± 91.3 mg/dL vs. 178.9 ± 73.4, p=0.02) , white blood cell count (8969 ± 5002 /μL vs. 6227 ± 2644, p=0.01) , C-reactive protein (CRP) (12.5 ± 9.2 mg/dL vs. 6.4 ± 5.5, p<0.01) , and lactate dehydrogenase (572.5 ± 165.9 U/L vs. 353.5 ± 150.9, p<0.01) level than did patients without severe infection. There was no significant difference with hypertension, dyslipidemia, smoking, obesity, and HbA1c. Patients with severe infection had significantly lower total protein and albumin levels. On multivariable logistic regression analysis, risk factors for severe infection included CRP on admission (odds ratio [OR], 1.090;95% CI, 1.005-1.183) , age (OR, 0.944;95% CI, 0.899-0.991) , and albumin (OR, 0.036;95% CI, 0.007-0.191) . Conclusions: In patients with diabetes, albumin was an independent predictor for the development of severe COVID-19.