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The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19).
Llauradó, Gemma; Vlacho, Bogdan; Wargny, Matthieu; Ruan, Yue; Franch-Nadal, Josep; Domingo, Pere; Gourdy, Pierre; Saulnier, Pierre-Jean; Hadjadj, Samy; Wild, Sarah H; Rea, Rustam; Cariou, Bertrand; Khunti, Kamlesh; Mauricio, Dídac.
  • Llauradó G; Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
  • Vlacho B; Department of Endocrinology and Nutrition, Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
  • Wargny M; 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.
  • Ruan Y; Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  • Franch-Nadal J; L'Institut du Thorax, Université de Nantes, CHU Nantes, CNRS, Nantes, Inserm, France.
  • Domingo P; CHU de Nantes, CIC Inserm 1413, Clinique Des Données, Nantes, France.
  • Gourdy P; Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Saulnier PJ; Oxford NIHR Biomedical Research Centre, Oxford, UK.
  • Hadjadj S; Department of Endocrinology and Nutrition, Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
  • Wild SH; 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.
  • Rea R; Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain.
  • Cariou B; Infectious Diseases, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
  • Khunti K; CHU de Toulouse & UMR1297/I2MC, Inserm, Université de Toulouse, Toulouse, France.
  • Mauricio D; Centre d'Investigation Clinique CIC 1402, Université de Poitiers, Inserm, CHU de Poitiers, Poitiers, France.
Cardiovasc Diabetol ; 21(1): 216, 2022 10 19.
Article in English | MEDLINE | ID: covidwho-2079423
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Myocardial Ischemia / Diabetes Mellitus / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Reviews Limits: Adult / Humans Language: English Journal: Cardiovasc Diabetol Journal subject: Vascular Diseases / Cardiology / Endocrinology Year: 2022 Document Type: Article Affiliation country: S12933-022-01657-8

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Myocardial Ischemia / Diabetes Mellitus / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Reviews Limits: Adult / Humans Language: English Journal: Cardiovasc Diabetol Journal subject: Vascular Diseases / Cardiology / Endocrinology Year: 2022 Document Type: Article Affiliation country: S12933-022-01657-8