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Factors associated with critical care requirements in diabetic patients treated with dexamethasone for COVID-19 infection in the first wave of the pandemia.
Batule, Sol; Soldevila, Berta; Figueredo, Carme; Julián, María Teresa; Egea-Cortés, Laia; Reyes-Ureña, Juliana; Casabona, Jordi; Mateu, Lourdes; Paredes, Roger; Clotet, Bonaventura; López, Rosa; Puig-Domingo, Manel; Alonso, Núria.
  • Batule S; Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute and Hospital, Badalona, Spain.
  • Soldevila B; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Figueredo C; Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute and Hospital, Badalona, Spain.
  • Julián MT; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Egea-Cortés L; Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute and Hospital, Badalona, Spain.
  • Reyes-Ureña J; Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute and Hospital, Badalona, Spain.
  • Casabona J; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Mateu L; Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.
  • Paredes R; Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.
  • Clotet B; Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.
  • López R; Infectious Disease Service, Germans Trias i Pujol Research Institute and Hospital, Badalona, Spain.
  • Puig-Domingo M; Infectious Disease Service, Germans Trias i Pujol Research Institute and Hospital, Badalona, Spain.
  • Alonso N; IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain.
Front Endocrinol (Lausanne) ; 13: 1009028, 2022.
Article in English | MEDLINE | ID: covidwho-2198764
ABSTRACT

Introduction:

Diabetes mellitus (DM) and hyperglycemia are important risk factors for poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to analyze the factors associated with the composite outcome of the necessity of invasive mechanical ventilation (IMV) or admission to the intensive care unit (ICU) in subjects with severe COVID-19 infection treated with dexamethasone comparing patients with DM vs. patients without DM. Research design and

methods:

An observational retrospective cohort study was performed, including hospitalized subjects with a diagnosis of SARS-CoV-2 pneumonia. Inclusion criteria were age ≥18 years old with severe COVID-19 disease requiring daily intravenous 6 mg dexamethasone treatment for 10 days. Exclusion criteria were <18 years old, non-severe illness and/or patients in charge of ICU. Variables related to clinical and analytical parameters, glycemic control, acquired-hospital superinfections, mortality, IMV requirement, ICU admission and length of stay were included.

Results:

Two hundred and nine individuals with COVID-19 disease treated with dexamethasone were included. One hundred twenty-five out of these subjects (59.8%) were patients with DM. Overall, from the 209 subjects, 66 (31.6%) required IMV or were admitted to the ICU, with significant differences between patients with DM (n=50) vs. patients without DM (n=16) (76% vs. 24%, p=0.002). Among the group of subjects with DM (n=125), those who required IMV or were admitted to the ICU showed higher serum concentrations of C-reactive protein, interleukin-6, D-dimer, ferritin and pro-calcitonin and significantly lower serum concentrations of albumin compared to those who did not require IMV or were not admitted to the ICU. Besides, between these two groups of patients with DM, we observed no differences in glycemic parameters, including median capillary blood glucose values, glycosylated hemoglobin, coefficient of variability and hypoglycemic episodes. In the multinomial analysis, factors independently associated with the composite outcome of IMV or admission to the ICU in the insulin-treated group were the National Early Warning Score (NEWS) 2 score (OR 1.55 [1.17-2.17], p=0.005) and the presence of hospital-acquired superinfections (OR 35.21 [5.11-386.99], p=0.001).

Conclusions:

In our study, parameters related to glycemic control were not associated with IMV requirement nor admission to the ICU in patients with DM and severe COVID-19 disease receiving daily 6 mg of dexamethasone for 10 days. However, hospital-acquired superinfections and disease severity at admission were independent factors associated with this composite outcome.
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Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Superinfection / Diabetes Mellitus / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adolescent / Humans Language: English Journal: Front Endocrinol (Lausanne) Year: 2022 Document Type: Article Affiliation country: Fendo.2022.1009028

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Superinfection / Diabetes Mellitus / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adolescent / Humans Language: English Journal: Front Endocrinol (Lausanne) Year: 2022 Document Type: Article Affiliation country: Fendo.2022.1009028