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Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study.
Mayerhöfer, Timo; Klein, Sebastian; Wernly, Bernhard; Flaatten, Hans; Guidet, Bertrand; De Lange, Dylan W; Fjølner, Jesper; Leaver, Susannah; Beil, Michael; Sviri, Sigal; Bruno, Raphael Romano; Artigas, Antonio; van Heerden, Peter Vernon; Pinto, Bernardo Bollen; Schefold, Joerg C; Moreno, Rui; Cecconi, Maurizio; Szczeklik, Wojciech; Jung, Christian; Joannidis, Michael.
  • Mayerhöfer T; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
  • Klein S; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
  • Wernly B; Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria.
  • Flaatten H; Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria.
  • Guidet B; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
  • De Lange DW; Assistance Publique, Hôpitaux de Paris, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, 75012, Paris, France.
  • Fjølner J; Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
  • Leaver S; Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark.
  • Beil M; Department of Critical Care, St George's Hospital, London, UK.
  • Sviri S; Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Bruno RR; Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Artigas A; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
  • van Heerden PV; Intensive Intensive Care Medicine Department Corporacion Sanitària Parc Tauli CIBER Enfermedades Respiratorias Institut de Investigacio e Innovació I3PT, Autonomous University of Barcelona Sabadell, Sabadell, Spain.
  • Pinto BB; Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Schefold JC; Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
  • Moreno R; Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Cecconi M; Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Lisbon, Portugal.
  • Szczeklik W; Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy.
  • Jung C; Department of Biomedical Sciences, Humanitas University, Rozzano, MI, Italy.
  • Joannidis M; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
Infection ; 2023 Mar 01.
Article in English | MEDLINE | ID: covidwho-2271413
ABSTRACT

BACKGROUND:

Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age.

METHODS:

This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan-Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality.

RESULTS:

This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06-1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis.

CONCLUSION:

Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19. STUDY REGISTRATION NCT04321265, registered March 19th, 2020.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2023 Document Type: Article Affiliation country: S15010-023-02001-2

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2023 Document Type: Article Affiliation country: S15010-023-02001-2