Diabetology & Metabolic Syndrome (Nov 2022)

Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19

  • Sara Madaschi,
  • Eugenia Resmini,
  • Silvia Bonfadini,
  • Giulia Massari,
  • Paola Gamba,
  • Marco Sandri,
  • Stefano Calza,
  • Elena Cimino,
  • Emanuela Zarra,
  • Silvia Dotti,
  • Cristina Mascadri,
  • Barbara Agosti,
  • Emirena Garrafa,
  • Angela Girelli

DOI
https://doi.org/10.1186/s13098-022-00941-7
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 11

Abstract

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Abstract Introduction The role of glycemic control, both prior and during hospitalization, on mortality from COVID-19 in diabetic patients is debated. Furthermore, it is not clear whether hyperglycemia has a direct effect or requires inflammatory mechanisms. Objective To identify predictors of clinical outcomes (in-hospital mortality, length of hospitalization, respiratory failure, need for intensive care), considering hyperglycemia, inflammation markers and clinical history. Methods Retrospective observational study of 291 diabetic patients hospitalized with COVID-19 in the Spedali Civili di Brescia from February 1th 2020 to March 31th 2021, with also outpatient electronic records. Glucose, inflammatory parameters, creatinine were collected within 24 h after admission to the hospital. A causal mediation analysis allowed the estimation of the direct and indirect effects of hyperglycemia on mortality. Results Glucose at admission ≥ 165 mg/dL and reduced renal function were associated with an increased risk of in-hospital mortality and length of hospitalization (all p < 0.001), while an increase in inflammatory parameters was significantly associated with an increased risk of all outcomes. High basophil count was associated with reduced mortality (p < 0.001). Hyperglycemia had a direct effect on mortality (p < 0.001); the indirect, through inflammatory markers, was significant only for absolute neutrophil count, C-Reactive protein and procalcitonin (p = 0.007, p = 0.029, p = 0.042). Patients with microvascular complications and with chronic kidney disease showed higher mortality (p = 0.03, p = 0.01). Conclusions Hyperglycemia at admission, renal function and inflammatory parameters were found to be predictors of in-hospital mortality, while an increased basophil count was protective. Hyperglycemia had a direct effect on mortality, the indirect effect was only through few markers and markedly lower than the direct one.

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