Biomarkers Predictive for In-Hospital Mortality in Patients with Diabetes Mellitus and Prediabetes Hospitalized for COVID-19 in Austria: An Analysis of COVID-19 in Diabetes Registry
Faisal Aziz,
Hannah Stöcher,
Alexander Bräuer,
Christian Ciardi,
Martin Clodi,
Peter Fasching,
Mario Karolyi,
Alexandra Kautzky-Willer,
Carmen Klammer,
Oliver Malle,
Felix Aberer,
Erich Pawelka,
Slobodan Peric,
Claudia Ress,
Caren Sourij,
Lars Stechemesser,
Harald Stingl,
Thomas Stulnig,
Norbert Tripolt,
Michael Wagner,
Peter Wolf,
Andreas Zitterl,
Othmar Moser,
Christian Schelkshorn,
Susanne Kaser,
Harald Sourij,
for the COVID-19 in Diabetes in Austria
Affiliations
Faisal Aziz
Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
Hannah Stöcher
Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
Alexander Bräuer
Medical Division for Endocrinology, Rheumatology and Acute Geriatrics, Wilhelminen Hospital Vienna, 1160 Vienna, Austria
Christian Ciardi
Clinical Division for Internal Medicine, Endocrinology, Diabetology and Metabolic Diseases, St. Vinzenz Hospital Zams, 6511 Zams, Austria
Martin Clodi
Clinical Division for Internal Medicine, Konventhospital Barmherzige Brüder Linz, 4020 Linz, Austria
Peter Fasching
Medical Division for Endocrinology, Rheumatology and Acute Geriatrics, Wilhelminen Hospital Vienna, 1160 Vienna, Austria
Mario Karolyi
4th Medical Division with Infectiology, SMZ Süd–KFJ-Hospital Vienna, 1100 Vienna, Austria
Alexandra Kautzky-Willer
Clinical Division for Endocrinology and Diabetology and Metabolic Diseases, AKH Vienna, 1090 Vienna, Austria
Carmen Klammer
Clinical Division for Internal Medicine, Konventhospital Barmherzige Brüder Linz, 4020 Linz, Austria
Oliver Malle
Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
Felix Aberer
Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
Erich Pawelka
4th Medical Division with Infectiology, SMZ Süd–KFJ-Hospital Vienna, 1100 Vienna, Austria
Slobodan Peric
3rd Department and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria
Claudia Ress
Department for Internal Medicine I, Medical University Innsbruck, 6020 Innsbruck, Austria
Caren Sourij
Clinical Division for Cardiology, Medical University Graz, 8036 Graz, Austria
Lars Stechemesser
Department for Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria
Harald Stingl
Division for Internal Medicine, Hospital Melk, 3390 Melk, Austria
Thomas Stulnig
3rd Department and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria
Norbert Tripolt
Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
Michael Wagner
Division for Internal Medicine, Hospital Melk, 3390 Melk, Austria
Peter Wolf
Clinical Division for Endocrinology and Diabetology and Metabolic Diseases, AKH Vienna, 1090 Vienna, Austria
Andreas Zitterl
3rd Department and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria
Othmar Moser
Department for Exercise Physiology & Metabolism, University of Bayreuth, 95445 Bayreuth, Germany
Christian Schelkshorn
Division for Internal Medicine, Hospital Stockerau, 2000 Stockerau, Austria
Susanne Kaser
Department for Internal Medicine I, Medical University Innsbruck, 6020 Innsbruck, Austria
Harald Sourij
Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
Background: This study assessed the predictive performance of inflammatory, hepatic, coagulation, and cardiac biomarkers in patients with prediabetes and diabetes mellitus hospitalized for COVID-19 in Austria. Methods: This was an analysis of a multicenter cohort study of 747 patients with diabetes mellitus or prediabetes hospitalized for COVID-19 in 11 hospitals in Austria. The primary outcome of this study was in-hospital mortality. The predictor variables included demographic characteristics, clinical parameters, comorbidities, use of medication, disease severity, and laboratory measurements of biomarkers. The association between biomarkers and in-hospital mortality was assessed using simple and multiple logistic regression analyses. The predictive performance of biomarkers was assessed using discrimination and calibration. Results: In our analysis, 70.8% had type 2 diabetes mellitus, 5.8% had type 1 diabetes mellitus, 14.9% had prediabetes, and 8.6% had other types of diabetes mellitus. The mean age was 70.3 ± 13.3 years, and 69.3% of patients were men. A total of 19.0% of patients died in the hospital. In multiple logistic regression analysis, LDH, CRP, IL-6, PCT, AST-ALT ratio, NT-proBNP, and Troponin T were significantly associated with in-hospital mortality. The discrimination of NT-proBNP was 74%, and that of Troponin T was 81%. The calibration of NT-proBNP was adequate (p = 0.302), while it was inadequate for Troponin T (p = 0.010). Conclusion: Troponin T showed excellent predictive performance, while NT-proBNP showed good predictive performance for assessing in-hospital mortality in patients with diabetes mellitus hospitalized with COVID-19. Therefore, these cardiac biomarkers may be used for prognostication of COVID-19 patients.
