Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study
Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study
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中国武汉市 COVID-19 糖尿病患者的临床特征和死亡危险因素：一项两中心回顾性研究
DOI：
10.2337/dc20-0598
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发表时间：
2020-07-01
期刊：
影响因子：
16.2
通讯作者：
Wang, Weixing
中科院分区：
文献类型：
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作者：
Shi, Qiao;Zhang, Xiaoyi;Wang, Weixing
目的糖尿病在COVID-19患者中很常见，并且与不利的结果相关。我们的目的是描述COVID-19合并糖尿病患者的特征和结局，并分析院内死亡率的风险因素。研究设计和方法本研究在中国武汉的两所三级医院进行。已识别于2020年1月1日至2020年3月8日期间出院或死亡的确诊COVID-19糖尿病患者（N = 153）。每名糖尿病患者随机选择一名性别和年龄匹配的非糖尿病COVID-19患者。提取人口统计学、临床和实验室数据。考克斯比例风险回归分析，以确定与这些患者的死亡率相关的危险因素。在1,561名COVID-19患者中，153名（9.8%）患有糖尿病，中位年龄为64.0岁（四分位数范围56.0-72.0）。与匹配患者相比，COVID-19糖尿病患者的重症监护室入院比例更高（17.6% vs. 7.8%，P = 0.01），死亡病例更多（20.3% vs. 10.5%，P = 0.017）。这306例患者的多变量考克斯回归分析显示，高血压（风险比[HR] 2.50，95% CI 1.30-4.78）、心血管疾病（HR 2.24，95% CI 1.19-4.23）和慢性肺部疾病（HR 2.51，95% CI 1.07-5.90）与院内死亡独立相关。调整后，糖尿病（HR 1.58，95% CI 0.84-2.99）与院内死亡无统计学显著相关性。在糖尿病患者中，死亡者年龄较大（76.0 vs. 63.0岁），大多数为男性（71.0% vs. 29.0%），他们更可能患有基础高血压（83.9% vs. 50.0%）和心血管疾病（45.2% vs. 14.8%）（所有P值均<0.05）。年龄≥70岁（HR 2.39，95%CI 1.03-5.56）和高血压（HR 3.10，95%CI 1.14-8.44）是糖尿病患者院内死亡的独立危险因素。结论：与性别和年龄匹配的非糖尿病患者相比，COVID-19糖尿病患者的结局更差。高龄和合并高血压是糖尿病患者住院死亡的独立原因。
OBJECTIVE Diabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics and outcomes and to analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes. RESEARCH DESIGN AND METHODS This two-center retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N = 153) who were discharged or died from 1 January 2020 to 8 March 2020 were identified. One sex- and age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients. RESULTS Of 1,561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (interquartile range 56.0–72.0) years. A higher proportion of intensive care unit admission (17.6% vs. 7.8%, P = 0.01) and more fatal cases (20.3% vs. 10.5%, P = 0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazard ratio [HR] 2.50, 95% CI 1.30–4.78), cardiovascular disease (HR 2.24, 95% CI 1.19–4.23), and chronic pulmonary disease (HR 2.51, 95% CI 1.07–5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84–2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs. 63.0 years), most were male (71.0% vs. 29.0%), and they were more likely to have underlying hypertension (83.9% vs. 50.0%) and cardiovascular disease (45.2% vs. 14.8%) (all P values <0.05). Age ≥70 years (HR 2.39, 95% CI 1.03–5.56) and hypertension (HR 3.10, 95% CI 1.14–8.44) were independent risk factors for in-hospital death of patients with diabetes. CONCLUSIONS COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.