Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study
Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study
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DOI：
10.1007/s00125-020-05180-x
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发表时间：
2020-05-29
期刊：
影响因子：
8.2
通讯作者：
Gourdy, Pierre
中科院分区：
文献类型：
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作者：
Cariou, Bertrand;Hadjadj, Samy;Gourdy, Pierre
目的/假设 2019 冠状病毒病 (COVID-19) 是由严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2) 病毒引起的危及生命的感染。糖尿病已迅速成为 COVID-19 严重程度的主要合并症。然而，COVID-19 患者的糖尿病表型特征尚不清楚。 方法 我们对 2020 年 3 月 10 日至 31 日期间在 53 个中心因 COVID-19 住院的糖尿病患者进行了一项全国性多中心观察性研究。主要结局为机械通气气管插管和/或入院 7 天内死亡。进行年龄和性别调整的多变量逻辑回归来评估临床和生物学特征与终点的预后价值。标准化后 OR 增加 1 SD。 结果 当前分析主要针对 1317 名参与者：64.9% 为男性，平均年龄 69.8 +/- 13.0 岁，中位 BMI 28.4（第 25-75 个百分位：25.0-32.7）kg/m(2)；其中以 2 型糖尿病为主（88.5%）。微血管和大血管糖尿病并发症的发生率分别为 46.8% 和 40.8%。 29.0% (95% CI 26.6, 31.5) 的参与者出现主要结局，10.6% (9.0, 12.4) 死亡，18.0% (16.0, 20.2) 在第 7 天出院。在单变量分析中，入院前与主要结局显着相关的特征是性别、BMI 和既往肾素-血管紧张素-醛固酮系统 (RAAS) 治疗阻滞剂，但不是 年龄、糖尿病类型、HbA(1c)、糖尿病并发症或降糖疗法。在入院前协变量的多变量分析中，只有 BMI 与主要结局保持正相关（OR 1.28 [1.10, 1.47]）。入院时，呼吸困难（OR 2.10 [1.31，3.35]）以及淋巴细胞计数（OR 0.67 [0.50，0.88]）、C反应蛋白（OR 1.93 [1.43，2.59]）和AST（OR 2.23 [1.70，2.93]）水平是主要结局的独立预测因子。最后，年龄（OR 2.48 [1.74, 3.53]）、治疗的阻塞性睡眠呼吸暂停（OR 2.80 [1.46, 5.38]）、微血管并发症（OR 2.14 [1.16, 3.94]）和大血管并发症（OR 2.54 [1.44, 4.50]）与当日死亡风险独立相关。 7.结论/解释 对于住院治疗的糖尿病患者 新冠肺炎。 BMI（而非长期血糖控制）与气管插管和/或 7 天内死亡呈正相关且独立相关。
Aims/hypothesis Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown.Methods We conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 ench centres in the period 10-31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission. Age- and sex-adjusted multivariable logistic regressions were performed to assess the prognostic value of clinical and biological features with the endpoint. ORs are reported for a 1 SD increase after standardisation.Results The current analysis focused on 1317 participants: 64.9% men, mean age 69.8 +/- 13.0 years, median BMI 28.4 (25th-75th percentile: 25.0-32.7) kg/m(2); with a predominance of type 2 diabetes (88.5%). Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively. The primary outcome was encountered in 29.0% (95% CI 26.6, 31.5) of participants, while 10.6% (9.0, 12.4) died and 18.0% (16.0, 20.2) were discharged on day 7. In univariate analysis, characteristics prior to admission significantly associated with the primary outcome were sex, BMI and previous treatment with renin-angiotensin-aldosterone system (RAAS) blockers, but not age, type of diabetes, HbA(1c), diabetic complications or glucose-lowering therapies. In multivariable analyses with covariates prior to admission, only BMI remained positively associated with the primary outcome (OR 1.28 [1.10, 1.47]). On admission, dyspnoea (OR 2.10 [1.31, 3.35]), as well as lymphocyte count (OR 0.67 [0.50, 0.88]), C-reactive protein (OR 1.93 [1.43, 2.59]) and AST (OR 2.23 [1.70, 2.93]) levels were independent predictors of the primary outcome. Finally, age (OR 2.48 [1.74, 3.53]), treated obstructive sleep apnoea (OR 2.80 [1.46, 5.38]), and microvascular (OR 2.14 [1.16, 3.94]) and macrovascular complications (OR 2.54 [1.44, 4.50]) were independently associated with the risk of death on day 7.Conclusions/interpretations In people with diabetes hospitalised for COVID-19. BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days.