The impact of type 2 diabetes and its management on the prognosis of patients with severeCOVID-19
The impact of type 2 diabetes and its management on the prognosis of patients with severeCOVID-19
复制标题
DOI：
10.1111/1753-0407.13084
复制
发表时间：
2020-08-16
影响因子：
4.5
通讯作者：
Gao, Ling
中科院分区：
文献类型：
--
作者：
Xu, Zihui;Wang, Zhongjing;Gao, Ling
背景虽然与非糖尿病患者相比，患有2019冠状病毒病（COVID-19）的2型糖尿病（T2 DM）患者病情更严重，但其机制尚不清楚。此外，抗高血糖药物和糖皮质激素治疗的影响尚不清楚。方法从1584例COVID-19患者中，纳入364例有临床结局的重症/危重症COVID-19患者进行最终分析，排除既往无T2 DM但血糖水平升高的患者。获得流行病学数据并进行临床状态评价，以评估T2 DM及其管理对临床结局的影响。结果364例重症COVID-19住院患者中，114例（31.3%）有T2 DM病史。27例（23.7%）T2 DM患者死亡，与非DM患者相比，T2 DM患者的炎症、凝血激活、心肌损伤、肝损伤和肾损伤更严重。在严重的COVID-19合并T2 DM患者中，我们证明了糖皮质激素治疗的全因死亡风险较高（校正风险比[HR]，3.61; 95% CI，1.14-11.46;P= 0.029）和重度高血糖（空腹血糖>= 11.1 mmol/L;校正HR，11.86; 95% CI，1.21-116.44;P= .034）。结论T2 DM状态加重了COVID-19患者的临床病情，增加了其危重病风险。空腹血糖不佳（>= 11. 1 mmol/L）和糖皮质激素治疗与严重COVID-19的T2 DM患者预后不良相关。
Background Although type 2 diabetes mellitus (T2DM) patients with coronavirus disease 2019 (COVID-19) develop a more severe condition compared to those without diabetes, the mechanisms for this are unknown. Moreover, the impact of treatment with antihyperglycemic drugs and glucocorticoids is unclear. Methods From 1584 COVID-19 patients, 364 severe/critical COVID-19 patients with clinical outcome were enrolled for the final analysis, and patients without preexisting T2DM but elevated glucose levels were excluded. Epidemiological data were obtained and clinical status evaluation carried out to assess the impact of T2DM and its management on clinical outcomes. Results Of 364 enrolled severe COVID-19 inpatients, 114 (31.3%) had a history of T2DM. Twenty-seven (23.7%) T2DM patients died, who had more severe inflammation, coagulation activation, myocardia injury, hepatic injury, and kidney injury compared with non-DM patients. In severe COVID-19 patients with T2DM, we demonstrated a higher risk of all-cause fatality with glucocorticoid treatment (adjusted hazard ratio [HR], 3.61; 95% CI, 1.14-11.46;P= .029) and severe hyperglycemia (fasting plasma glucose >= 11.1 mmol/L; adjusted HR, 11.86; 95% CI, 1.21-116.44;P= .034). Conclusions T2DM status aggravated the clinical condition of COVID-19 patients and increased their critical illness risk. Poor fasting blood glucose (>= 11.1 mmol/L) and glucocorticoid treatment are associated with poor prognosis for T2DM patients with severe COVID-19.