Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.
Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.
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评估因2019冠状病毒病（COVID-19）住院的1型糖尿病（T1DM）患者发生严重结局的风险是否与无糖尿病或2型糖尿病（T2DM）患者不同。利用2020年3月至11月美国医院COVID-19住院后出院患者的Premier Healthcare Database Special COVID-19发布记录（N = 269,674，排除后），我们估计了T1DM患者与非糖尿病或T2DM患者相比，重症监护病房入院或有创机械通气（ICU/MV）和死亡的风险差异（RD）和风险比（RR）。Logistic模型根据年龄、性别、种族或民族进行了调整。根据其他人口统计学和临床特征调整的模型用于检查其他因素是否解释了T1DM与严重COVID-19结局之间的关联。与无糖尿病患者相比，T1DM与ICU/MV绝对风险增加21%相关（RD 0.21, 95% CI 0.19-0.24; RR 1.49, 95% CI 1.43-1.56），与死亡率绝对风险增加5%相关（RD 0.05, 95% CI 0.03-0.07; RR 1.40, 95% CI 1.24-1.57），校正了年龄、性别、种族或民族。与T2DM相比，T1DM与ICU/MV的绝对风险高9%相关（RD为0.09,95% CI为0.07-0.12；RR为1.17,95% CI为1.12-1.22），但死亡率无差异（RD为0.00,95% CI为- 0.02 ~ 0.02；RR为1.00,95% CI为0.89-1.13）。在调整了在COVID-19诊断前或诊断时发生的糖尿病酮症酸中毒（DKA）后，与T2DM患者相比，T1DM患者的ICU/MV风险不再增加（RD为0.01,95% CI为−0.01至−0.03），死亡率降低（RD为−0.03,95% CI为−0.05至−0.01）。因COVID-19住院的T1DM患者发生严重后果的风险高于非糖尿病患者。T1DM患者发生ICU/MV的风险高于T2DM患者，主要原因是DKA的存在。这些发现可能会进一步指导与糖尿病管理和预防COVID-19相关的建议。
To assess whether risk of severe outcomes among patients with type 1 diabetes mellitus (T1DM) hospitalized for coronavirus disease 2019 (COVID-19) differs from that of patients without diabetes or with type 2 diabetes mellitus (T2DM). Using the Premier Healthcare Database Special COVID-19 Release records of patients discharged after COVID-19 hospitalization from U.S. hospitals from March to November 2020 (N = 269,674 after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without diabetes or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes. Compared with patients without diabetes, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD 0.21, 95% CI 0.19–0.24; RR 1.49, 95% CI 1.43–1.56) and a 5% higher absolute risk of mortality (RD 0.05, 95% CI 0.03–0.07; RR 1.40, 95% CI 1.24–1.57), with adjustment for age, sex, and race or ethnicity. Compared with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD 0.09, 95% CI 0.07–0.12; RR 1.17, 95% CI 1.12–1.22), but no difference in mortality (RD 0.00, 95% CI −0.02 to 0.02; RR 1.00, 95% CI 0.89–1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD 0.01, 95% CI −0.01 to 0.03) and had lower mortality (RD −0.03, 95% CI −0.05 to −0.01) in comparisons with patients with T2DM. Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without diabetes. Higher risk of ICU/MV in patients with T1DM than in patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to diabetes management and the prevention of COVID-19.