Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes.
Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes.
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DOI：
10.3389/fendo.2020.600439
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发表时间：
2020
影响因子：
5.2
通讯作者：
Shalev A
中科院分区：
文献类型：
--
作者：
Crouse AB;Grimes T;Li P;Might M;Ovalle F;Shalev A
冠状病毒病-2019 （COVID-19）是一种日益严重的大流行病，死亡人数不断增加，与各种合并症和种族差异有关。然而，这些高危人群的具体特征仍然不为人所知，也缺乏降低死亡率的方法。我们对美国南部种族多元化的三级卫生保健中心阿拉巴马大学伯明翰医院（University of Alabama at Birmingham Hospital）于2020年2月25日至6月22日期间接受COVID-19检测的25,326名受试者进行了回顾性电子健康记录数据分析。主要结局是COVID-19阳性受试者的死亡率，并使用简单和多元线性逻辑回归分析受试者特征和合并症的相关性。黑人/非裔美国人感染COVID-19的优势比（OR 2.6; 95% CI 2.19-3.10; p<0.0001）和肥胖（OR 1.93; 95% CI 1.64-2.28; p<0.0001）、高血压（OR 2.46; 95% CI 2.07-2.93; p<0.0001）和糖尿病（OR 2.11; 95% CI 1.78-2.48; p<0.0001）的受试者的优势比不成比例地高。糖尿病还与死亡率的急剧增加相关（OR 3.62; 95% CI 2.11-6.2; p<0.0001），即使在校正了年龄、种族、性别、肥胖和高血压后，糖尿病仍成为这一多样化人群的独立危险因素。有趣的是，我们发现在诊断COVID-19之前接受二甲双胍治疗与糖尿病和COVID-19患者死亡率的显著降低独立相关（OR 0.33; 95% CI 0.13-0.84; p=0.0210）。因此，这些结果表明，虽然糖尿病是COVID-19相关死亡的独立危险因素，但在诊断为COVID-19之前服用二甲双胍的受试者中，这种风险显着降低，这提高了二甲双胍可能为这一高风险人群提供保护方法的可能性。
Coronavirus disease-2019 (COVID-19) is a growing pandemic with an increasing death toll that has been linked to various comorbidities as well as racial disparity. However, the specific characteristics of these at-risk populations are still not known and approaches to lower mortality are lacking. We conducted a retrospective electronic health record data analysis of 25,326 subjects tested for COVID-19 between 2/25/20 and 6/22/20 at the University of Alabama at Birmingham Hospital, a tertiary health care center in the racially diverse Southern U.S. The primary outcome was mortality in COVID-19-positive subjects and the association with subject characteristics and comorbidities was analyzed using simple and multiple linear logistic regression. The odds ratio of contracting COVID-19 was disproportionately high in Blacks/African-Americans (OR 2.6; 95% CI 2.19–3.10; p<0.0001) and in subjects with obesity (OR 1.93; 95% CI 1.64–2.28; p<0.0001), hypertension (OR 2.46; 95% CI 2.07–2.93; p<0.0001), and diabetes (OR 2.11; 95% CI 1.78–2.48; p<0.0001). Diabetes was also associated with a dramatic increase in mortality (OR 3.62; 95% CI 2.11–6.2; p<0.0001) and emerged as an independent risk factor in this diverse population even after correcting for age, race, sex, obesity, and hypertension. Interestingly, we found that metformin treatment prior to diagnosis of COVID-19 was independently associated with a significant reduction in mortality in subjects with diabetes and COVID-19 (OR 0.33; 95% CI 0.13–0.84; p=0.0210). Thus, these results suggest that while diabetes is an independent risk factor for COVID-19-related mortality, this risk is dramatically reduced in subjects taking metformin prior to diagnosis of COVID-19, raising the possibility that metformin may provide a protective approach in this high risk population.