Département d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093, Nantes Cedex 01, France.
CIC-EC 1413, Clinique des Données, CHU Nantes, Nantes, France.
Diabetologia. 2020 Aug;63(8):1500-1515. doi: 10.1007/s00125-020-05180-x. Epub 2020 May 29.
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.
We conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 French 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.
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; 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, 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.
clinicaltrials.gov NCT04324736.
目的/假设：2019 年冠状病毒病（COVID-19）是由严重急性呼吸系统综合征冠状病毒 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 患者中糖尿病的表型特征尚不清楚。
我们在 2020 年 3 月 10 日至 31 日期间，在法国 53 个中心对因 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 7 天内气管插管进行机械通气和/或死亡。采用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，报告每增加 1 个标准差的比值比（OR）。
目前的分析集中在 1317 名参与者：64.9%为男性，平均年龄 69.8±13.0 岁，中位数 BMI 为 28.4（25-75 百分位：25.0-32.7）kg/m2；以 2 型糖尿病为主（88.5%）。微血管和大血管糖尿病并发症分别见于 46.8%和 40.8%的病例。主要结局在 29.0%（95%CI 26.6，31.5）的参与者中出现，10.6%（9.0，12.4）死亡，18.0%（16.0，20.2）在第 7 天出院。单变量分析显示，入院前的特征与主要结局显著相关的有性别、BMI 和之前使用肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂，但与年龄、糖尿病类型、HbA1c、糖尿病并发症或降糖治疗无关。在入院前有协变量的多变量分析中，只有 BMI 与主要结局呈正相关（OR 1.28[1.10，1.47]）。入院时，呼吸困难（OR 2.10[1.31，3.35]）、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]）和天冬氨酸转氨酶（AST）（OR 2.23[1.70，2.93]）水平是主要结局的独立预测因素。最后，年龄（OR 2.48[1.74，3.53]）、治疗性阻塞性睡眠呼吸暂停（OR 2.80[1.46，5.38]）、微血管（OR 2.14[1.16，3.94]）和大血管并发症（OR 2.54[1.44，4.50]）与第 7 天的死亡风险独立相关。
结论/解释：在因 COVID-19 住院的糖尿病患者中，BMI 与气管插管和/或 7 天内死亡呈正相关，而与长期血糖控制无关。
clinicaltrials.gov NCT04324736。
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