Department of Gastroenterology/Hepatology, Zhongnan Hospital of Wuhan University, Wuhan, P.R. of China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, P.R. of China.
Department of Gastroenterology/Hepatology, Zhongshan Hospital of Hubei Province, Wuhan, P.R. of China.
Am J Med. 2021 Jan;134(1):e6-e14. doi: 10.1016/j.amjmed.2020.05.033. Epub 2020 Jul 10.
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first appeared in Wuhan, China, and quickly spread throughout the world. We aimed to understand the relationship between diabetes mellitus and the prognosis of COVID-19.
Demographic, clinical, laboratory, radiologic, treatments, complications, and clinical outcomes data were extracted from electronic medical records and compared between diabetes (n = 84) and nondiabetes (n = 500) groups. Kaplan-Meier method and multivariate Cox analysis were applied to determine the risk factors for the prognosis of COVID-19.
Compared with nondiabetic patients, diabetic patients had higher levels of neutrophils (P = .014), C-reactive protein (P = .008), procalcitonin (P < .01), and D-dimer (P = .033), and lower levels of lymphocytes (P = .032) and albumin (P = .035). Furthermore, diabetic patients had a significantly higher incidence of bilateral pneumonia (86.9%, P = .020). In terms of complications and clinical outcomes, the incidence of respiratory failure (36.9% vs 24.2%, P = .022), acute cardiac injury (47.4% vs 21.2%, P < .01), and death (20.2% vs 8.0%, P = .001) in the diabetes group was significantly higher than that in the nondiabetes group. Kaplan-Meier survival curve showed that COVID-19 patients with diabetes had a shorter overall survival time. Multivariate Cox analysis indicated that diabetes (hazard ratio 2.180, P = .031) was an independent risk factor for COVID-19 prognosis. In subgroup analysis, we divided diabetic patients into insulin-required and non-insulin-required groups according to whether they needed insulin, and found that diabetic patients requiring insulin may have a higher risk of disease progression and worse prognosis after the infection of severe acute respiratory syndrome coronavirus 2.
Diabetes is an independent risk factor for the prognosis of COVID-19. More attention should be paid to the prevention and treatment for diabetic patients, especially those who require insulin therapy.
2019 年冠状病毒病（COVID-19）是一种新发传染病，最初出现在中国武汉，迅速蔓延至全球。我们旨在了解糖尿病与 COVID-19 预后之间的关系。
从电子病历中提取人口统计学、临床、实验室、影像学、治疗、并发症和临床结局数据，并在糖尿病（n=84）和非糖尿病（n=500）组之间进行比较。应用 Kaplan-Meier 法和多变量 Cox 分析确定 COVID-19 预后的危险因素。
与非糖尿病患者相比，糖尿病患者的中性粒细胞（P=.014）、C 反应蛋白（P=.008）、降钙素原（P<.01）和 D-二聚体（P=.033）水平较高，淋巴细胞（P=.032）和白蛋白（P=.035）水平较低。此外，糖尿病患者双侧肺炎的发生率明显较高（86.9%，P=.020）。在并发症和临床结局方面，糖尿病组呼吸衰竭（36.9% vs 24.2%，P=.022）、急性心脏损伤（47.4% vs 21.2%，P<.01）和死亡（20.2% vs 8.0%，P=.001）的发生率明显高于非糖尿病组。Kaplan-Meier 生存曲线显示，COVID-19 合并糖尿病患者的总生存时间较短。多变量 Cox 分析表明，糖尿病（风险比 2.180，P=.031）是 COVID-19 预后的独立危险因素。在亚组分析中，我们根据是否需要胰岛素将糖尿病患者分为需要胰岛素和不需要胰岛素两组，发现感染严重急性呼吸综合征冠状病毒 2 后，需要胰岛素的糖尿病患者疾病进展和预后更差的风险可能更高。
糖尿病是 COVID-19 预后的独立危险因素。应更加关注糖尿病患者，尤其是需要胰岛素治疗的患者的预防和治疗。
