Department of Medicine, University of Padova, Italy.
Department of Medicine, University of Padova, Italy.
Diabetes Res Clin Pract. 2020 Oct;168:108374. doi: 10.1016/j.diabres.2020.108374. Epub 2020 Aug 15.
We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders.
We retrospectively analyzed data on patients with COVID-19 hospitalized between February and April 2020 in an outbreak hospital in North-East Italy. Pre-existing diabetes was defined by self-reported history, electronic medical records, or ongoing medications. Newly-diagnosed diabetes was defined by HbA1c and fasting glucose. The primary outcome was a composite of ICU admission or death.
413 subjects were included, 107 of whom (25.6%) had diabetes, including 21 newly-diagnosed. Patients with diabetes were older and had greater comorbidity burden. The primary outcome occurred in 37.4% of patients with diabetes compared to 20.3% in those without (RR 1.85; 95%C.I. 1.33-2.57; p < 0.001). The association was stronger for newly-diagnosed compared to pre-existing diabetes (RR 3.06 vs 1.55; p = 0.004). Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p < 0.001). Admission glucose was correlated with most clinical severity indexes and its association with adverse outcome was mostly mediated by a worse respiratory function.
Newly-diagnosed diabetes and admission hyperglycemia are powerful predictors of COVID-19 severity due to rapid respiratory deterioration.
我们旨在研究是否在排除混杂因素后，预先存在的糖尿病、新诊断的糖尿病和入院高血糖与 COVID-19 严重程度有关。
我们回顾性分析了 2020 年 2 月至 4 月期间在意大利东北部一家暴发医院住院的 COVID-19 患者的数据。预先存在的糖尿病通过自我报告的病史、电子病历或正在服用的药物来定义。新诊断的糖尿病通过 HbA1c 和空腹血糖来定义。主要结局是 ICU 入院或死亡的复合结局。
共纳入 413 例患者，其中 107 例（25.6%）患有糖尿病，包括 21 例新诊断的糖尿病。患有糖尿病的患者年龄更大，合并症负担更重。患有糖尿病的患者中主要结局的发生率为 37.4%，而无糖尿病的患者中主要结局的发生率为 20.3%（RR 1.85；95%CI 1.33-2.57；p<0.001）。与预先存在的糖尿病相比，新诊断的糖尿病与 COVID-19 严重程度的相关性更强（RR 3.06 比 1.55；p=0.004）。入院时的血糖水平与 COVID-19 严重程度相关，在无预先存在的糖尿病的患者中相关性更强（交互作用 p<0.001）。入院血糖与大多数临床严重程度指标相关，其与不良结局的相关性主要通过更差的呼吸功能来介导。
新诊断的糖尿病和入院高血糖是 COVID-19 严重程度的有力预测因素，这是由于呼吸功能迅速恶化所致。
