比较伴有和不伴有 2 型糖尿病的 COVID-19 成年患者的死亡率和肺部受累严重程度：一项队列研究。
Comparison of Mortality Rate and Severity of Pulmonary Involvement in Coronavirus Disease-2019 Adult Patients With and Without Type 2 Diabetes: A Cohort Study.
机构信息
Department of Internal Medicine, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
Can J Diabetes. 2021 Aug;45(6):524-530. doi: 10.1016/j.jcjd.2020.10.014. Epub 2020 Nov 1.
OBJECTIVES
Patients with diabetes are potentially at higher risk of mortality due to coronavirus disease-2019 (COVID-19). In this study, we aimed to compare the outcomes and severity of pulmonary involvement in COVID-19 patients with and without diabetes.
METHODS
In this cohort study, we recruited patients with diabetes who were hospitalized due to COVID-19 during the period from February 2020 to May 2020. Hospitalized individuals without diabetes were enrolled as control subjects. All patients were followed for 90 days and clinical findings and patients' outcomes were reported.
RESULTS
Over a period of 4 months, 127 patients with diabetes and 127 individuals without diabetes with a diagnosis of COVID-19 were recruited. Their mean age was 65.70±12.51 years. Mortality was higher in the group with diabetes (22.8% vs 15.0%; p=0.109), although not significantly. More severe pulmonary involvement (p=0.015), extended hospital stay (p<0.001) and greater need for invasive ventilation (p=0.029) were reported in this population. Stepwise logistic regression revealed that diabetes was not independently associated with mortality (p=0.092). Older age (odds ratio [OR], 1.054; p=0.003), aggravated pulmonary involvement on admission (OR, 1.149; p=0.001), presence of comorbidities (OR, 1.290; p=0.020) and hypothyroidism (OR, 6.576; p=0.021) were associated with mortality. Diabetic foot infection had a strong positive correlation with mortality (OR, 49.819; p=0.016), whereas insulin therapy had a negative correlation (OR, 0.242; p=0.045).
CONCLUSIONS
The mortality rate due to COVID-19 did not differ significantly between patients with or without diabetes. Older age, macrovascular complications and presence of comorbidities could increase mortality in people with diabetes. Insulin therapy during hospitalization could attenuate the detrimental effects of hyperglycemia and improve prognosis of patients with COVID-19 and diabetes.
目的
患有糖尿病的患者由于 2019 年冠状病毒病（COVID-19）而面临更高的死亡风险。在本研究中，我们旨在比较 COVID-19 合并糖尿病与不合并糖尿病患者的结局和肺部受累严重程度。
方法
在这项队列研究中，我们招募了 2020 年 2 月至 2020 年 5 月期间因 COVID-19 住院的糖尿病患者。未合并糖尿病的住院患者被纳入对照组。所有患者均随访 90 天，并报告临床发现和患者结局。
结果
在 4 个月期间，共招募了 127 例糖尿病患者和 127 例诊断为 COVID-19 的无糖尿病患者。他们的平均年龄为 65.70±12.51 岁。糖尿病组死亡率更高（22.8%比 15.0%；p=0.109），但差异无统计学意义。该人群报告了更严重的肺部受累（p=0.015）、延长的住院时间（p<0.001）和更需要有创通气（p=0.029）。逐步逻辑回归显示，糖尿病与死亡率无关（p=0.092）。年龄较大（比值比[OR]，1.054；p=0.003）、入院时肺部受累加重（OR，1.149；p=0.001）、合并症（OR，1.290；p=0.020）和甲状腺功能减退症（OR，6.576；p=0.021）与死亡率相关。糖尿病足感染与死亡率呈强正相关（OR，49.819；p=0.016），而胰岛素治疗与死亡率呈负相关（OR，0.242；p=0.045）。
结论
COVID-19 导致的死亡率在合并糖尿病与不合并糖尿病的患者之间无显著差异。年龄较大、大血管并发症和合并症的存在可能会增加糖尿病患者的死亡率。住院期间的胰岛素治疗可能会减轻高血糖的不良影响，并改善 COVID-19 和糖尿病患者的预后。
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