Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
Divison of Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
Sci Rep. 2021 Dec 24;11(1):24436. doi: 10.1038/s41598-021-03898-1.
Patients diagnosed with diabetes mellitus (DM) who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) belong to the most vulnerable patient subgroups. Emerging data has shown increased risks of severe infections, increased in ICU admissions, longer durations of admission, and increased mortality among coronavirus disease 2019 (COVID-19) patients with diabetes. We performed a subgroup analysis comparing the outcomes of patients diagnosed with DM (n = 2191) versus patients without DM (n = 8690) on our data from our study based on a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from around the Philippines. We determined distribution differences between two independent samples using Mann-Whitney U and t tests. Data on the time to onset of mortality, respiratory failure, intensive care unit (ICU) admission were used to build Kaplan-Meier curves and to compute for hazard ratios (HR). The odds ratios (OR) for longer ventilator dependence, longer ICU stay, and longer hospital stays were computed via multivariate logistic regression. Adjusted hazard ratios (aHR) and ORs (aOR) with 95% CI were calculated. We included a total of 10,881 patients with confirmed COVID-19 infection (2191 have DM while 8690 did not have DM). The median age of the DM cohort was 61, with a female to male ratio of 1:1.25 and more than 50% of the DM population were above 60 years old. The aOR for mortality was significantly higher among those in the DM group by 1.46 (95% CI 1.28-1.68; p < 0.001) as compared to the non-DM group. Similarly, the aOR for respiratory failure was also significantly higher among those in the DM group by 1.67 (95% CI 1.46-1.90). The aOR for developing severe COVID-19 at nadir was significantly higher among those in the DM group by 1.85 (95% CI 1.65-2.07; p < 0.001). The aOR for ICU admission was significantly higher among those in the DM group by 1.80 (95% CI 1.59-2.05) than those in the non-DM group. DM patients had significantly longer duration of ventilator dependence (aOR 1.33, 95% CI 1.08-1.64; p = 0.008) and longer hospital admission (aOR 1.13, 95% CI 1.01-1.26; p = 0.027). The presence of DM among COVID-19 patients significantly increased the risk of mortality, respiratory failure, duration of ventilator dependence, severe/critical COVID-19, ICU admission, and length of hospital stay.
患有糖尿病(DM)并感染严重急性呼吸综合征冠状病毒 2(SARS-COV-2)的患者属于最脆弱的患者亚组。新出现的数据表明,COVID-19 患者的严重感染风险增加、重症监护病房(ICU)入院率增加、住院时间延长以及死亡率增加。我们对来自菲律宾各地 37 家医院的一项全国性、对照、回顾性队列研究中 COVID-19 住院患者的 2191 例 DM 患者与 8690 例无 DM 患者的数据进行了亚组分析。我们使用 Mann-Whitney U 和 t 检验确定两个独立样本之间的分布差异。使用死亡、呼吸衰竭、重症监护病房(ICU)入院的发病时间数据来构建 Kaplan-Meier 曲线并计算危险比(HR)。通过多变量逻辑回归计算更长的呼吸机依赖、更长的 ICU 住院时间和更长的住院时间的比值比(OR)。使用 95%CI 计算调整后的危险比(aHR)和比值比(aOR)。我们共纳入 10881 例确诊 COVID-19 感染患者(2191 例患有 DM,8690 例未患有 DM)。DM 队列的中位年龄为 61 岁,男女比例为 1:1.25,超过 50%的 DM 人群年龄在 60 岁以上。与非 DM 组相比,DM 组的死亡率调整后比值比(aOR)显著更高,为 1.46(95%CI 1.28-1.68;p<0.001)。同样,DM 组呼吸衰竭的 aOR 也显著更高,为 1.67(95%CI 1.46-1.90)。DM 组严重 COVID-19 发病时的 aOR 显著更高,为 1.85(95%CI 1.65-2.07;p<0.001)。DM 组 ICU 入院的 aOR 显著更高,为 1.80(95%CI 1.59-2.05),而非 DM 组。DM 患者呼吸机依赖时间明显延长(aOR 1.33,95%CI 1.08-1.64;p=0.008),住院时间明显延长(aOR 1.13,95%CI 1.01-1.26;p=0.027)。COVID-19 患者中存在 DM 显著增加了死亡率、呼吸衰竭、呼吸机依赖时间、严重/危急 COVID-19、ICU 入院和住院时间的风险。