Nantes Université, CHU Nantes, CNRS, Inserm, l'Institut du Thorax, Nantes, France.
Centre d'Investigation Clinique CIC 1402, Université de Poitiers, Inserm, CHU de Poitiers, Poitiers, France.
Diabetes Obes Metab. 2023 Jan;25(1):78-88. doi: 10.1111/dom.14845. Epub 2022 Sep 12.
To provide a detailled analysis of the microvascular burden in patients with diabetes hopitalized for COVD-19.
We analysed data from the French CORONADO initiative and the UK Association of British Clinical Diabetologists (ABCD) COVID-19 audit, two nationwide multicentre studies, and the AMERICADO, a multicentre study conducted in New York area. We assessed the association between risk of all-cause death during hospital stay and the following microvascular complications in patients with diabetes hospitalized for COVID-19: diabetic retinopathy and/or diabetic kidney disease and/or history of diabetic foot ulcer.
Among 2951 CORONADO, 3387 ABCD COVID-19 audit and 9327 AMERICADO participants, microvascular diabetic complications status was ascertained for 1314 (44.5%), 1809 (53.4%) and 7367 (79.0%) patients, respectively: 1010, 1059 and 1800, respectively, had ≥1 severe microvascular complication(s) and 304, 750 and 5567, respectively, were free of any complications. The patients with isolated diabetic kidney disease had an increased risk of all-cause death during hospital stay: odds ratio [OR] 2.53 (95% confidence interval [CI] 1.66-3.83), OR 1.24 (95% CI 1.00-1.56) and OR 1.66 (95% CI 1.40-1.95) in the CORONADO, the ABCD COVID-19 national audit and the AMERICADO studies, respectively. After adjustment for age, sex, hypertension and cardiovascular disease (CVD), compared to those without microvascular complications, patients with microvascular complications had an increased risk of all-cause death during hospital stay in the CORONADO, the ABCD COVID-19 diabetes national audit and the AMERICADO studies: adjusted OR ( OR) 2.57 (95% CI 1.69-3.92), OR 1.22 (95% CI 1.00-1.52) and OR 1.33 (95% CI 1.15-1.53), respectively. In meta-analysis of the three studies, compared to patients free of complications, those with microvascular complications had an unadjusted OR for all-cause death during hospital stay of 2.05 (95% CI 1.42-2.97), which decreased to 1.62 (95% CI 1.19-2.119) after adjustment for age and sex, and to 1.50 (1.12-2.02) after hypertension and CVD were further added to the model.
Microvascular burden is associated with an increased risk of death in patients hospitalized for COVID-19.
对因 COVID-19 住院的糖尿病患者的微血管负担进行详细分析。
我们分析了法国 CORONADO 计划和英国英国临床糖尿病学会 (ABCD) COVID-19 审计的两项全国性多中心研究以及 AMERICADO 的数据，这是一项在纽约地区进行的多中心研究。我们评估了糖尿病患者因 COVID-19 住院期间全因死亡的风险与以下微血管并发症之间的关系：糖尿病视网膜病变和/或糖尿病肾病和/或糖尿病足溃疡史。
在 2951 名 CORONADO、3387 名 ABCD COVID-19 审计和 9327 名 AMERICADO 参与者中，分别确定了 1314（44.5%）、1809（53.4%）和 7367（79.0%）名患者的微血管糖尿病并发症状态：分别为 1010、1059 和 1800 名患者患有≥1 种严重的微血管并发症，分别为 304、750 和 5567 名患者无任何并发症。仅患有糖尿病肾病的患者住院期间全因死亡的风险增加：优势比 [OR] 2.53（95%置信区间 [CI] 1.66-3.83），OR 1.24（95% CI 1.00-1.56）和 OR 1.66（95% CI 1.40-1.95）分别在 CORONADO、ABCD COVID-19 国家审计和 AMERICADO 研究中。在校正年龄、性别、高血压和心血管疾病 (CVD) 后，与无微血管并发症的患者相比，CORONADO、ABCD COVID-19 糖尿病国家审计和 AMERICADO 研究中患有微血管并发症的患者住院期间全因死亡的风险增加：调整后的比值比（OR）为 2.57（95% CI 1.69-3.92），OR 1.22（95% CI 1.00-1.52）和 OR 1.33（95% CI 1.15-1.53）。在三项研究的荟萃分析中，与无并发症的患者相比，有微血管并发症的患者住院期间全因死亡的未调整比值比为 2.05（95% CI 1.42-2.97），在校正年龄和性别后降至 1.62（95% CI 1.19-2.119），进一步加入高血压和 CVD 后降至 1.50（1.12-2.02）。
微血管负担与 COVID-19 住院患者的死亡风险增加相关。
