糖尿病与老年危重症 COVID-19 患者 90 天死亡率相关：一项多中心前瞻性观察队列研究。
Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study.
机构信息
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria.
出版信息
Infection. 2023 Oct;51(5):1407-1415. doi: 10.1007/s15010-023-02001-2. Epub 2023 Mar 1.
BACKGROUND
Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age.
METHODS
This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan-Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality.
RESULTS
This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06-1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis.
CONCLUSION
Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19.
STUDY REGISTRATION
NCT04321265, registered March 19th, 2020.
背景
多项研究发现，糖尿病、疾病严重程度和 COVID-19 患者的预后之间存在关联。老年重症患者风险尤其高。本研究旨在调查糖尿病对 70 岁以上重症高危患者 90 天死亡率的影响。
方法
这是一项多中心国际前瞻性队列研究，在 26 个国家的 151 个 ICU 进行。我们纳入了 2020 年 3 月 19 日至 2021 年 7 月 15 日期间因确诊 SARS-CoV-2 感染而入住 ICU 的年龄≥70 岁的患者。根据是否患有糖尿病将患者分为两组。主要结局为 90 天死亡率。分析并比较了直至第 90 天的 Kaplan-Meier 总体生存曲线，并使用对数秩检验进行比较。计算混合效应 Weibull 回归模型以调查糖尿病对 90 天死亡率的影响。
结果
本研究共纳入 3420 例患者，中位年龄为 76 岁。其中，37.3%（n=1277）有糖尿病病史。糖尿病患者的衰弱率更高（32% vs. 18%），且合并多种疾病，包括慢性心力衰竭（20% vs. 11%）、高血压（79% vs. 59%）和慢性肾脏病（25% vs. 11%），但肺部合并症无差异（22% vs. 22%）。糖尿病患者 90 天死亡率显著高于无糖尿病患者（64% vs. 56%，p<0.001）。在 Weibull 回归分析中，校正年龄、性别、SOFA 评分和其他合并症后，糖尿病与 90 天死亡率的相关性仍然显著（HR 1.18 [1.06-1.31]，p=0.003）。
结论
糖尿病是 COVID-19 老年重症患者 90 天死亡率的重要危险因素。
研究注册
NCT04321265，于 2020 年 3 月 19 日注册。
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