Gujral Unjali, Vanasse Lauren T, Goyal Abhinav, Quyyumi Arshed, Ayers Colby, Das Sandeep, Pasquel Francisco
Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
Emory University, Atlanta, Georgia, USA.
BMJ Open. 2024 Dec 4;14(12):e084087. doi: 10.1136/bmjopen-2024-084087.
To examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established heart failure (HF) or established atherosclerotic cardiovascular disease (ASCVD).
Observational study; longitudinal analysis of registry data.
Hospitals in the USA reporting to the American Heart Association (AHA) COVID-19 Registry from January 2020 to May 2021.
20 796 individuals with diabetes (11 244 men; mean age 64.2) and 30 798 without diabetes (15 980 men; mean age 59.0) hospitalised for COVID-19 in the USA.
Primary outcome measures were all-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilation. Secondary outcome measures included the association with diabetes and these outcomes among those with and without pre-existing ASCVD and HF and the association with insulin use and these outcomes in patients hospitalised for COVID-19.
After adjustment for relevant covariates diabetes increased the risk of mortality (HR 1.12, 95% CI: 1.03 to 1.21), MACE (HR 1.32, 95% CI: 1.17 to 1.48) and mechanical ventilation (HR 1.33, 95% CI: 1.26 to 1.42). Among patients with established ASCVD or HF, diabetes did not modify the risk of adverse outcomes. There was a significant difference in the risk of mortality between patients taking insulin compared with those who were not (HR 1.32, 95% CI: 1.01 to 1.26); however, there was no difference in the risk of MACE or mechanical ventilation.
Diabetes was associated with a higher risk of in-hospital all-cause mortality, MACE and need for mechanical ventilation in patients hospitalised for COVID-19. Diabetes was independently associated with adverse outcomes, particularly among those without pre-existing cardiovascular disease.
研究仅患有糖尿病或有确诊心力衰竭（HF）病史或确诊动脉粥样硬化性心血管疾病（ASCVD）病史的新冠肺炎住院患者的相关预后情况。
观察性研究；对登记数据进行纵向分析。
2020年1月至2021年5月期间向美国心脏协会（AHA）新冠肺炎登记处报告数据的美国医院。
美国20796例因新冠肺炎住院的糖尿病患者（11244例男性；平均年龄64.2岁）和30798例非糖尿病患者（15980例男性；平均年龄59.0岁）。
主要结局指标为全因死亡率、住院期间主要不良心血管事件（MACE）和/或住院期间机械通气。次要结局指标包括在有和没有预先存在的ASCVD和HF的患者中糖尿病与这些结局的关联，以及在因新冠肺炎住院的患者中胰岛素使用与这些结局的关联。
在对相关协变量进行调整后，糖尿病增加了死亡风险（风险比[HR]1.12，95%置信区间[CI]：1.03至1.21）、MACE风险（HR 1.32，95%CI：1.17至1.48）和机械通气风险（HR 1.33，95%CI：1.26至1.42）。在已确诊ASCVD或HF的患者中，糖尿病并未改变不良结局的风险。使用胰岛素的患者与未使用胰岛素的患者之间的死亡风险存在显著差异（HR 1.32，95%CI：1.01至1.26）；然而，MACE风险或机械通气风险没有差异。
糖尿病与新冠肺炎住院患者的院内全因死亡率、MACE风险及机械通气需求较高相关。糖尿病与不良结局独立相关，尤其是在那些没有预先存在心血管疾病的患者中。
