The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
Llauradó, Gemma (CIBERDEM. Instituto de Salud Carlos III. Department of Endocrinology and Nutrition)
Vlacho, Bogdan (Institut d'Investigació Biomèdica Sant Pau)
Wargny, Matthieu (CHU de Nantes. Clinique Des Données)
Ruan, Yue (Oxford NIHR Biomedical Research Centre)
Franch-Nadal, Josep (Institut Català de la Salut. Centre d'Atenció Primària Raval Sud (Barcelona, Catalunya))
Domingo, Pere (Institut d'Investigació Biomèdica Sant Pau)
Gourdy, Pierre (Université de Toulouse)
Saulnier, Pierre-Jean (Centre d'Investigation Clinique CIC 1402. Université de Poitiers. Inserm)
Hadjadj, Samy (L'Institut du Thorax. Université de Nantes. CHU Nantes. CNRS. Inserm)
Wild, Sasrah H. (Usher Institute. University of Edinburgh)
Rea, Rustam (Oxford NIHR Biomedical Research Centre)
Cariou, Bertrand (L'Institut du Thorax. Université de Nantes. CHU Nantes. CNRS. Inserm)
Khunti, Kamlesh (Diabetes Research Centre. Leicester General Hospital. University Hospitals of Leicester NHS Trust)
Mauricio Puente, Dídac (Institut d'Investigació Biomèdica Sant Pau)

Fecha:	2022
Resumen:	BACKGROUND: It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS: We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020-October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS: Complete data were available for 4,106 (60. 4%) individuals. Of these, 1,652 (40. 2%) had any prior macrovascular disease of whom 28. 5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37. 7% vs 22. 4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2. 12 (95% CI 1. 83-2. 45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1. 53 [95% CI 1. 29-1. 81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0. 48 [95% CI 0. 31-0. 75], I2 60%) and the use of IMV during hospitalization (adjOR 0. 52 [95% CI 0. 40-0. 68], I2 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS: This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.
Ayudas:	Ministerio de Economía y Competitividad CB15/00071
Nota:	Altres ajuts: CIBER-Consorcio Centro de Investigación Biomédica en Red; Ministerio de Ciencia e Innovación; Fondation Francophone de Recherche sur le Diabète (FFRD); Novo Nordisk; MSD; Abbott; AstraZeneca; Lilly; Fédération Française des Diabétiques; Société Francophone du Diabète; Air Liquide Health Care international; Allergan; Elivie; Fortil; Lifescan; Nantes Métroplole; NHC; Sanof; PHRC National COVID-19 Hospitalization and Care Organization Division; Hospital Clinical Research Program (PHRC COVID-19-20-0138).
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Diabetes ; Macrovascular disease ; Mortality ; COVID-19
Publicado en:	Cardiovascular diabetology, Vol. 21 Núm. 1 (October 2022) , p. 216, ISSN 1475-2840

DOI: 10.1186/s12933-022-01657-8
PMID: 36261811

18 p, 1017.4 KB

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