10.6084/M9.FIGSHARE.C.6256770
Gemma Llauradó
Gemma
Llauradó
Institut Hospital del Mar d'Investigacions Mèdiques
Instituto de Salud Carlos III
Bogdan Vlacho
Bogdan
Vlacho
Matthieu Wargny
Matthieu
Wargny
Centre Hospitalier Universitaire de Nantes
Yue Ruan
Yue
Ruan
Oxford University Hospitals NHS Trust
NIHR Oxford Musculoskeletal Biomedical Research Centre
Josep Franch-Nadal
Josep
Franch-Nadal
Institut Català de la Salut
Instituto de Salud Carlos III
Pere Domingo
Pere
Domingo
Hospital de Sant Pau
Pierre Gourdy
Pierre
Gourdy
Pierre-Jean Saulnier
Pierre-Jean
Saulnier
Centre Hospitalier Universitaire de Poitiers
Samy Hadjadj
Samy
Hadjadj
Centre Hospitalier Universitaire de Nantes
Sarah H. Wild
Sarah H.
Wild
University of Edinburgh
Rustam Rea
Rustam
Rea
Oxford University Hospitals NHS Trust
NIHR Oxford Musculoskeletal Biomedical Research Centre
Bertrand Cariou
Bertrand
Cariou
Centre Hospitalier Universitaire de Nantes
Kamlesh Khunti
Kamlesh
Khunti
University Hospitals of Leicester NHS Trust
Dídac Mauricio
Dídac
Mauricio
Hospital de Sant Pau
Instituto de Salud Carlos III
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)
Abstract 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.
Medicine
Biotechnology
Chemical Sciences not elsewhere classified
Sociology
Immunology
Biological Sciences not elsewhere classified
Cancer
Science Policy
Infectious Diseases
figshare
2022
2022-10-20
2022-10-20
Collection
CC BY 4.0