Journal Article

Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study

Cazenave-Roblot France, Coudol Sandrine, Amadou Coralie, Tramunt Blandine, Jean-Pierre, Riveline, Pierre-Jean, Saulnier, Potier, Louis, Arnault Gwénaëlle, Prevost Gaëtan, Bourgeon-Ghittori Muriel, René, Robert, Jean-François, Thébaut, Disse Emmanuel, Cariou Bertrand, Boutoille, David, Marchand, Lucien, Pichelin Matthieu, Gourdy Pierre, Vatier Camille, Bourron Olivier, Ducet-Boiffard Amélie, Hadjadj Samy, Al-Salameh, Abdallah, Gautier Jean-François, Chaumeil Claude, Wargny Matthieu, Bauduceau Bernard, Thivolet, Charles, Meyer, Laurent, Kerlan Véronique, Laviolle Bruno, Sultan Ariane, Allix Ingrid, Darmon Patrice, Baudoux Florence, Cosson Emmanuel, Roussel Ronan, Gaborit Bénédicte, Borot Sophie, Joubert, Michael

2020

Overview

Aims/hypothesisCoronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown.MethodsWe conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 French centres in the period 10–31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission. Age- and sex-adjusted multivariable logistic regressions were performed to assess the prognostic value of clinical and biological features with the endpoint. ORs are reported for a 1 SD increase after standardisation.ResultsThe current analysis focused on 1317 participants: 64.9% men, mean age 69.8 ± 13.0 years, median BMI 28.4 (25th–75th percentile: 25.0–32.7) kg/m2; with a predominance of type 2 diabetes (88.5%). Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively. The primary outcome was encountered in 29.0% (95% CI 26.6, 31.5) of participants, while 10.6% (9.0, 12.4) died and 18.0% (16.0, 20.2) were discharged on day 7. In univariate analysis, characteristics prior to admission significantly associated with the primary outcome were sex, BMI and previous treatment with renin–angiotensin–aldosterone system (RAAS) blockers, but not age, type of diabetes, HbA1c, diabetic complications or glucose-lowering therapies. In multivariable analyses with covariates prior to admission, only BMI remained positively associated with the primary outcome (OR 1.28 [1.10, 1.47]). On admission, dyspnoea (OR 2.10 [1.31, 3.35]), as well as lymphocyte count (OR 0.67 [0.50, 0.88]), C-reactive protein (OR 1.93 [1.43, 2.59]) and AST (OR 2.23 [1.70, 2.93]) levels were independent predictors of the primary outcome. Finally, age (OR 2.48 [1.74, 3.53]), treated obstructive sleep apnoea (OR 2.80 [1.46, 5.38]), and microvascular (OR 2.14 [1.16, 3.94]) and macrovascular complications (OR 2.54 [1.44, 4.50]) were independently associated with the risk of death on day 7.Conclusions/interpretationsIn people with diabetes hospitalised for COVID-19, BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days.Trial registrationclinicaltrials.gov NCT04324736.

• Publisher: Springer Nature B.V
• Subject: Age / Aldosterone / Angiotensin / Apnea / Body mass index / C-reactive protein / Cell number / Coronaviruses / COVID-19 / Death / Diabetes / Diabetes mellitus (non-insulin dependent) / Dyspnea / Genotype & phenotype / Glucose / Hemoglobin / Hypertension / Intubation / Lymphocytes / Mechanical ventilation / Medical prognosis / Microvasculature / Pathophysiology / Renin / Severe acute respiratory syndrome coronavirus 2 / Sleep / Sleep apnea / Sleep disorders