One-fifth of COVID-19 patients with diabetes die within 28 days of hospitalization
New data from the CORONADO study show that 20% of people with diabetes hospitalized with COVID-19 die within 28 days of admission, whereas half are discharged in that same time span.
“CORONADO is the first registered study that specifically aimed to describe the phenotypic characteristics and to identify prognostic factors in patients with diabetes hospitalized for COVID-19,” Samy Hadjadj, MD, PhD, professor of endocrinology and diabetes at L’institut du Thorax and University Hospital Nantes and associate head of the department of endocrinology, diabetes and nutrition at University of Nantes in France; Bertrand Cariou, MD, PhD, professor of endocrinology at the University Hospital Nantes; and colleagues wrote in a study published in Diabetologia. “The present analysis reports the results of the complete CORONADO study totaling 2,796 participants from 68 centers with complete follow-up up to day 28.”
Researchers analyzed data from 2,796 people with diabetes who were hospitalized with COVID-19 (63.7% men; mean age, 69.7 years) at 68 hospitals in France between March 10 and April 10. Data on clinical characteristics before admission and clinical, radiologic and biological characteristics at admission were retrospectively analyzed. The updated analysis followed up with patients at day 28 to determine mortality and hospital discharge outcomes.
At 28 days after hospital admission, 50.2% of the study population was discharged, whereas 20.6% of the study population died, 16.9% were transferred to a different facility and 12.2% remained hospitalized.
Older adults and those with a history of hypertension, microvascular or macrovascular diabetes complications, heart failure and chronic obstructive pulmonary disease (COPD) were less likely to be discharged at 28 days. Those taking metformin or DPP-IV inhibitors had a higher likelihood for discharge, whereas insulin, diuretics, beta-blockers and anticoagulation therapy were associated with lower odds for discharge. Dyspnea, plasma creatinine and nearly all biological findings associated with an inflammatory profile were associated with a lower likelihood for discharge. Predictors for discharge within 28 days of admission were younger age, metformin therapy and longer time between symptom onset and hospital admission.
HbA1c history or at admission was not associated with outcomes at 28 days.
In age-adjusted analysis, men, those with a longer diabetes duration, and people with a history of microvascular or macrovascular complications, heart failure and COPD were more likely to die of COVID-19 within 28 days of admission. People with fever or dyspnea at admission had higher odds for 28-day mortality, and nearly all biological covariates reflecting COVID-19 severity were also associated with death. In multivariable models, older age, history of microvascular complications, insulin and statin routine medication, dyspnea on admission, higher aspartate aminotransferase, higher white cell count, lower platelet count and higher C-reactive protein were associated with an increased risk for death. Metformin therapy and a longer time between symptom onset and admission were associated with lower odds for mortality.
“The identification of favorable variables associated with hospital discharge and unfavorable variables associated with death can lead to patient reclassification and help to use resources adequately according to individual patient profile,” the researchers wrote.