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Observational Study
. 2020 Oct 1;19(1):164.
doi: 10.1186/s12933-020-01140-2.

Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II)

Ernesto Maddaloni  1   2 , Luca D'Onofrio  1 , Francesco Alessandri  1 , Carmen Mignogna  1 , Gaetano Leto  3 , Giuseppe Pascarella  4 , Ivano Mezzaroma  1 , Miriam Lichtner  3 , Paolo Pozzilli  4 , Felice Eugenio Agrò  4 , Monica Rocco  5 , Francesco Pugliese  1 , Andrea Lenzi  1 , Rury R Holman  2 , Claudio Maria Mastroianni  1 , Raffaella Buzzetti  6 ; CoViDiab Study Group
Collaborators, Affiliations
Observational Study

Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II)

Ernesto Maddaloni et al. Cardiovasc Diabetol. .

Abstract

Background: Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity.

Methods: We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders.

Results: Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12-3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37-3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23-5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61-6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90-3.06, adjp = 0.10).

Conclusions: Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.

Keywords: COPD; Covid-19; Diabetes; Hypertension; SARS-CoV-2.

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Conflict of interest statement

E.M. reports research support from scientific societies with unrestricted grants from Lilly and from AstraZeneca and personal fees from Merck Serono, AstraZeneca, Abbott, PikDare. C.M. has received speaker fees from AstraZeneca. G.L. has received honoraria from NovoNordisk, Lilly, AstraZeneca, Sanofi. P.P. has received research support from Eli Lilly and Company and serves on the speaker bureau for Sanofi‐Aventis. R.R.H. reports research support from AstraZeneca, Bayer and Merck Sharp & Dohme, and personal fees from Bayer, Intarcia, Merck Sharp & Dohme, Novartis and Novo Nordisk. R.B. has received honoraria or consulting fees from Sanofi, Eli Lilly, Abbott, and AstraZeneca. All other authors declare no conflicts of interests related to this manuscript.

Figures

Fig. 1
Fig. 1
Proportion of patients experiencing the primary composite outcome (a), and the secondary outcomes of ICU admission or death (b), or death (c) among patients with or without different comorbidities. Age and sex adjusted odds ratios (OR) with 95% confidence intervals (CI) for those with, compared with those without, each comorbidity are reported. Error bars represent 95% confidence intervals
Fig. 2
Fig. 2
Proportion of patients experiencing the primary composite outcome according to their number of underlying cardiometabolic conditions (hypertension, diabetes, dyslipidaemia). P-values are adjusted for age, sex and COPD. Error bars represent 95% confidence intervals
See this image and copyright information in PMC

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