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Observational Study
. 2021 Jan 19;21(1):84.
doi: 10.1186/s12879-021-05771-y.

Critically ill patients with diabetes and Middle East respiratory syndrome: a multi-center observational study

Jesna Jose  1   2 , Hasan M Al-Dorzi  3 , Awad Al-Omari  4 , Yasser Mandourah  5 , Fahad Al-Hameed  6 , Musharaf Sadat  3 , Eman Al Qasim  3 , Basem Alraddadi  7   8 , Abdulrahman Al Harthy  9 , Ghaleb A Al Mekhlafi  10 , Abdullah Almotairi  11 , Kasim Al Khatib  12 , Ahmed Abdulmomen  13 , Ismael Qushmaq  14 , Anees A Sindi  15 , Ahmed Mady  9   16 , Othman Solaiman  17 , Rajaa Al-Raddadi  18 , Khalid Maghrabi  17 , Ahmed Ragab  19 , Ayman Kharaba  20 , Sarah Shalhoub  21   22 , Abdulsalam M Al-Aithan  23 , Gajendra K Vishwakarma  2 , Atanu Bhattacharjee  24 , Yaseen M Arabi  25 ; Saudi Critical Care Trials Group
Affiliations
Observational Study

Critically ill patients with diabetes and Middle East respiratory syndrome: a multi-center observational study

Jesna Jose et al. BMC Infect Dis. .

Abstract

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).

Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012-January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.

Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p < 0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72).

Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.

Keywords: Acute respiratory distress syndrome; Coronavirus; Diabetes; Middle East respiratory syndrome.

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Conflict of interest statement

Yaseen Arabi provided nonpaid consultations on therapeutics for MERS for Gilead Sciences and SAB Biotherapeutics and he is a Board Member of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). He is the Lead-Co Chair of the Think-20 Saudi Arabia (T20) Taskforce for COVID-19. Other authors declared that they have no competing interests.

Figures

Fig. 1
Fig. 1
Panel a: Time-to-clearance of the Middle East respiratory syndrome coronavirus (MERS-CoV) RNA among patients with diabetes and no diabetes. Time to clearance was defined as the time taken from the date of ICU admission to having two negative RT-PCR tests not followed by positive test. Log-rank test is used to calculate the P-value. Panel b: Kaplan Meir curves for survival among patients with diabetes and no diabetes and Middle East respiratory syndrome (MERS)
See this image and copyright information in PMC

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