Poor prognosis indicators of type-2 diabetic COVID-19 patients

Abstract

Diabetes is associated with a worse prognosis and a high risk of morbidity and mortality in COVID-19 patients. We aimed to evaluate the main factors involved in the poor prognosis in diabetic patients. A total of 984 patients diagnosed with COVID-19 admitted to the hospital were included in this study. Patients were first divided into type-2 diabetic (DM+) and non-diabetic (DM-) groups. The participants were analyzed based on the National Early Warning Score (NEWS) and on the Quick-Sequential Organ Failure Assessment (qSOFA) to find the best prognostic risk score for our study. The DM+ and DM- groups were divided into non-severe and severe groups. Comparative and correlative analyses were used to identify the physiological parameters that could be employed for creating a potential risk indicator for DM+ COVID-19 patients. We found a poorer prognosis for the DM+ COVID-19 patients with a higher ICU admission rate, mechanical ventilation rate, vasopressor use, dialysis, and longer treatment times compared with the DM- group. DM+ COVID-19 patients had increased plasma glucose, lactate, age, urea, NEWS, and D-dimer levels, herein referred to as the GLAUND set, and worse prognosis and outcomes when compared with infected DM- patients. The NEWS score was a better indicator for assessing COVID-19 severity in diabetic patients than the q-SOFA score. In conclusion, diabetic COVID-19 patients should be assessed with the NEWS score and GLAUND set for determining their prognosis COVID-19 prognosis.

Figure 1. Comparative analysis between the National Early Warning Score (NEWS) and the Quick-Sequential Organ Failure Assessment (qSOFA) in non-diabetic (DM–) and type-2 diabetic (DM+) patients. Total amount of leukocytes (A and B) and neutrophils (C and D) and plasma levels of C-reactive protein (CRP) (E and F) and D-dimer (G and H). Data are reported as means±SE. P<0.05, ANOVA and t-test (P value with an asterisk).

Figure 2. Risk scores and plasma biochemical parameters in non-diabetic (DM–) and type-2 diabetic (DM+) patients with COVID-19 classified as non-severe and severe according to the National Early Warning Score (NEWS). NEWS (A), Quick-Sequential Organ Failure Assessment (qSOFA) (B), C-reactive protein (CRP) (C), D-dimer (D), plasma glucose (E), lactate (F), age (G), and urea (H) in type 2 diabetic and non-diabetic patients. Data are reported as means±SE. P<0.05, ANOVA and t-test (P value with an asterisk).

Figure 3. Plasma cellular parameters in non-diabetic (DM–) and type-2 diabetic (DM+) patients with COVID-19 classified as non-severe and severe according to the National Early Warning Score (NEWS). Total leukocytes (A), neutrophils (B), lymphocytes (C), neutrophil to lymphocyte ratio (NLR) (D), d-lymphocytes (E), d-neutrophils (F), d-NLR (G), and basophils (H). Data are reported as means±SE. P<0.05, ANOVA and t-test (P value with an asterisk).

Figure 4. Correlation analysis between the National Early Warning Score (NEWS) and plasma C-reactive protein (CRP) (A), D-dimer (B), glucose (C), lactate (D), and urea (E) levels, and age (F) in type 2 diabetic (DM+) and non-diabetic (DM) COVID-19 patients.

Figure 5. Number of days in the ICU (A), with mechanical ventilation (B), receiving vasopressor drugs (C), and on dialysis (D) of type-2 diabetic (DM+) and non-diabetic (DM–) patients classified as non-severe and severe, according to their National Early Warning Score (NEWS). The GLAUND (E) index scores were calculated using plasma glucose levels, plasma lactate levels, age, plasma urea levels, NEWS score, and plasma D-dimer levels. ICU: intensive care unit. Data are reported as means±SE. P<0.05, ANOVA followed by Bonferroni post hoc test and t-test (P value with an asterisk).