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Observational Study
. 2023 Oct;51(5):1407-1415.
doi: 10.1007/s15010-023-02001-2. Epub 2023 Mar 1.

Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study

Timo Mayerhöfer  1 , Sebastian Klein  1 , Bernhard Wernly  2   3 , Hans Flaatten  4 , Bertrand Guidet  5 , Dylan W De Lange  6 , Jesper Fjølner  7 , Susannah Leaver  8 , Michael Beil  9 , Sigal Sviri  9 , Raphael Romano Bruno  10 , Antonio Artigas  11 , Peter Vernon van Heerden  12 , Bernardo Bollen Pinto  13 , Joerg C Schefold  14 , Rui Moreno  15 , Maurizio Cecconi  16   17 , Wojciech Szczeklik  18 , Christian Jung  10 , Michael Joannidis  19 ; COVIP study group
Collaborators, Affiliations
Observational Study

Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study

Timo Mayerhöfer et al. Infection. 2023 Oct.

Abstract

Background: Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age.

Methods: This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan-Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality.

Results: This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06-1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis.

Conclusion: Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19.

Study registration: NCT04321265, registered March 19th, 2020.

Keywords: Critical care; Elderly; Intensive care unit; Old; Risk factors; SARS-CoV-2; Ventilation.

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Conflict of interest statement

JCS (full departmental disclosure:) report grants from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Phagenesis, and Nycomed outside the submitted work. The money was paid into departmental funds. No personal financial gain applied. The other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival analysis displaying the survival probability in relation to the diabetes mellitus status at admission. CI confidence interval
Fig. 2
Fig. 2
Forest plot for univariable hazard ratios for patients with DM in different subgroups. CI confidence interval, aHR adjusted hazard ratio, aHT arterial hypertension, ASCVD atherosclerotic cardiovascular disease, BMI body mass index, CHF chronic heart failure, CKD chronic kidney disease, MV mechanical ventilation
See this image and copyright information in PMC

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