Original Article

Predictors of Mortality Among COVID-19 Patients With or Without Comorbid Diabetes Mellitus

Abstract

Background: late in 2019, the first case of COVID-19 was detected in China, and the disease caused pandemic state worldwide. Up to now, many studies investigated the impact of comorbid diseases, especially diabetes mellitus on COVID-19 outcomes.

Objectives: In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses.

Methods: In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients were assessed in the correlation analyses.

Results: discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow up for patients who discharged healthily, and 384 person-day follow up for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49 and serum creatinine of 1.39

Conclusion: The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.

1. Mohammadi M, Meskini M, do Nascimento Pinto AL. 2019 Novel coronavirus (COVID-19) overview. Zeitschrift fur Gesundheitswissenschaften = Journal of public health. 2020:1-9.
2. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2020, StatPearls Publishing LLC.; 2020.
3. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [updated 11 March 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
4. Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, et al. Obesity ‑ a risk factor for increased COVID‑19 prevalence, severity and lethality (Review). Molecular medicine reports. 2020;22(1):9-19.
5. Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. The American journal of gastroenterology. 2020;115(5):766-73.
6. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020:200642.
7. Chen Y, Yang D, Cheng B, Chen J, Peng A, Yang C, et al. Clinical Characteristics and Outcomes of Patients With Diabetes and COVID-19 in Association With Glucose-Lowering Medication. Diabetes Care. 2020:dc200660.
8. Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. Journal of diabetes science and technology. 2020:1932296820924469.
9. Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 2020;127:104354.
10. World Health O. Clinical management of severe acute respiratory infection when novel coronavirus (‎‎‎nCoV)‎‎‎ infection is suspected: interim guidance, 25 January 2020. Geneva: World Health Organization; 2020 2020. Contract No.: WHO/nCoV/Clinical/2020.2.
11. Wu Y, Guo W, Liu H, Qi B, Liang K, Xu B, et al. Clinical outcomes of 402 patients with COVID-2019 from a single center in Wuhan, China. medRxiv. 2020.
12. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology. 2020:200490.
13. Fadini GP, Morieri ML, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest. 2020;43(6):867-9.
14. Cristelo C, Azevedo C, Moreira Marques J, Nunes R, Sarmento B. SARS-CoV-2 and Diabetes: New Challenges for the Disease. Diabetes Res Clin Pract. 2020:108228-.
15. Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 Expression in Pancreas May Cause Pancreatic Damage After SARS-CoV-2 Infection. Clin Gastroenterol Hepatol. 2020:S1542-3565(20)30537-1.
16. Wang X, Wang S, Sun L, Qin G. Prevalence of diabetes mellitus in 2019 novel coronavirus: A meta-analysis. Diabetes Res Clin Pract. 2020;164:108200-.
17. McKeever TM, Weston PJ, Hubbard R, Fogarty A. Lung function and glucose metabolism: an analysis of data from the Third National Health and Nutrition Examination Survey. American journal of epidemiology. 2005;161(6):546-56.
18. Shah SH, Sonawane P, Nahar P, Vaidya S, Salvi S. Pulmonary function tests in type 2 diabetes mellitus and their association with glycemic control and duration of the disease. Lung India. 2013;30(2):108-12.
19. Liu XJ, Zhang ZD, Ma XC. High glucose enhances LPS-stimulated human PMVEC hyperpermeability via the NO pathway. Experimental and therapeutic medicine. 2013;6(2):361-7.
20. Pearson-Stuttard J, Blundell S, Harris T, Cook DG, Critchley J. Diabetes and infection: assessing the association with glycaemic control in population-based studies. The lancet Diabetes & endocrinology. 2016;4(2):148-58.
21. Spindler MP, Ho AM, Tridgell D, McCulloch-Olson M, Gersuk V, Ni C, et al. Acute hyperglycemia impairs IL-6 expression in humans. Immunity, inflammation and disease. 2016;4(1):91-7.
22. Yan Y, Yang Y, Wang F, Ren H, Zhang S, Shi X, et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Research & Care. 2020;8(1):e001343.
23. Yang A-P, Liu J-P, Tao W-Q, Li H-M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504-.
24. Jiménez-Ibáñez EO, Castillejos-López M, Hernández A, Gorocica P, Alvarado-Vásquez N. High mortality associated with hyperglycemia, neutrophilia, and lymphopenia in critically ill patients. The Tohoku journal of experimental medicine. 2012;226(3):213-20.
25. Butler SO, Btaiche IF, Alaniz C. Relationship between hyperglycemia and infection in critically ill patients. Pharmacotherapy. 2005;25(7):963-76.
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IssueVol 59, No 7 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/acta.v59i7.7018
Keywords
Coronavirus disease 2019 (COVID-19) Diabetes mellitus Lymphopenia Neutrophils Prognosis
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How to Cite
1.
Mirsoleymani S, Taherifard E, Taherifard E, Taghrir MH, Ahmadi Marzaleh M, Peyravi M, Rezaee R, Nekooghadam SM. Predictors of Mortality Among COVID-19 Patients With or Without Comorbid Diabetes Mellitus. Acta Med Iran. 2021;59(7):393-399.