Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis

Abstract

The presence of SARS-CoV-2 was officially documented in Europe at the end of February 2020. Despite many observations, the real impact of COVID-19 in the European Union (EU), its underlying factors and their contribution to mortality and morbidity outcomes were never systematically investigated. The aim of the present work is to provide an overview and a meta-analysis of main predictors and of country differences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-associated mortality rate (MR) in hospitalized patients. Out of 3714 retrieved articles, 87 studies were considered, including 35,486 patients (mean age 60.9 ± 8.2 years) and 5867 deaths. After adjustment for confounders, diabetes mellitus was the best predictors of MR in an age- and sex-dependent manner, followed by chronic pulmonary obstructive diseases and malignancies. In both the US and Europe, MR was higher than that reported in Asia (25[20;29] % and 20[17;23] % vs. 13[10;17]%; both p < 0.02). Among clinical parameters, dyspnea, fatigue and myalgia, along with respiratory rate, emerged as the best predictors of MR. Finally, reduced lymphocyte and platelet count, along with increased D-dimer levels, all significantly contributed to increased mortality. The optimization of glucose profile along with an adequate thrombotic complications preventive strategy must become routine practice in diseased SARS-CoV-2 infected patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11154-021-09630-8.

Hepatic-Metabolite-Based Intermittent Fasting Enables a Sustained Reduction in Insulin Resistance in Type 2 Diabetes and Metabolic Syndrome

“…Insulin resistance is independently correlated with increased risk of incident diabetes in Chinese adults, as reported by Li et al [15], and is closely related with higher mortality for COVID-19, according to data reported by Ren et al [16]. Diabetes is the most important cause of mortality in COVID-19 hospitalized patients, as reported by Corona et al [17]. A large-scale analysis reported by McGovern et al [18] found that the COVID-19 mortality risk increases in patients with Type 2 Diabetes due to drastic biological age acceleration.…”

Clinical profile, risk factors and comorbidities associated with mortality among COVID-19 inpatients at a tertiary care centre in Visakhapatnam: a retrospective study

“…Meta-analysis done by corona showed higher mortality in COVID-19 patients having diabetes mellitus. 12 This may be due to altered immune response caused by diabetes and hypertension. Study done by Cook showed higher mortality in COVID-19 patients with associated hypertension as comorbidity.…”

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

“…Alzahrani and colleagues reported on an impaired adrenocortical response in 28 patients with COVID-19 with plasma cortisol and ACTH concentrations indicating central adrenal insufficiency [85]. The authors found an inverse correlation between disease severity and [70] 20-47 % Corona et al [9] • Optimization of medical treatment is recommended to improve the eventual clinical course of COVID-19 Hypercoagulability [63] 54 % Levi et al [62] • Strict monitoring of coagulation parameters • Treatment with low-molecular-weight heparin is recommended, especially for hospitalized, moderately to severely ill patients Immune impairments [45] 21-51% Wu et al [116] • Due to a poor immune response, febrile response in the early phase might be limited • Because of the increased risk of secondary infections, prolonged antiviral treatment and empirical prophylaxis with broad-spectrum antibiotics should be considered in hospitalized cases of COVID-19 and florid CS Obesity [117] 32-41 % Rottoli et al [118] • Patients with CS and visceral obesity should be carefully monitored in case of COVID-19, due to an increased morbidity and mortality Atherosclerosis/ cardiovascular diseases [68] 27-31 % Zou et al [8] • Optimization of medical treatment is recommended to improve the eventual clinical course of COVID-19 Myopathy [75] 60-82 % De Giorgio et al [119] • Dyspnea might be enhanced due to left ventricular cardiomyopathy and/or thoracic muscle weakness in patients with CS Dyslipidemia [120] 38-71 % Zuin et al [121] • Optimization of medical treatment is recommended to improve the eventual clinical course of COVID-19 Mental illness [122] 50-81 % Barcella et al [123] • As mental illness is associated with an unfavorable outcome in patients with COVID-19, neuropsychiatric disorders in patients with CS should be considered and adequately treated Obstructive sleep apnea [115] 50 % Strausz et al [124] • Consistent therapy is recommended to improve the risk profile and prevent secondary consequences such as hypertension, reduced physical performance and further systemic effects above-mentioned report of Tan and colleagues on higher cortisol concentrations in patients with COVID-19 [51]. Autopsy studies showed frequent microscopic adrenal lesions in patients with severe COVID-19 [86,87].…”

“…In further studies, older age and a large body of comorbidities have been found to be associated with morbidity and mortality due to COVID-19 [2,8]. But the underlying mechanisms remain largely unknown [9]. Especially patients with chronic metabolic diseases, like obesity, diabetes, hypertension, cardiovascular and kidney diseases showed a higher risk of acute respiratory distress syndrome (ARDS) and fatal outcome [10].…”