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

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.

Diabetes Mellitus and Its Association with Adverse In-Hospital Outcomes in Patients with COVID-19—A Nationwide Study

“…In the same assessment, mortality was also investigated; two studies were included in this analysis, without revealing a significantly elevated risk of mortality due to DM in patients with COVID-19 [ 27 ]. In critically ill COVID-19 patients aged ≥70 years who were admitted to an intensive care unit, the presence of DM was associated with higher rates of frailty, relevant comorbidities like chronic heart failure or chronic kidney disease, and an 18% elevated 90-day mortality rate [ 35 ]. In their systematic review including 729 studies and more than 29 million COVID-19 patients, Li et al calculated that in COVID-19-infected patients, 9.5% of severe COVID-19 disease courses and 16.8% of COVID-19-related deaths are attributed to the presence of DM.…”