Effects of hypertension, diabetes and coronary heart disease on COVID-19 diseases severity: a systematic review and meta-analysis

Chen, Y; Gong, Xiao; Wang, L; Guo, J.

doi:10.1101/2020.03.25.20043133

Cited by 127 publications

(139 citation statements)

References 19 publications

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“…35-4.05; p = 0.002) for acute respiratory distress syndrome (ARDS) [2] has been reported. Further, meta-analysis of nine studies from China (n = 1936) showed a significant correlation between severity of COVID-19 and diabetes (OR, 2.67, 95% CI; 1.91-3.74; p < 0.01) [3]. Similarly, case fatality rate was 7.3% in patients with diabetes as opposed to 2.3% in those without diabetes in a report of 44,672 patients of COVID-19 by Chinese Centre for Disease Control [4].…”

Section: Why Patients With Diabetes Have Increased Severity and Mortamentioning

confidence: 97%

Diabetes and COVID-19: evidence, current status and unanswered research questions

2020

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Patients with diabetes who get coronavirus disease 2019 are at risk of a severe disease course and mortality. Several factors especially the impaired immune response, heightened inflammatory response and hypercoagulable state contribute to the increased disease severity. However, there are many contentious issues about which the evidence is rather limited. There are some theoretical concerns about the effects of different anti-hyperglycaemic drugs. Similarly, despite the recognition of angiotensin converting enzyme 2 (ACE2) as the receptor for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), and the role of ACE2 in lung injury; there are conflicting results with the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in these patients. Management of patients with diabetes in times of restrictions on mobility poses some challenges and novel approaches like telemedicine can be useful. There is a need to further study the natural course of COVID-19 in patients with diabetes and to understand the individual, regional and ethnic variations in disease prevalence and course.

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Section: Why Patients With Diabetes Have Increased Severity and Mortamentioning

confidence: 97%

Diabetes and COVID-19: evidence, current status and unanswered research questions

2020

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“…The most common comlaints at prsentaion were shortness of breath (56.7%), caugh (45.9%), fever (37.4%), and tiredness (23.3%). At admission, lack of consciousness and O2 saturation less than 93% were observed in 5.7% (26) Compared to survivors, patients who dead (non-survivors) were signi cantly older (mean (SD) age: 69.4 years (12.2) vs. 62.6 years (13.5); P < 0.001), were more likely to have underlying comorbidity CKD (35.4% (28) vs. 19.4% (73); P= 0.002). In terms of numbers of comorbidities, a higher percentage of non-survivors had 3 or more comorbidities (22.8 vs. 12.5%; P= 0.008) than survivors.…”

Section: Resultsmentioning

confidence: 96%

“…patients [8,25,26]; however no study focused on biochemical indicators as predicting factors for death in diabetic infected patients, presenting the optimal cutoff points to discriminate between survivors and nonsurvivors. Among laboratory parameters for predicting death, neutrophil and lymphocyte count as indicators for immune function and LDH level as a marker of tissue breakdown had the highest diagnostic accuracy in infected diabetic patients.…”

Section: Previous Studies Have Been Indicated Diabetes As a Risk Factmentioning

confidence: 99%

Factors associated with the poor outcomes in diabetic patients with COVID-19

Rastad

Ejtahed

Mahdavi-Ghorabi

et al. 2020

Preprint

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Background Diabetic’s patients are supposed to experience higher rates of COVID-19 related poor outcomes. We aimed to determined factors predicting poor outcomes in hospitalized diabetic patients with COVID-19. Methods This retrospective cohort study included all adult diabetic patients with radiological or laboratory confirmed COVID-19 who hospitalized between 20 February 2020 and 27 April 2020 in Alborz province, Iran. Data on demographic, medical history, and laboratory test at presentation were obtained from electronic medical records. Diagnosis of diabetes mellitus was self-reported. Comorbidities including cancer, rheumatism, immunodeficiency, or chronic diseases of respiratory, liver, and blood were classified as “other comorbidities” due to low frequency. The assessed poor outcomes were in-hospital mortality, need to ICU care, and receiving invasive mechanical ventilation. Self-reported. Multivariate logistic regression models were fitted to quantify the predictors of in-hospital mortality from COVID-19 in patients with DM. Results Of 455 included patients, 98(21.5%) received ICU care, 65(14.3%) required invasive mechanical ventilation, and 79 (17.4%) dead. In the multivariate model, significant predictors of “death of COVID-19” were age 65 years or older (OR (95% CI): 2.0 (1.16–3.44), chronic kidney disease (CKD) (2.05 (1.16–3.62), presence of “other comorbidities” (2.20 (1.04–4.63)), neutrophil count ≥ 8.0 × 10⁹/L )6.62 (3.73–11.7 ((, Hb level < 12.5 g/dl (2.05 (1.13–3.72) (, and creatinine level ≥ 1.36 mg/dl (3.10 (1.38–6.98)). (All p –values < 0.05). Some of these factors were also associated with other assessed poor outcomes, e.g., need to ICU care or invasive mechanical ventilation. Conclusions Diabetic patients with age 65 years or older, comorbidity CKD, “other comorbidities”, as well as neutrophil count ≥ 8.0 × 10⁹/L, Hb level < 12.5 g/dl, and creatinine level ≥ 1.36 mg/dl, were more likely to dead after COVID-19. Presence of hypertension and cardiovascular disease were associated with none of the poor outcomes.

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“…The defect of cellular immune response and cytokine storm may play roles in the development of acute respiratory distress syndrome [17]. Since diabetic patients suffer from a less robust immune system due to chronic hyperglycemic and in ammatory states, DM could be a risk factor for COVID-19 progression and death [17][18][19][20] Moreover, there are con icting results regarding the use of angiotensin-converting enzyme 2 (ACE2)-increasing drugs in COVID-19 patients [20,21]. Some studies proposed the harmful effects of these drugs on infection severity while the other ones found the drugs useful for preventing pneumonia and the risk of mortality [16,22].…”

Section: Discussionmentioning

confidence: 99%

Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease

Rastad

Karim

Ejtahed

et al. 2020

Preprint

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Background: Diabetes mellitus (DM) and cardiovascular disease (CVD) are present in a large number of patients with novel Coronavirus disease 2019 (COVID-19). We aimed to determine the risk and predictors of in-hospital mortality from COVID-19 in patients with DM and CVD.Methods: This retrospective cohort study included hospitalized patients aged ≥ 18 years with confirmed COVID-19 in Alborz province, Iran, from 20 February 2020 to 25 March 2020. Data on demographic, clinical and outcome (in-hospital mortality) data were obtained from electronic medical records. Self-reported comorbidities were classified into the following groups: “DM” (having DM with or without other comorbidities), “only DM” (having DM without other comorbidities), “CVD” (having CVD with or without other comorbidities), “only CVD” (having CVD without other comorbidities), and “having any comorbidity”. Multivariate logistic regression models were fitted to quantify the risk and predictors of in-hospital mortality from COVID-19 in patients with these comorbidities.Results: Among 2957 patients with COVID-19, 2656 were discharged as cured, and 301 died. In multivariate model, DM (OR: 1.62 (95%CI: 1.14-2.30)) and only DM (1.69 (1.05-2.74)) increased the risk of death from COVID-19; but, both CVD and only CVD showed non-significant associations (p>0.05). Moreover, “having any comorbidities” increased the risk of in-hospital mortality from COVID-19 (OR: 2.66 (95%CI: 2.09 -3.40)). Significant predictors of mortality from COVID-19 in patients with DM were lymphocyte count, creatinine and C-reactive protein (CRP) level (all P- values < 0.05).Conclusions: Our findings suggest that diabetic patients have an increased risk of in-hospital mortality following COVID-19; also, lymphocyte count, creatinine and CRP concentrations could be considered as significant predictors for the death of COVID-19 in these patients.

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Effects of hypertension, diabetes and coronary heart disease on COVID-19 diseases severity: a systematic review and meta-analysis

Cited by 127 publications

References 19 publications

Diabetes and COVID-19: evidence, current status and unanswered research questions

Diabetes and COVID-19: evidence, current status and unanswered research questions

Factors associated with the poor outcomes in diabetic patients with COVID-19

Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease

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