The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
journal contributionposted on 2023-05-26, 14:29 authored by G Llauradó, B Vlacho, M Wargny, Y Ruan, J Franch-Nadal, P Domingo, P Gourdy, PJ Saulnier, S Hadjadj, SH Wild, R Rea, B Cariou, K Khunti, D Mauricio
BACKGROUND: It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS: We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020-October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS: Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83-2.45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29-1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31-0.75], I2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40-0.68], I2 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS: This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.
This research was supported by CIBER-Consorcio Centro de Investigación Biomédica en Red- (CB15/00071), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación. CORONADO study received the following funding: the Fondation Francophone de Recherche sur le Diabète (FFRD), supported by Novo Nordisk, MSD, Abbott, AstraZeneca, Lilly and FFD (Fédération Française des Diabétiques) – CORONADO initiative emergency grant; Société Francophone du Diabète (SFD) – CORONADO initiative emergency grant; Air Liquide Health Care international. CORONADO initiative emergency grant; Allergan. CORONADO initiative emergency grant; AstraZeneca. CORONADO initiative emergency grant; Elivie. CORONADO initiative emergency grant; Fortil. CORONADO initiative emergency grant; Lifescan. CORONADO initiative emergency grant; CORONADO initiative emergency grant; Nantes Métroplole. NHC. CORONADO initiative emergency grant; Novo Nordisk. CORONADO initiative emergency grant; Sanof. CORONADO emergency grant; PHRC National COVID-19 Hospitalization and Care Organization Division (DGOS) as part of the Hospital Clinical Research Program (PHRC COVID-19–20-0138)
CitationLlauradó, G., Vlacho, B., Wargny, M. et al. The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19). Cardiovasc Diabetol 21, 216 (2022). https://doi.org/10.1186/s12933-022-01657-8
Author affiliationDiabetes Research Centre
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