New onset COVID-19–related diabetes: an indicator of mortality

  1. Jin-Kui Yang
  2. Jian-Min Jin
  3. Shi Liu
  4. Peng Bai
  5. Wei He
  6. Fei Wu
  7. Xiao-Fang Liu
  8. Zhong-Lin Chai
  9. De-Min Han

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Abstract

Background

Concomitance with diabetes is associated with high mortality in critical conditions. Patients with previous diabetes are more vulnerable to COVID-19. However, new-onset COVID-19–related diabetes (CRD) and its relevance have scarcely been reported. This study investigates new-onset CRD and its correlation with poor outcomes or death in patients with COVID-19.

Methods

We performed a single center, retrospective case series study in 120 patients with laboratory confirmed COVID-19 at a university hospital. Fasting blood glucose (FBG) ≥7.0 mmol/L for two times during hospitalization and without a history of diabetes were defined as CRD. The Critical status was defined as admitted to intensive care unit (ICU) or death.

Results

After excluding patients with a history of diabetes, chronic heart, kidney, and liver disease, 69 patients with COVID-19 were included in the final analysis. Of the 69 patients, 23 were Moderate , 20 were Severe , and 26 were Critical (including 16 deceased patients). The prevalence of CRD in Critical and Moderate+Severe patients was 53.85% and 13.95%, respectively. Kaplan-Meier survival analysis revealed a significantly higher mortality rate in patients with CRD (P=0.0019). Multivariable analysis indicated that CRD was an independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Cluster analysis suggested that indicators for multi-organ injury were interdependent, and more proximities of FBG with indicators for multi-organ injury was present.

Conclusion

Our results suggest that new onset COVID-19–related diabetes is an indicator of multi-organ injury and predictor for poor outcomes and death in COVID- 19 patients. As it is easy to perform for clinical practices and even self-monitoring, glucose testing will be much helpful for predicting poor outcomes to facilitate appropriate intensive care in patients with COVID-19.

Funding

National Key Research and Development Program of China; The Beijing Science and Technology Project.

Significance of this study

Evidence before this study

Concomitance with diabetes is associated with high mortality in critical conditions. Patients with previous diabetes are more vulnerable to COVID-19. However, new-onset COVID-19–related diabetes (CRD) and its relevance have scarcely been reported. Recently, an international group of leading diabetes researchers participating in the CoviDIAB Project have established a global registry of patients with Covid-19–related diabetes (covidiab.e-dendrite.com).

Added value of this study?

New-onset diabetes in COVID-19 defined as CRD was investigated. Correlation between CRD and poor outcomes or death in patients with COVID-19 was found. About half of the Critical patients have new onset CRD. CRD is the representative of the clustered indicators of multi-organ injury and is the predictor for poor outcomes and death.

How might these results change the focus of research or clinical practice?

Our results suggest that new onset diabetes is an indicator of multi-organ injury and predictor for poor outcomes and death in COVID-19 patients. The study of CRD may also uncover novel mechanisms of disease.

Article activity feed

  1. Version published to 10.1101/2020.04.08.20058040v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2020.04.08.20058040: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    SPSS for Windows 17.0 and Graphpad prism 7.0 software were used for statistical analysis, with statistical significance set at 2-sided P<0.05.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    Graphpad
    suggested: (GraphPad, RRID:SCR_000306)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations in our study. First, we only assessed FBG and some most accessible biochemical parameters. It would have produced better results if some more specific indicators such as serum insulin levels, echocardiography, glomerular filtration rate were measured in this study. Second, interpretation might be limited by the sample size of the study. Last but not least, missing of HbA1c level is a limitation. Because, low HbA1c would indicate no history of recent diabetes and support the confirmation of new onset of diabetes. In summary, except pneumonia, multi-organ injury including the heart, kidney, and possibly pancreatic islet injuries can cause CRD at an early stage and thereby increase the risk of mortality in patients with COVID-19, if hyperglycemia cannot be improved as shown in Fig 1. These multi-organ injury indicators were associated with higher odds of death and were interdependent, indicating that the multi-organ damage happened at the same time. Among them, COVID-19–related diabetes is a representative of the clustered multi-organ injury for predicting mortality of COVID-19. As it is easy to perform for clinical practices and self-monitoring, blood glucose testing will be much helpful for predicting critical condition to facilitate appropriate intensive care.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.04.08.20058040v1 on medRxiv