Increased risk of poor clinical outcome in COVID ‐19 patients with diabetes mellitus and in‐hospital mortality predictors: A retrospective cohort from a tertiary hospital in Indonesia
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Abstract
Aim
To determine association between diabetes in confirmed cases of COVID‐19 and intensive care admission and in‐hospital mortality, evaluate several laboratory parameters as mortality predictor and develop predictors of in‐hospital mortality among diabetics with COVID‐19.
Methods
This retrospective cohort recruited all cases of COVID‐19 hospitalized in Fatmawati General Hospital from March to October 2020. Inclusion criterion was RT‐PCR confirmed cases of COVID‐19 who aged 18 years and older while exclusion criteria were incomplete medical record or cannot be found and pregnant women.
Results
We enrolled 506 participants to this study with median age of 51 years (IQR:22), female (56.32%), and diabetes (28.46%). Diabetes increased intensive care admission (adjusted OR: 2.57; 95% CI: 3.52–10.43) and in‐hospital mortality (adjusted OR: 2.50; 95% CI: 1.61–3.89). In predicting in‐hospital mortality, ferritin and lactate dehydrogenase offered an acceptable discrimination, AUC: 0.71 (95% CI: 0.62–0.79) and AUC: 0.70 (95% CI: 0.61–0.78), respectively. The optimal cut‐off of predicting mortality for ferritin was 786 g/mL and for LDH was 514.94 u/L. Factors include age above 70 years old, RBGs level on admission above 250 mg/dL or below 140 mg/dL, ferritin level above 786 ng/mL and presence of ARDS increased the odds of mortality among individuals with diabetes.
Conclusions
Diabetes increases risk intensive care admission and in hospital mortality in COVID‐19. Multivariate analysis showed that older age, RBG on admission, high ferritin level, presence of ARDS increased the odds of mortality among individuals with diabetes.
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SciScore for 10.1101/2021.12.30.21266217: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was reviewed and approved by the Research Ethic Committee of Fatmawati General Hospital (27/KEP/XII/2020). Sex as a biological variable Individuals who were pregnant and data for the outcome cannot be achieved excluded from this study. Randomization Diabetes was determined based on the patient’s medical history and laboratory parameters, including HbA1C > 6.5 or fasting blood glucose > 126 mg/dL or random blood glucose > 200 mg/dL in two consecutive measurements. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All the analysis was performed using STATA Version 12. STATAsuggested: (Stata, RRID:SCR_012763)Results from OddPub:…
SciScore for 10.1101/2021.12.30.21266217: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was reviewed and approved by the Research Ethic Committee of Fatmawati General Hospital (27/KEP/XII/2020). Sex as a biological variable Individuals who were pregnant and data for the outcome cannot be achieved excluded from this study. Randomization Diabetes was determined based on the patient’s medical history and laboratory parameters, including HbA1C > 6.5 or fasting blood glucose > 126 mg/dL or random blood glucose > 200 mg/dL in two consecutive measurements. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All the analysis was performed using STATA Version 12. STATAsuggested: (Stata, RRID:SCR_012763)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:This study has several limitations to be discussed. First, we cannot analyze the time relationship in this study. That is because we did not measure the diabetes duration. Second, diabetes is a heterogeneous population. We included all subjects with diabetes conditions, including type 1 diabetes, type 2 diabetes, newly diagnosed diabetes, controlled or uncontrolled diabetes, those who received insulin or oral diabetes medication. Therefore, there is no specificity in this study, nor we performed a sub-analysis of which of these different factors might play a role in the outcome. Lastly, our study is conducted in a tertiary facility and one of the largest hospitals in Indonesia that the government-appointed as an advanced referral hospital. About 45.85% of subjects in this study already came with critical conditions, and 8.89% were already in severe conditions. Therefore, readers should be careful in generalizing our results. In accordance with our findings, a meta-analysis including 22 studies showed individuals with a more severe diabetes condition have a poorer prognosis of COVID-19 compared to those with milder diabetes conditions.27 A Spanish COVID-19 registry found admission hyperglycemia (RBG > 180 mg/dL) regardless of diabetes diagnosis was a strong predictor of all-cause mortality in non-critically hospitalized patients.28 Moreover, the chronic hyperglycemia condition also leads to increased fibrinogen amyloid changes, leading to hypercoagulability conditions.29 It is...
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