Determinants of mortality among COVID-19 patients with diabetes mellitus in Addis Ababa, Ethiopia, 2022: An unmatched case-control study
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Abstract
Introduction
COVID-19 remains one of the leading causes of death seeking global public health attention. Diabetes mellitus is associated with severity and lethal outcomes up to death independent of other comorbidities. Nevertheless, information regarding the determinant factors that contributed to the increased mortality among diabetic COVID-19 patients is limited. Thus, this study aimed at identifying the determinants of mortality among COVID-19 infected diabetic patients.
Methods
An unmatched case-control study was conducted on 340 randomly selected patients by reviewing patient records. Data were collected using a structured extraction checklist, entered into Epi data V-4.4.2.2, and analyzed using SPSS V-25. Then, binary logistic regression was used for bivariate and multivariable analysis. Finally, an adjusted odds ratio with 95% CI and a p-value of less than 0.05 was used to determine the strength of association and the presence of a statistical significance consecutively.
Results
The study was conducted on 340 COVID-19 patients (114 case and 226 controls). Patient age (AOR=4.90; 95% CI: 2.13, 11.50), severity of COVID-19 disease (AOR=4.95; 95% CI: 2.20, 11.30), obesity (AOR=7.78; 95% CI: 4.05, 14.90), hypertension (AOR=5.01; 95% CI: 2.40, 10.60), anemia at presentation (AOR=2.93; 95% CI: 1.29, 6.65), and AKI after hospital admission (AOR=2.80; 95% CI: 1.39, 5.64) had statistically significant association with increased mortality of diabetic patients with COVID-19 infection. Conversely, presence of RVI co-infection was found to be protective against mortality (AOR=0.35; 95% CI: 0.13, 0.90).
Conclusion
Patient age (<65years), COVID-19 disease severity (mild and moderate illness), presence of hypertension, obesity, anemia at admission, and AKI on admission was independently associated with increased mortality of diabetic COVID-19 patients. Contrariwise, the presence of RVI co-infection was found to be protective against patient death. Consequently, COVID-19 patients with diabetes demand untiring efforts, and focused management of the identified factors will substantially worth the survival of diabetic patients infected with COVID-19.
What is already known on this topic?
Diabetes mellitus is associated with severity and lethal outcomes up to death independent of other comorbidities. Previous studies indicated that diabetic patients have almost four times increased risk of severe disease and death due to COVID-19 infection. Consequently, with this increased mortality and other public health impacts, numerous reports have been evolved worldwide on the link between COVID-19 and DM, and diabetes management during the COVID-19 pandemic. However, information regarding the determinant factors that lead to the increased mortality among diabetic COVID-19 patients is not well-studied yet.
What this study adds?
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Patient age (<65years), COVID-19 disease severity (mild and moderate illness), presence of hypertension, obesity, anemia at admission, and AKI on hospital admission were independently associated with increased mortality of COVID-19 patients with DM.
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In addition, RVI co-infection was found to be protective against patient death.
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SciScore for 10.1101/2022.04.04.22273344: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical consideration: Ethical clearance was obtained from Saint Paul’s Millennium Medical College institutional review board (IRB).
Consent: Then, the chief executive director and the clinical director were communicated about the purpose of the study, and permission was obtained on behalf of patients to access the data.Sex as a biological variable not detected. Randomization Cases were selected consecutively, and two respective controls next to the sampled case were included randomly with replacement after confining all death records in their order of medical record number (MRN). Blinding not detected. Power Analysis Sample size and recruitment methods: The sample size was estimated using … SciScore for 10.1101/2022.04.04.22273344: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical consideration: Ethical clearance was obtained from Saint Paul’s Millennium Medical College institutional review board (IRB).
Consent: Then, the chief executive director and the clinical director were communicated about the purpose of the study, and permission was obtained on behalf of patients to access the data.Sex as a biological variable not detected. Randomization Cases were selected consecutively, and two respective controls next to the sampled case were included randomly with replacement after confining all death records in their order of medical record number (MRN). Blinding not detected. Power Analysis Sample size and recruitment methods: The sample size was estimated using the double population proportion formula by the statcalc program of Epi info software, considering unmatched case-control study assumptions. Table 2: Resources
Software and Algorithms Sentences Resources Then, it was exported to SPSS software version 25 for analysis. SPSSsuggested: (SPSS, RRID:SCR_002865)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 certain limitations. First, it would be nice to run a stratified analysis for each type of DM and differentiate among newly versus known diabetic patients, which is not the case in our study. It did not enable us to see the possible variation in the mortality and factors affecting it among the two groups (newly diagnosed and chronic DM). Second, the retrospective nature of the study would delimit the strength of evidence drawn from the study since data were not collected primarily for research purposes.
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.
Results from scite Reference Check: We found no unreliable references.
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