COVID‐19 fatality prediction in people with diabetes and prediabetes using a simple score upon hospital admission
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Abstract
Aim
To assess predictors of in‐hospital mortality in people with prediabetes and diabetes hospitalized for COVID‐19 infection and to develop a risk score for identifying those at the greatest risk of a fatal outcome.
Materials and Methods
A combined prospective and retrospective, multicentre, cohort study was conducted at 10 sites in Austria in 247 people with diabetes or newly diagnosed prediabetes who were hospitalized with COVID‐19. The primary outcome was in‐hospital mortality and the predictor variables upon admission included clinical data, co‐morbidities of diabetes or laboratory data. Logistic regression analyses were performed to identify significant predictors and to develop a risk score for in‐hospital mortality.
Results
The mean age of people hospitalized (n = 238) for COVID‐19 was 71.1 ± 12.9 years, 63.6% were males, 75.6% had type 2 diabetes, 4.6% had type 1 diabetes and 19.8% had prediabetes. The mean duration of hospital stay was 18 ± 16 days, 23.9% required ventilation therapy and 24.4% died in the hospital. The mortality rate in people with diabetes was numerically higher (26.7%) compared with those with prediabetes (14.9%) but without statistical significance ( P = .128). A score including age, arterial occlusive disease, C‐reactive protein, estimated glomerular filtration rate and aspartate aminotransferase levels at admission predicted in‐hospital mortality with a C‐statistic of 0.889 (95% CI: 0.837‐0.941) and calibration of 1.000 ( P = .909).
Conclusions
The in‐hospital mortality for COVID‐19 was high in people with diabetes but not significantly different to the risk in people with prediabetes. A risk score using five routinely available patient variables showed excellent predictive performance for assessing in‐hospital mortality.
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SciScore for 10.1101/2020.11.02.20224311: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Nationwide ethics approval was obtained from the Ethics Committee of the Medical University of Graz, Austria (EK 32-355 ex 19/20).
Consent: Living patients who were unable to give their consent to participate in this study before discharge, were contacted later for consent to use their clinical data.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
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 …SciScore for 10.1101/2020.11.02.20224311: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Nationwide ethics approval was obtained from the Ethics Committee of the Medical University of Graz, Austria (EK 32-355 ex 19/20).
Consent: Living patients who were unable to give their consent to participate in this study before discharge, were contacted later for consent to use their clinical data.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
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:One limitation of our study is the sample size of 238 subjects. However, given the total population of Austria of less than 9 million people and the importance of having in-hospital mortality data in people with diabetes available for as many as possible countries, these data are of importance. Another limitation is the lack of comparison data in people without diabetes from Austria, hospitalized for COVID-19. In addition, due to the pragmatic design we do not have a ful dataset on all laboratory parameters of interest available in this pragmatic registry. Hence, we decided to use only those laboratory parameters in the risk score model, which were available in more than 80% of participants. Sensitivity analyses including further laboratory parameters (even if the frequency was less than 80%) did not change the predictive performance of the score substantially. Given that HbA1c is not routinely measured in all people admitted to the hospital, prediabetes was likely be underdiagnosed in the overall cohort of people having COVID-19, which needs further investigation. While a strength of this publication is the data on people with prediabetes and COVID-19 and the idea of summarizing the risk parameters into a simple clinical score, the limitation is the lack of external validation of this score, which is of importance for its potential usage in routine care. Our data show high in-hospital mortality in people with diabetes and prediabetes in Austria. A simple 5 parameter risk sco...
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.
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