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Coagulopathy is a major extrapulmonary risk factor for mortality in hospitalized patients with COVID-19 with type 2
Xiaoyan Chen1, Ying Chen2, Chaomin Wu1,3
1Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
Patients with type 2 diabetes mellitus (T2DM) hospitalized with COVID-19 faced higher mortality. Coagulopathy emerged as a key risk factor for death in T2DM patients, unlike those without diabetes.
Area of Science:
- Infectious Diseases
- Endocrinology
- Critical Care Medicine
Background:
- Type 2 diabetes mellitus (T2DM) is a significant comorbidity associated with severe outcomes in COVID-19 patients.
- Understanding specific risk factors for mortality in T2DM patients with COVID-19 is crucial for targeted interventions.
Purpose of the Study:
- To identify and analyze the risk factors contributing to in-hospital death among patients with COVID-19 and pre-existing type 2 diabetes mellitus.
- To compare mortality risk factors between COVID-19 patients with and without T2DM.
Main Methods:
- Retrospective cohort study of 1105 inpatients with COVID-19.
- Comparison of epidemiological and clinical data between non-T2DM and T2DM groups.
- Univariable and multivariable Cox regression analyses to determine risk factors for in-hospital death.
Main Results:
- In-hospital mortality was significantly higher in COVID-19 patients with T2DM (35.3%) compared to those without (17.4%).
- In T2DM patients with COVID-19, acute respiratory distress syndrome (ARDS) and coagulopathy were primary mortality drivers.
- In non-T2DM patients with COVID-19, ARDS and acute cardiac injury (ACI) were the main causes of mortality.
Conclusions:
- Coagulopathy is a significant extrapulmonary risk factor for mortality in COVID-19 patients with T2DM.
- Acute cardiac injury and acute kidney injury were associated with mortality in non-T2DM COVID-19 patients but not as prominently in T2DM patients.
Introduction:
To investigate the risk factors for the death in patients with COVID-19 with type 2 diabetes mellitus (T2DM).
Research Design And Methods:
We retrospectively enrolled inpatients with COVID-19 from Wuhan Jinyintan Hospital (Wuhan, China) between December 25, 2019, and March 3, 2020. The epidemiological and clinical data were compared between non-T2DM and T2DM or between survivors and non-survivors. Univariable and multivariable Cox regression analyses were used to explore the effect of T2DM and complications on in-hospital death.
Results:
A total of 1105 inpatients with COVID-19, 967 subjects with without T2DM (n=522 male, 54.0%) and 138 subjects with pre-existing T2DM (n=82 male, 59.4%) were included for baseline characteristics analyses. The complications were also markedly increased in patients with pre-existing T2DM, including acute respiratory distress syndrome (ARDS) (48.6% vs 32.3%, p<0.001), acute cardiac injury (ACI) (36.2% vs 16.7%, p<0.001), acute kidney injury (AKI) (24.8% vs 9.5%, p<0.001), coagulopathy (24.8% vs 11.1%, p<0.001), and hypoproteinemia (21.2% vs 9.4%, p<0.001). The in-hospital mortality was significantly higher in patients with pre-existing T2DM compared with those without T2DM (35.3% vs 17.4%, p<0.001). Moreover, in hospitalized patients with COVID-19 with T2DM, ARDS and coagulopathy were the main causes of mortality, with an HR of 7.96 (95% CI 2.25 to 28.24, p=0.001) for ARDS and an HR of 2.37 (95% CI 1.08 to 5.21, p=0.032) for coagulopathy. This was different from inpatients with COVID-19 without T2DM, in whom ARDS and cardiac injury were the main causes of mortality, with an HR of 12.18 (95% CI 5.74 to 25.89, p<0.001) for ARDS and an HR of 4.42 (95% CI 2.73 to 7.15, p<0.001) for cardiac injury.
Conclusions:
Coagulopathy was a major extrapulmonary risk factor for death in inpatients with COVID-19 with T2DM rather than ACI and AKI, which were well associated with mortality in inpatients with COVID-19 without T2DM.
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