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The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)

BACKGROUND: It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS: We conducted cohort studies of adults with pre-existing...

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Autores principales: Llauradó, Gemma, Vlacho, Bogdan, Wargny, Matthieu, Ruan, Yue, Franch-Nadal, Josep, Domingo, Pere, Gourdy, Pierre, Saulnier, Pierre-Jean, Hadjadj, Samy, Wild, Sarah H., Rea, Rustam, Cariou, Bertrand, Khunti, Kamlesh, Mauricio, Dídac
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580453/
https://www.ncbi.nlm.nih.gov/pubmed/36261811
http://dx.doi.org/10.1186/s12933-022-01657-8
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author Llauradó, Gemma
Vlacho, Bogdan
Wargny, Matthieu
Ruan, Yue
Franch-Nadal, Josep
Domingo, Pere
Gourdy, Pierre
Saulnier, Pierre-Jean
Hadjadj, Samy
Wild, Sarah H.
Rea, Rustam
Cariou, Bertrand
Khunti, Kamlesh
Mauricio, Dídac
author_facet Llauradó, Gemma
Vlacho, Bogdan
Wargny, Matthieu
Ruan, Yue
Franch-Nadal, Josep
Domingo, Pere
Gourdy, Pierre
Saulnier, Pierre-Jean
Hadjadj, Samy
Wild, Sarah H.
Rea, Rustam
Cariou, Bertrand
Khunti, Kamlesh
Mauricio, Dídac
author_sort Llauradó, Gemma
collection PubMed
description BACKGROUND: It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS: We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020—October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS: Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83–2.45 with an I(2) of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29–1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31–0.75], I(2) 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40–0.68], I(2) 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS: This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-022-01657-8.
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spelling pubmed-95804532022-10-19 The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19) Llauradó, Gemma Vlacho, Bogdan Wargny, Matthieu Ruan, Yue Franch-Nadal, Josep Domingo, Pere Gourdy, Pierre Saulnier, Pierre-Jean Hadjadj, Samy Wild, Sarah H. Rea, Rustam Cariou, Bertrand Khunti, Kamlesh Mauricio, Dídac Cardiovasc Diabetol Research BACKGROUND: It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS: We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020—October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS: Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83–2.45 with an I(2) of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29–1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31–0.75], I(2) 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40–0.68], I(2) 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS: This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-022-01657-8. BioMed Central 2022-10-19 /pmc/articles/PMC9580453/ /pubmed/36261811 http://dx.doi.org/10.1186/s12933-022-01657-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Llauradó, Gemma
Vlacho, Bogdan
Wargny, Matthieu
Ruan, Yue
Franch-Nadal, Josep
Domingo, Pere
Gourdy, Pierre
Saulnier, Pierre-Jean
Hadjadj, Samy
Wild, Sarah H.
Rea, Rustam
Cariou, Bertrand
Khunti, Kamlesh
Mauricio, Dídac
The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
title The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
title_full The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
title_fullStr The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
title_full_unstemmed The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
title_short The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)
title_sort association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (covid-19)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580453/
https://www.ncbi.nlm.nih.gov/pubmed/36261811
http://dx.doi.org/10.1186/s12933-022-01657-8
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