Cargando…
Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19
INTRODUCTION: The role of glycemic control, both prior and during hospitalization, on mortality from COVID-19 in diabetic patients is debated. Furthermore, it is not clear whether hyperglycemia has a direct effect or requires inflammatory mechanisms. OBJECTIVE: To identify predictors of clinical out...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652602/ https://www.ncbi.nlm.nih.gov/pubmed/36371199 http://dx.doi.org/10.1186/s13098-022-00941-7 |
_version_ | 1784828508302737408 |
---|---|
author | Madaschi, Sara Resmini, Eugenia Bonfadini, Silvia Massari, Giulia Gamba, Paola Sandri, Marco Calza, Stefano Cimino, Elena Zarra, Emanuela Dotti, Silvia Mascadri, Cristina Agosti, Barbara Garrafa, Emirena Girelli, Angela |
author_facet | Madaschi, Sara Resmini, Eugenia Bonfadini, Silvia Massari, Giulia Gamba, Paola Sandri, Marco Calza, Stefano Cimino, Elena Zarra, Emanuela Dotti, Silvia Mascadri, Cristina Agosti, Barbara Garrafa, Emirena Girelli, Angela |
author_sort | Madaschi, Sara |
collection | PubMed |
description | INTRODUCTION: The role of glycemic control, both prior and during hospitalization, on mortality from COVID-19 in diabetic patients is debated. Furthermore, it is not clear whether hyperglycemia has a direct effect or requires inflammatory mechanisms. OBJECTIVE: To identify predictors of clinical outcomes (in-hospital mortality, length of hospitalization, respiratory failure, need for intensive care), considering hyperglycemia, inflammation markers and clinical history. METHODS: Retrospective observational study of 291 diabetic patients hospitalized with COVID-19 in the Spedali Civili di Brescia from February 1th 2020 to March 31th 2021, with also outpatient electronic records. Glucose, inflammatory parameters, creatinine were collected within 24 h after admission to the hospital. A causal mediation analysis allowed the estimation of the direct and indirect effects of hyperglycemia on mortality. RESULTS: Glucose at admission ≥ 165 mg/dL and reduced renal function were associated with an increased risk of in-hospital mortality and length of hospitalization (all p < 0.001), while an increase in inflammatory parameters was significantly associated with an increased risk of all outcomes. High basophil count was associated with reduced mortality (p < 0.001). Hyperglycemia had a direct effect on mortality (p < 0.001); the indirect, through inflammatory markers, was significant only for absolute neutrophil count, C-Reactive protein and procalcitonin (p = 0.007, p = 0.029, p = 0.042). Patients with microvascular complications and with chronic kidney disease showed higher mortality (p = 0.03, p = 0.01). CONCLUSIONS: Hyperglycemia at admission, renal function and inflammatory parameters were found to be predictors of in-hospital mortality, while an increased basophil count was protective. Hyperglycemia had a direct effect on mortality, the indirect effect was only through few markers and markedly lower than the direct one. |
format | Online Article Text |
id | pubmed-9652602 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-96526022022-11-14 Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19 Madaschi, Sara Resmini, Eugenia Bonfadini, Silvia Massari, Giulia Gamba, Paola Sandri, Marco Calza, Stefano Cimino, Elena Zarra, Emanuela Dotti, Silvia Mascadri, Cristina Agosti, Barbara Garrafa, Emirena Girelli, Angela Diabetol Metab Syndr Research INTRODUCTION: The role of glycemic control, both prior and during hospitalization, on mortality from COVID-19 in diabetic patients is debated. Furthermore, it is not clear whether hyperglycemia has a direct effect or requires inflammatory mechanisms. OBJECTIVE: To identify predictors of clinical outcomes (in-hospital mortality, length of hospitalization, respiratory failure, need for intensive care), considering hyperglycemia, inflammation markers and clinical history. METHODS: Retrospective observational study of 291 diabetic patients hospitalized with COVID-19 in the Spedali Civili di Brescia from February 1th 2020 to March 31th 2021, with also outpatient electronic records. Glucose, inflammatory parameters, creatinine were collected within 24 h after admission to the hospital. A causal mediation analysis allowed the estimation of the direct and indirect effects of hyperglycemia on mortality. RESULTS: Glucose at admission ≥ 165 mg/dL and reduced renal function were associated with an increased risk of in-hospital mortality and length of hospitalization (all p < 0.001), while an increase in inflammatory parameters was significantly associated with an increased risk of all outcomes. High basophil count was associated with reduced mortality (p < 0.001). Hyperglycemia had a direct effect on mortality (p < 0.001); the indirect, through inflammatory markers, was significant only for absolute neutrophil count, C-Reactive protein and procalcitonin (p = 0.007, p = 0.029, p = 0.042). Patients with microvascular complications and with chronic kidney disease showed higher mortality (p = 0.03, p = 0.01). CONCLUSIONS: Hyperglycemia at admission, renal function and inflammatory parameters were found to be predictors of in-hospital mortality, while an increased basophil count was protective. Hyperglycemia had a direct effect on mortality, the indirect effect was only through few markers and markedly lower than the direct one. BioMed Central 2022-11-12 /pmc/articles/PMC9652602/ /pubmed/36371199 http://dx.doi.org/10.1186/s13098-022-00941-7 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 Madaschi, Sara Resmini, Eugenia Bonfadini, Silvia Massari, Giulia Gamba, Paola Sandri, Marco Calza, Stefano Cimino, Elena Zarra, Emanuela Dotti, Silvia Mascadri, Cristina Agosti, Barbara Garrafa, Emirena Girelli, Angela Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19 |
title | Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19 |
title_full | Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19 |
title_fullStr | Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19 |
title_full_unstemmed | Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19 |
title_short | Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19 |
title_sort | predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for covid-19 |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652602/ https://www.ncbi.nlm.nih.gov/pubmed/36371199 http://dx.doi.org/10.1186/s13098-022-00941-7 |
work_keys_str_mv | AT madaschisara predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT resminieugenia predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT bonfadinisilvia predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT massarigiulia predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT gambapaola predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT sandrimarco predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT calzastefano predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT ciminoelena predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT zarraemanuela predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT dottisilvia predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT mascadricristina predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT agostibarbara predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT garrafaemirena predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 AT girelliangela predictivemarkersforclinicaloutcomesinacohortofdiabeticpatientshospitalizedforcovid19 |