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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...

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Autores principales: 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
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
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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.
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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
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