Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression

Clinical characteristics and outcomes in patients with diabetes mellitus affected by COVID-19: a retrospective cross-sectional study from a tertiary care center in Pakistan

BACKGROUND

COVID-19, caused by SARS-CoV-2, emerged in December 2019 and quickly became a global public health concern. Diabetes, a major risk factor for severe COVID-19, affects 537 million people worldwide, with high prevalence in low- and middle-income countries like Pakistan. Studies show diabetes increases the risk of severe COVID-19 complications and mortality. However, there is limited data on COVID-19 outcomes in diabetic patients in Pakistan. This study aims to fill this gap and examine factors affecting outcomes in this population.

METHODS

We conducted a retrospective cross-sectional study at The Aga Khan University Hospital, Karachi, encompassing 2,346 confirmed COVID-19 patients from February 26, 2020, to September 6, 2021. Data on diabetic status, following ADA guidelines and other clinical outcomes were collected from medical records and patient interviews. Statistical analysis was performed using SPSS V.25.

RESULTS

A total of 1,342 patients were included, with 864 males (64.4%) and 478 females (35.6%). The mean age was 56.59 ± 15.55 years. SARS-CoV-2 infection was the primary diagnosis for 741 patients (55.2%), while 601 patients (44.8%) had it as a secondary diagnosis. Of the total, 348 patients (25.9%) had T2DM, 2 patients (0.15%) had T1DM, and 991 patients (73.8%) were non-diabetic. The mean duration of diabetes was 2.01 ± 1.32 years. Diabetic patients had a significantly shorter mean hospital stay (4.99 ± 4.46 days) compared to non-diabetic patients (6.79 ± 7.32 days) (p < 0.001). The overall discharge rate was 70.3%, with a mortality rate of 10.7%. T2DM was associated with lower in-hospital mortality (p < 0.001) but higher rates of ARDS (p < 0.001). There was no significant association between T2DM and the risk of pulmonary aspergillosis, pulmonary embolism, or septic shock. Higher financial class was associated with longer hospital stays and a greater likelihood of being discharged home (p < 0.001).

CONCLUSION

In conclusion, our study highlights the heightened susceptibility of COVID-19 patients with concurrent T1DM and T2DM to developing ARDS. Despite no significant association found between diabetes and adverse outcomes, the crucial role of tailored care for high-risk groups, particularly those with diabetes, cannot be overstated.

Impact of COVID-19 pandemic on glycaemic and blood pressure control among patients with type 2 diabetes in primary care in Hong Kong

OBJECTIVES

To evaluate the impact of social distancing measures due to COVID-19 pandemic on glycemic and blood pressure control in primary care in Hong Kong.

METHODS

This was a retrospective cross-sectional study. Diabetic patients with regular follow-up in 8 public primary care clinics in Hong Kong within the study period were recruited. The outcomes were to detect any difference of HbA1c levels and BP between pre-pandemic group (2019 group) and the 1-year post-pandemic group (2020 group) in all patients and in sub-group analysis of different age groups, sex, body mass index, presence of diabetic complications and different diabetic treatment.

RESULTS

There was no statistically significant change in HbA1c level between 2020 and 2019 groups which was 0.019% (95% confidence interval [CI] -0.057% to 0.094%, p = 0.632). There was also no statistically significant change in both systolic and diastolic BP between 2020 and 2019 groups which were -0.143 mmHg (95%CI -1.005 mmHg to 0.719 mmHg, p = 0.745) and 0.148 mmHg (95%CI -0.422 mmHg to 0.718 mmHg, p = 0.611). Subgroup analysis showed that female gender had statistically significant improvement in glycaemic control (HbA1c 6.92% in 2020 group versus HbA1c 7.03% in 2019 group, p = 0.021). Patients with diabetic retinopathy had statistically significant lower diastolic BP (diastolic BP 73 mmHg in 2020 group versus diastolic BP 75 mmHg in 2019 group with p = 0.011).

CONCLUSIONS

Despite the implementation of various social distancing measures resulting in significant change in lifestyle, COVID-19 pandemic did not worsen glycaemic and blood pressure control in T2DM patients. In fact, slight improvement in glycaemic control among female patients was found.

TRIAL REGISTRATION

Not applicable.

Direct and indirect burden of COVID-19 on mortality in Spain (2020 to 2022)

BACKGROUND

Life expectancy in high-income countries remained lower in 2022 compared to pre-pandemic levels in 2019. This study explores the deficit of life expectancy and excess of years of life lost (YLL) in Spain from 2020 to 2022, assessing both direct effects of infectious diseases and indirect effects of other causes of death.

METHODS

Data on life expectancy and YLL from 2010 to 2022 were obtained from the Spanish Institute for Statistics (INE). Using linear regression, we estimated expected life expectancy and YLL for 2020-2022 under the assumption that pre-pandemic trends (2010-2019) had continued.

RESULTS

During the first year of the pandemic, Spanish women lost 1.10 years and men lost 1.40 years in life expectancy. By 2022, life expectancy remained lower than in 2019 for both sexes. The excess YLL was similar across 2020 (2.40 million YLL and 5.3 YLL/100 people), 2021 (2.35 million YLL, 5.1 YLL/100 people), and 2022 (2.35 million YLL, 5.0 YLL/100 people). Approximately 70% of this excess was attributable to infectious diseases (87% in 2020, 78% in 2021, and 43% in 2022). Other major contributors to excess YLL included external causes, circulatory diseases, digestive diseases, and endocrine, nutritional, and metabolic diseases, while cancer mortality did not show an excess during the pandemic period.

CONCLUSIONS

Mortality in Spain in 2022 remained elevated compared to pre-pandemic expectations. The contribution of non-infectious diseases to excess mortality increased over time.

TRIAL REGISTRATION

Not applicable.

Diabetes Mellitus and Multidrug-Resistant Gram-Negative Bacterial Infections in Critically Ill COVID-19 Patients: A Retrospective Observational Study

Background: Diabetes mellitus (DM) is an independent risk factor for severe SARS-CoV-2 infection and is linked to higher incidences of infections and adverse outcomes in patients with DM. This study examines the association between DM and multidrug-resistant Gram-negative bacteria (MDR-GNB) in critically ill, intubated COVID-19 patients in the intensive care unit (ICU) and evaluates mortality rates and clinical factors contributing to unfavorable outcomes. Methods: This retrospective observational study included intubated COVID-19 patients diagnosed with secondary infections due to MDR-GNB. Patients were treated for acute respiratory distress syndrome (ARDS) in a tertiary care university hospital ICU between October 2020 and February 2022. Collected data included demographics, comorbidities, medication, and laboratory parameters including blood tests and culture samples. Results: Among 416 COVID-19 patients, 112 (26.9%) had T2DM. Cultures from lower respiratory tract specimens revealed a significantly higher likelihood of isolating Acinetobacter baumannii in patients with DM (OR: 2.18, 95% CI: 1.40-3.40, p < 0.001), and DM is an independent predictor of isolation Acinetobacter baumannii in bronchial secretions of COVID-19 intubated patients (OR: 2.046, 95% CI: 1.256-3.333. p < 0.004). DM was not significantly associated with differences in length of stay (LOS) until discharge or death (HR: 0.76, 95% CI: 0.51-1.12, p = 0.16; HR: 0.91, 95% CI: 0.70-1.19, p = 0.50) or 28-day ICU mortality (OR: 1.12, 95% CI: 0.52-2.41, p = 0.77). Age was linked to an increased 28-day mortality risk in patients with DM (OR: 1.10, 95% CI: 1.02-1.18, p = 0.011). Conclusions: In critically ill intubated COVID-19 patients, DM emerged as a significant and independent predictor for the isolation of Acinetobacter baumannii from bronchial secretions, highlighting a key link between DM and specific multidrug-resistant pathogens, even though no broader association with MDR-GNB-related secondary infections was observed.

Hyperglycemia in the diabetic range, but not previous diagnosis of diabetes mellitus, is an independent indicator of poor outcome in patients hospitalized for severe COVID-19

AIMS

Diabetes mellitus (DM) and hyperglycemia are associated with poor outcome(s) in COVID-19 hospitalized patients, but their independent impact on prognosis remains unclear. We aimed to assess the impact of DM and hyperglycemia on COVID-19 outcomes.

METHODS

Clinical data/records from COVID-19 patients admitted to the Parma University-Hospital (February 23rd to March 31st, 2020) were retrieved and analysed (NCT04550403). Fasting plasma glucose (FPG), inflammatory markers and the main biochemical variables were collected at admission. Patients underwent chest high-resolution CT and arterial blood gas analysis to determine the PaO2/FiO2 ratio (P/F ratio). The primary outcome was a composite of intensive care unit admission and/or death.

RESULTS

Among 756 subjects, 143 (19%) had DM. These patients were older with higher comorbidity rates. The primary outcome occurred in 61.5% DM patients versus 43.4% without DM (p < 0.001). In multivariable analysis (accuracy UC = 0.93), older age, cardiovascular and kidney diseases, FPG ≥ 126 mg/dl, C-reactive protein, and P/F ratio, but not previous DM, were independent risk indicators.

CONCLUSIONS

DM indicated poor COVID-19 outcomes, but not when adjusted for other clinical variables/comorbities, suggesting that its impact was mostly driven by concomitant factors. The independent role of fasting hyperglycemia points to the need for further research on its contribution to COVID-19.

Charting the COVID-19 vaccination journey in Saudi Arabia: Insights into post-vaccination adverse effects and immunization dynamics

Background

The current study evaluated the effects of different COVID-19 vaccines on Saudi Arabian residents, focusing on their safety, acceptance, and effectiveness. Gaining a better knowledge of these vaccination results will help develop more successful public health initiatives and increase confidence in vaccination campaigns throughout the Kingdom.

Methods

A cross-sectional study was conducted with 401 participants from diverse backgrounds, covering different ages, genders, nationalities, weights, and education levels. The survey gathered information about participants' health conditions, their vaccines, side effects, and infection rates before and after vaccination. The data were analyzed to compare vaccine preferences, side effects, and infection trends overtime.

Results

Sociodemographic-wise, most participants were men (62.84%) and Saudi nationals (96.01%), showing significant differences by gender and nationality (P < 0.001). The largest age group was 21-30 years (45.89%, P < 0.001), with 66.58% being university graduates (P < 0.001). Pfizer/BioNTech was the top choice across all doses, with 83.46% receiving it for the first dose, 78.1% for the second, and 39.28% for the third, reflecting a clear preference over other vaccines (P < 0.001). Pfizer/BioNTech recipients reported side effects after the first dose in 36.53% of cases, but only 1.86% needed medical help. Vaccination significantly reduced infection rates: Pfizer/BioNTech dropped infection rates from 43.18% to 8.33% after the third dose (P < 0.001), while Oxford/AstraZeneca saw rates fall from 12.88% to 0.76% after the third dose, but did not reach significance (P = 0.34). Overall, vaccinated individuals had much lower infection rates (28.17%) than among unvaccinated ones (100%), with a P-value of 0.020.

Conclusion

Our results concluded that Saudi Arabia's vaccination campaign has proven effective, especially after the second and third doses. Pfizer/BioNTech was the most preferred vaccine, demonstrating strong efficacy and safety, which helped build public confidence. Ongoing monitoring is crucial to maintaining pandemic control, post-marketing and public health strategies.

COVID-19 Vaccine Effectiveness and Risk Factors of Booster Failure in 480,000 Patients with Diabetes Mellitus: A Population-Based Cohort Study

To investigate the real-world effectiveness of COVID-19 vaccines in a large cohort of patients with diabetes mellitus (DM), we analyzed all >18-year-old patients with COVID-19 registered in a Brazilian nationwide surveillance database between February 2020 and February 2023. The primary outcome of interest was vaccine effectiveness against death, evaluated using multivariate logistic regression models. Among the 2,131,089 patients registered in the SIVEP-Gripe, 482,677 (22.6%) had DM. After adjusting for covariates, patients with DM had a higher risk of death than those without comorbidities (adjusted odds ratio [aOR] = 1.43, 95% CI, 1.39-1.47). For patients without comorbidities (72.7%, 95% CI, 70.5-74.7) and those with DM (73.4%, 95% CI, 68.2-76.7), vaccine effectiveness was similar after the booster dose. However, it was reduced in patients with DM associated with other comorbidities (60.5%; 95% CI, 57.5-63.2). The strongest factor associated with booster failure was the omicron variant (aOR = 27.8, 95% CI, 19.9-40.1). Our study revealed that COVID-19 vaccines provided robust protection against death in individuals with DM. However, our findings underscore the need to update vaccines and develop tailored strategies for individuals with diabetes, especially those with additional underlying conditions.

Clinically meaningful phenotypes among SARS-CoV-2 reinfections: Informing prevention strategies for future pandemics

OBJECTIVE

Rapidly phenotyping patients can inform public health action plans in new pandemics. This study aimed to derive meaningful SARS-CoV-2 reinfected patients' phenotypes based on easily-available patient data and explore key epidemiological factors of reinfections.

METHODS

We conducted a retrospective study of a cohort of SARS-CoV-2 reinfected adults from the Basque Country between January 1, 2021 and January 9, 2022. Phenotypes were defined in an unsupervised manner with clustering algorithms, incorporating variables like age, Charlson score, vaccination status and pre-existing treatments and comorbidities. Subsequently, clinical characteristics of phenotypes were compared, and their behavioral differences were evaluated through generalized additive models. Finally, their association with clinical outcomes was assessed.

RESULTS

Four phenotypes were identified, which subsequently had a direct relationship with the risk levels for severe COVID-19 outcomes. The highest-risk group, phenotype 4, consisted of older adults -76 years, [62-85] (Median, [Interquartile range])- with multiple comorbidities and extensive baseline medication use. Phenotype 3 was slightly younger -64 years, [58-77]- but presented very low Charlson scores and few comorbidities, representing an intermediate-risk group. Phenotypes 1 and 2 were younger and healthier adults with similar clinical profiles. However, phenotype 1 showed a less protective attitude, with a higher rate of unvaccinated patients and shorter time intervals between infections.

CONCLUSIONS

We were able to classify reinfected patients into four distinct groups based on easily available variables, and these phenotypes had a direct relationship with COVID-19 clinical outcomes. Thus, rapidly phenotyping infected individuals can serve as a preventive public health strategy during new pandemics.

A comprehensive review on the treatment of pharmaceutically active compounds using moving bed biofilm reactor: A systematic meta-analysis coupled with meta-neural approach

Pharmaceutically active compounds (PhACs) in wastewater pose challenges to cleaner environment due to their recalcitrance and toxicity, restricting the use of conventional treatment methods. On the other hand, advanced oxidation processes face technical complexity and financial constraints, which also discourage their applicability especially in large scale treatment system. Moving Bed Biofilm Reactor (MBBR) as an advanced biological treatment system has shown remarkable efficacy and cost-effectiveness in treating various PhACs. However, studies report significant variations in the efficacy of MBBR across removing different pollutants, leading to a complication in their performance assessment. The present review has targeted a systematic meta-analysis coupled with a meta-neural approach over the conventional bibliometric study. The statistical approach resolves the publication bias and associated formation of a pertinent databases, providing significant insights into MBBR's performance and process variables. The novel approach of meta-neural exhibited a multivariate prediction model with a significant F value of 257.66 and a p-value of <0.001 relating the role of various process parameters on the treatment efficacy. Among various pharmaceuticals, beta-blockers were eliminated most effectively by MBBR technology, with removal rates exceeding those of antibiotics, analgesics, antidepressants, fibrates, and anticonvulsants. Sensitivity analysis revealed the significant influence of the operating parameters on the outcome in the order of initial COD > HRT > filling ratio > pH > initial concentration of the contaminant. The present meta-analysis approach vis-à-vis meta-neural is instrumental for delineating the technology selection and design for removing PhACs or other emerging contaminants.

Impact of COVID-19 infection on mortality, diabetic complications and haematological parameters in patients with diabetes mellitus: a systematic review and meta-analysis

OBJECTIVES

SARS-CoV-2 poses significant challenges to people living with diabetes (PLWD). This systematic review aimed to explore the impact of COVID-19 on mortality, complications associated with diabetes and haematological parameters among PLWD.

DESIGN

Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

DATA SOURCES

EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched between 1 December 2019 and 14 January 2025.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Eligible studies included case-control and cohort studies involving PLWD categorised into two groups: those with confirmed SARS-CoV-2 infection and those without.

DATA EXTRACTION AND SYNTHESIS

Meta-analyses estimated the odds ratios (ORs) and mean differences (MDs) of outcomes including mortality, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), acute kidney injury, hospitalisation length and haematological parameters. We pooled results using random-effects models and assessed study quality with the Newcastle-Ottawa Scale. A funnel plot was used to detect potential publication bias. The overall certainty of evidence was assessed using GRADE.

RESULTS

25 of 7266 unique studies were eligible, including 1 154674 PLWD (561 558 with COVID-19 and 593 116 without COVID-19). SARS-CoV-2 infection in PLWD was associated with significantly increased mortality (OR 2.52, 95% CI 1.45 to 4.36, I2=99%), acute kidney injury (3.69, 95% CI 2.75 to 4.94, I2=0%), random plasma glucose in subjects with type 1 diabetes (MD 20.38 mg/dL, 95% CI 7.39 to 33.36, I2=0%), haemoglobin A1C in subjects with type 2 diabetes (0.21%, 95% CI 0.05 to 0.38, I2=13%), creatinine (0.12 mg/dL, 95% CI 0.04 to 0.19, I2=0%), C reactive protein (38.30 mg/L, 95% CI 4.79 to 71.82, I2=82%) and D-dimer (1.52 µg/mL, 95% CI 0.73 to 2.31, I2=0%). No significant differences were observed in the incidence of ICU admission and DKA, hospitalisation length, haemoglobin, leucocyte, lymphocyte, neutrophil to lymphocyte ratio, platelet, blood urea nitrogen, estimated glomerular filtration rate, procalcitonin, albumin, ferritin and bilirubin among PLWD with and without SARS-CoV-2 infection.

CONCLUSIONS

SARS-CoV-2 infection is associated with elevated risks of mortality and acute kidney injury and poor glycaemic control in PLWD, alongside increased levels of inflammatory and coagulation biomarkers. These findings underscore the urgent need for tailored clinical management strategies for PLWD with COVID-19.

PROSPERO REGISTRATION NUMBER

CRD42023418039.

Effect of high-dose N-acetyl cysteine on the clinical outcome of patients with diabetic peripheral neuropathy: a randomized controlled study

BACKGROUND

Diabetic peripheral neuropathy (DPN) is a vastly common and bothersome disorder with a clinically challenging course of treatment affecting patients with diabetes. This study aimed to evaluate the efficacy and safety of high dose oral N-acetyl cysteine (NAC) as adjuvant therapy on clinical outcome of DPN.

METHODS

A prospective, randomized, parallel, open label, controlled clinical trial. Ninety eligible DPN patients were randomly assigned to either control group receiving standard of care or NAC group receiving standard of care treatment and NAC at a dose of 2400 mg/day for 12 weeks. Glutathione peroxidase (GPx), nuclear factor erythoid-2 related factor (NRF-2) and tumor necrosis factor (TNF) were measured at baseline and after 12 weeks to assess anti-oxidant and anti-inflammatory properties. Michigan neuropathy screening instrument (MNSI), Toronto clinical neuropathy score (TCNS), Diabetic neuropathy score (DNS), Diabetes-39 quality of life questionnaire (DQOL) and pain score were assessed at baseline and after 12 weeks.

RESULTS

NAC group showed a significant increase (p < 0.05) in NRF-2 by 25.3% and GPx by 100% and a decline of 21.45% in TNF-alpha levels versus controls that reported a decline in NRF-2 and GPx and an increase in TNF-alpha. HgbA1C and AST levels significantly decreased in NAC versus controls (7.2 ± 1 vs 8 ± 1.1, p = 0.028 and 29.1 vs 55.4, p = 0.012) respectively. NAC administration resulted in a significant decline in MNSA, TCNS, DNS and pain scores versus controls that showed increase in all scores. The QOL total score and the anxiety and energy and mobility domain scores significantly decreased in the NAC group versus controls, p < 0.001.

CONCLUSION

High dose NAC administered for 12 weeks modulated inflammation by reducing TNF-alpha and increasing GPx and NRF2 versus controls. NAC improved clinical outcomes of DPN reflected by a decline in neuropathy and pain scores and an improvement in QOL.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04766450.

Inappropriate polypharmacy during the COVID-19 pandemic: impact, challenges, and solutions - a narrative review

The COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide, impacting various aspects of patient care. Polypharmacy, the concurrent use of multiple medications by a single patient, is a significant concern exacerbated by the pandemic. The dual threat of COVID-19 infection and polypharmacy for the same vulnerable group - the elderly and those with pre-existing multimorbidity - is particularly problematic, as polypharmacy has been shown to lead to suboptimal treatment outcomes in many chronic diseases. This comprehensive review explores the multifaceted issues surrounding polypharmacy during the COVID-19 pandemic, addressing its causes, consequences, and potential solutions.

Association between pre-existing cardiovascular risk factors and post-acute sequelae of COVID-19 in older adults

BACKGROUND

The long-term health impacts of COVID-19, including post-acute sequelae of SARS-CoV-2, remain insufficiently explored, especially concerning pre-existing cardiovascular risk factors in older adults. This study examines the association between these risk factors and post-acute sequelae of SARS-CoV-2 in this population.

METHODS

A retrospective study of Brazilian adults aged = 60 years assessed the persistence of post-acute sequelae of SARS-CoV-2 three months after infection in 2020. Cardiovascular risk factors (obesity, smoking, high blood pressure, diabetes mellitus, hypercholesterolemia, and chronic kidney disease) were analyzed in relation to sequelae and adjusting for sociodemographic variables. Data were obtained from the Department of Epidemiological Surveillance in Roraima, Brazil.

RESULTS

Of the 1,322 participants (55% female; mean age 70.4 years, SD = 7.87), 61.7% (95% CI: 59.1-63.9) reported at least one post-acute sequelae of SARS-CoV-2 at the three-month follow-up. The likelihood of post-acute sequelae of SARS-CoV-2 was significantly higher in participants with diabetes mellitus (OR = 4.39; 95% CI: 3.42-5.66), tobacco use (OR = 3.93; 95% CI: 2.47-6.23), hypertension (OR = 3.62; 95% CI: 2.73-4.78), or hypercholesterolemia (OR = 3.58; 95% CI: 2.80-4.59). Chronic kidney disease (OR = 2.28; 95% CI: 1.59-3.25) and obesity (OR = 1.83; 95% CI: 1.28-2.61) were less strongly associated.

CONCLUSIONS

Pre-existing cardiovascular risk factors are linked to a higher likelihood of long-term COVID-19 sequelae in adults aged = 60 years old. Preventing and managing these factors are crucial for reducing the long-term effects of COVID-19, particularly during a pandemic.

A Critical Review on the Long-Term COVID-19 Impacts on Patients With Diabetes

BACKGROUND

The world is currently grappling with the potentially life-threatening coronavirus disease 2019 (COVID-19), marking it as the most severe health crisis in the modern era. COVID-19 has led to a pandemic, with the World Health Organization (WHO) predicting that individuals with diabetes are at a higher risk of contracting the virus compared to the general population. This review aims to provide a practical summary of the long-term impacts of COVID-19 on patients with diabetes. Specifically, it focuses on the effects of SARS-CoV-2 on different types of diabetic patients, the associated mortality rate, the underlying mechanisms, related complications, and the role of vitamin D and zinc in therapeutic and preventive approaches.

METHODS

Relevant literature was identified through searches on PubMed, Web of Science, and Science Direct in English, up to April 2023.

RESULTS

COVID-19 can lead to distressing symptoms and pose a significant challenge for individuals living with diabetes. Older individuals and those with pre-existing conditions such as diabetes, coronary illness, and asthma are more susceptible to COVID-19 infection. Managing COVID-19 in individuals with diabetes presents challenges, as it not only complicates the fight against the infection but also potentially prolongs the recovery time. Moreover, the virus may thrive in individuals with high blood glucose levels. Various therapeutic approaches, including antidiabetic drugs, are available to help prevent COVID-19 in diabetic patients.

CONCLUSIONS

Diabetes increases the morbidity and mortality risk for patients with COVID-19. Efforts are globally underway to explore therapeutic interventions aimed at reducing the impact of diabetes on COVID-19.

Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study

BACKGROUND

People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.

METHODS

We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.

RESULTS

Incidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.

CONCLUSION

Diabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.

Predictors of severity of SARS-CoV-2 infections in Brazil: Post hoc analyses of a randomised controlled trial

OBJECTIVES

To identify demographic, clinical and immunological factors associated with adverse COVID-19 outcomes.

METHODS

A large randomised controlled trial of ChAdOx1 nCoV-19 was undertaken in Brazil. Participants were randomised 1:1 either to receive ChAdOx1 nCov-19 or to a control group. COVID-19 infections were confirmed by nucleic acid amplification test (NAAT) and classified using the WHO clinical progression scale. Anti-spike antibody responses and serum neutralising activity were measured 28 days after second vaccination in some participants. Exploratory analyses were conducted into factors associated with COVID-19 infection severity and hospitalisation, using logistic regression models adjusted for demographic and clinical factors.

RESULTS

10,416 participants were enrolled; 1790 had NAAT-positive COVID-19 infection; 63 cases required hospitalisation. More severe infection was associated with greater body-mass index (BMI) (odds ratio [OR] = 1.06 [95 %CI: 1.01-1.10], p = 0.01) and diabetes (OR = 3.67 [1.59-8.07], p = 0.003). Hospitalisation risk increased with greater age (OR = 1.06 [1.03-1.08], p < 0.001) and BMI (OR = 1.10 [1.05-1.16], p < 0.001). More severe infection and hospitalisation risks increased >180 days after last vaccination. In the fully vaccinated subgroup (n = 841), only greater age predicted hospitalisation (OR = 1.07 [1.03-1.12], p < 0.001). Serological responses to two vaccine doses diminished with age.

CONCLUSIONS

Unvaccinated individuals with high BMI and diabetes risked more severe COVID-19 outcomes. Vaccination mitigated this risk.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04536051.

Chronic inflammation in post-acute sequelae of COVID-19 modulates gut microbiome: a review of literature on COVID-19 sequelae and gut dysbiosis

BACKGROUND

Long COVID or Post-acute sequelae of COVID-19 is an emerging syndrome, recognized in COVID-19 patients who suffer from mild to severe illness and do not recover completely. Most studies define Long COVID, through symptoms like fatigue, brain fog, joint pain, and headache prevailing four or more weeks post-initial infection. Global variations in Long COVID presentation and symptoms make it challenging to standardize features of Long COVID. Long COVID appears to be accompanied by an auto-immune multi-faceted syndrome where the virus or viral antigen persistence causes continuous stimulation of the immune response, resulting in multi-organ immune dysregulation.

MAIN TEXT

This review is focused on understanding the risk factors of Long COVID with a special emphasis on the dysregulation of the gut-brain axis. Two proposed mechanisms are discussed here. The first mechanism is related to the dysfunction of angiotensin-converting enzyme 2 receptor due to Severe Acute Respiratory Syndrome Corona Virus 2 infection, leading to impaired mTOR pathway activation, reduced AMP secretion, and causing dysbiotic changes in the gut. Secondly, gut-brain axis dysregulation accompanied by decreased production of short-chain fatty acids, impaired enteroendocrine cell function, and increased leakiness of the gut, which favors translocation of pathogens or lipopolysaccharide in circulation causing the release of pro-inflammatory cytokines. The altered Hypothalamic-Pituitary-Adrenal axis is accompanied by the reduced level of neurotransmitter, and decreased stimulation of the vagus nerve, which may cause neuroinflammation and dysregulation of serum cortisol levels. The dysbiotic microbiome in Long COVID patients is characterized by a decrease in beneficial short chain fatty acid-producing bacteria (Faecalibacterium, Ruminococcus, Dorea, and Bifidobacterium) and an increase in opportunistic bacteria (Corynebacterium, Streptococcus, Enterococcus). This dysbiosis is transient and may be impacted by interventions including probiotics, and dietary supplements.

CONCLUSIONS

Further studies are required to understand the geographic variation, racial and ethnic differences in phenotypes of Long COVID, the influence of viral strains on existing and emerging phenotypes, to explore long-term effects of gut dysbiosis, and gut-brain axis dysregulation, as well as the potential role of diet and probiotics in alleviating those symptoms.

Predictors of developing severe COVID-19 among hospitalized patients: a retrospective study

Background

COVID-19 poses a significant threat to global public health. As the severity of SARS-CoV-2 infection varies among individuals, elucidating risk factors for severe COVID-19 is important for predicting and preventing illness progression, as well as lowering case fatality rates. This work aimed to explore risk factors for developing severe COVID-19 to enhance the quality of care provided to patients and to prevent complications.

Methods

A retrospective study was conducted in Saudi Arabia's eastern province, including all COVID-19 patients aged 18 years or older who were hospitalized at Prince Saud Bin Jalawi Hospital in July 2020. Comparative tests as well as both univariate and multivariate logistic regression analyses were performed to identify risk factors for developing severe COVID-19 and poor outcomes.

Results

Based on the comparative statistical tests patients with severe COVID-19 were statistically significantly associated with older age and had higher respiratory rate, longer hospital stay, and higher prevalence of diabetes than non-severe cases. They also exhibited statistically significant association with high levels of potassium, urea, creatinine, lactate dehydrogenase (LDH), D-dimer, and aspartate aminotransferase (AST). The univariate analysis shows that having diabetes, having high severe acute respiratory infection chest X-ray scores, old age, prolong hospitalization, high potassium and lactate dehydrogenase, as well as using insulin, heparin, corticosteroids, favipiravir or azithromycin were all statistically significant associated with severe COVID-19. However, after adjustments in the multivariate analysis, the sole predictor was serum LDH (p = 0.002; OR 1.005; 95% CI 1.002-1.009). In addition, severe COVID-19 patients had higher odds of being prescribed azithromycin than non-severe patients (p = 0.001; OR 13.725; 95% CI 3.620-52.043). Regarding the outcomes, the median hospital stay duration was statistically significantly associated with death, intensive care unit admission (ICU), and mechanical ventilation. On the other hand, using insulin, azithromycin, beta-agonists, corticosteroids, or favipiravir were statistically significantly associated with reduced mortality, ICU admission, and need of mechanical ventilation.

Conclusion

This study sheds light on numerous parameters that may be utilized to construct a prediction model for evaluating the risk of severe COVID-19. However, no protective factors were included in this prediction model.

Obesity rather than diabetes impacted severe Covid-19 on reunion island: A retrospective cohort study from a frontline hospital, 2020-2021

AIM

2019-Coronavirus reached the French island of Reunion, which is marked by a very high prevalence of metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM), in March 2020. The objective was to determine the metabolic factors associated with the severity of SARS-CoV-2 infection in Reunion Island.

METHODS

This retrospective observational cohort study enrolled patients who were hospitalized on the island from March 11th, 2020 to August 4th, 2021. Severe Covid-19 was defined according to the WHO's definition, including deaths. A multilevel logistic model with the circulation period of the variants as a random effect was performed.

RESULTS

The median age of the 681 patients enrolled was 56 years [42-68] and 54% were men. Obese patients and patients who were both diabetic and obese had an increased risk of developing severe Covid-19: 2.64 [1.46;4.78] and 2.96 [1.47;5.93], aOR [CI95%] respectively. Diabetic inpatients did not when adjusting for individual characteristics and accounting the period of circulation of variants: 1.24 [0.68;2.24] (P = 0.471).

CONCLUSION

This study reveals an unexpected prominence of obesity on T2DM (without precision) in the development of severe Covid-19. Despite a high prevalence of T2DM, this finding may partially explain why Covid-19 did not have an even greater impact on the island. Further studies should also consider the treatment of diabetes, diabetic complications, glycemic imbalance or stratify by the novel subgroups of T2DM to better understand the link between T2DM and severe Covid-19 in the Reunionese population.

Risk of Type 1 Diabetes Mellitus in SARS-CoV-2 Patients

Recent studies have found that a link between people with type 1 diabetes mellitus (T1DM) are at higher risk of morbidity as well as mortality from COVID-19 infection, indicating a need for vaccination. T1DM appears to impair innate and adaptive immunity. The overabundance of pro-inflammatory cytokines produced in COVID-19 illness that is severe and potentially fatal is known as a "cytokine storm." Numerous cohorts have revealed chronic inflammation as a key risk factor for unfavorable COVID-19 outcomes. TNF-α, interleukin (IL)-1a, IL-1, IL-2, IL-6, and other cytokines were found in higher concentrations in patients with T1DM. Even more importantly, oxidative stress contributes significantly to the severity and course of COVID- 19's significant role in the progression and severity of COVID-19 diseases. Severe glucose excursions, a defining characteristic of type 1 diabetes, are widely recognized for their potent role as mediating agents of oxidative stress via several routes, such as heightened production of advanced glycation end products (AGEs) and activation of protein kinase C (PKC). Furthermore, persistent endothelial dysfunction and hypercoagulation found in T1DM may impair microcirculation and endothelium, which could result in the development of various organ failure and acute breathing syndrome.

Short-term efficacy of moderate-intensity rosuvastatin in coronavirus disease 2019 patients: A randomized clinical trial

As the coronavirus disease 2019 (COVID-19) pandemic persists, the exploration of adjunct therapies to mitigate disease severity remains a priority. Statins, known for their pleiotropic effects, have been under investigation for their potential role in managing COVID-19 complications. The study was conducted in a single referral hospital and adhered to Consolidated Standards of Reporting Trials guidelines. Eligible participants were randomized in a 1:1 ratio into either the rosuvastatin group or the control group. Outcome measures included vital signs, laboratory data, clinical outcomes, and patient symptoms. Statistical analysis was performed using SPSS software (version 26.0, IBM Corp., Armonk, New York). A total of 100 patients were enrolled. No significant differences were observed between the rosuvastatin and control groups in terms of baseline characteristics and laboratory parameters, except for the fact that rosuvastatin-treated patients showed lower levels of C-reactive protein in comparison with the controls on both the 1st and 5th days (38.1 ± 16.3 vs 50.5 ± 25.3) compared to the control group. Clinical outcomes, including hospital length of stay, intensive care unit admission, need for intubation, and 1-month mortality, did not differ significantly between the two groups. Symptom scales, as assessed by the Borg Rating of Perceived Exertion and Leicester Cough Questionnaire, showed significant improvement in the rosuvastatin group compared to controls. Our study provides insights into the short-term efficacy of moderate-intensity rosuvastatin in COVID-19 patients. Further research is warranted to elucidate the long-term effects and optimal dosing of statins in COVID-19 management.

New Onset Diabetes After COVID 19 (NODAC) is predominantly due to exacerbated Insulin Resistance (IR) rather than beta cell dysfunction: Lessons from tertiary care hospital data during confluence of two epidemics

PURPOSE

To investigate determinants of new onset diabetes after COVID-19 (NODAC) and its recovery at 6 months.

METHODS

This was an observational follow up study conducted from August, 2020 to July, 2023, recruiting patients with preexisting DM and COVID 19 patients with no history of DM. Multivariate regression analysis was used to determine the factors responsible for severity of COVID 19 infection in preexisting DM group. Clinical, laboratory and glycometabolic parameters were estimated at baseline and 6 months in NODAC and euglycemic group to determine the factors responsible for NODAC and its persistence at 6 months.

RESULTS

Of 1310 patients, 855 (65.3%) COVID 19 patients were further divided based on their glycemic status: preexisting DM (19%), NODAC (8.5%) and euglycemia (72.5%). Older age and male gender were independent risk factors for severe COVID 19 disease in patients with preexisting diabetes. Prevalence of NODAC in present study was 8.5%. Patients with NODAC had higher mean fasting blood glucose (FBG), random blood glucose (RBG) and HbA1c at baseline as compared to COVID with euglycemic group with no difference in serum C-peptide levels. Female gender, family history of DM, signs of insulin resistance, higher BMI, WHR, HbA1c, serum insulin levels, FBG and RBG predicted persistence of NODAC at 6 months.

CONCLUSION

Preexisting DM is a risk factor for severe COVID 19 disease. Patients with NODAC have evidence of persistence insulin resistance on follow up, underscoring the need for long term glycemic monitoring.

Impact of COVID-19 and recovery of routine diabetic retinopathy digital screening across different regions in England: an analysis of publicly available data

OBJECTIVE

This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).

DESIGN

Retrospective data analysis.

SETTING

DESPs of England.

PARTICIPANTS

Individuals with diabetes who were invited to take part in the DESP programmes.

METHODS

Publicly available data from Public Health England (2018-2019) and National Health Service England (2019-2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.

PRIMARY OUTCOME MEASURES

Rate of uptake of RDS.

RESULTS

The national uptake of RDS decreased from 82% (2019-2020) to 68% (2020-2021) and then increased to 78% (2021-2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019-2020) to 53% (2020-2021), increasing to 73% (2021-2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020-2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021-2022 of 33%, 21% and 31%, they did not reach prepandemic (2018-2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%-89%) in 2020-2021.

CONCLUSION

COVID-19 had an impact on England's diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.

The Role of Age and Comorbidity Interactions in COVID-19 Mortality: Insights from Cardiac and Pulmonary Conditions

Background: Understanding the interactions between age and comorbidities is crucial for assessing COVID-19 mortality, particularly in patients with cardiac and pulmonary conditions. This study investigates the relationship between comorbidities and mortality outcomes in a cohort of hospitalized COVID-19 patients, emphasizing the interplay of age, cardiac, and pulmonary conditions. Methods: We analyzed a cohort of 3005 patients hospitalized with COVID-19 between 2020 and 2022. Key variables included age, comorbidities (diabetes, cardiac, pulmonary, and neoplasms), and clinical outcomes. Chi-square tests and logistic regression models were used to assess the association between comorbidities and mortality. Stratified analyses by age, diabetes, and pulmonary conditions were conducted to explore interaction effects. Additionally, interaction terms were included in multivariable logistic regression models to evaluate the combined impact of age, comorbidities, and mortality. Results: Cardiac conditions such as hypertension, ischemic cardiopathy, and myocardial infarction showed significant protective effects against mortality in younger patients and in those without pulmonary conditions (p < 0.001). However, these protective effects were diminished in older patients and those with pulmonary comorbidities. Age was found to be a significant modifier of the relationship between cardiac conditions and mortality, with a stronger protective effect observed in patients under the median age (p < 0.001). Pulmonary comorbidities significantly increased the risk of mortality, particularly when co-occurring with cardiac conditions (p < 0.001). Diabetes did not significantly modify the relationship between cardiac conditions and mortality. Conclusions: The findings highlight the complex interactions between age, cardiac conditions, and pulmonary conditions in predicting COVID-19 mortality. Younger patients with cardiac comorbidities show a protective effect against mortality, while pulmonary conditions increase mortality risk, especially in older patients. These insights suggest that individualized risk assessments incorporating age and comorbidities are essential for managing COVID-19 outcomes.

Association among diabetes, cardiovascular disease and mortality in patients hospitalised for COVID-19: an analysis of the American Heart Association COVID-19 CVD Registry

OBJECTIVE

To examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established heart failure (HF) or established atherosclerotic cardiovascular disease (ASCVD).

DESIGN

Observational study; longitudinal analysis of registry data.

SETTING

Hospitals in the USA reporting to the American Heart Association (AHA) COVID-19 Registry from January 2020 to May 2021.

PARTICIPANTS

20 796 individuals with diabetes (11 244 men; mean age 64.2) and 30 798 without diabetes (15 980 men; mean age 59.0) hospitalised for COVID-19 in the USA.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures were all-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilation. Secondary outcome measures included the association with diabetes and these outcomes among those with and without pre-existing ASCVD and HF and the association with insulin use and these outcomes in patients hospitalised for COVID-19.

RESULTS

After adjustment for relevant covariates diabetes increased the risk of mortality (HR 1.12, 95% CI: 1.03 to 1.21), MACE (HR 1.32, 95% CI: 1.17 to 1.48) and mechanical ventilation (HR 1.33, 95% CI: 1.26 to 1.42). Among patients with established ASCVD or HF, diabetes did not modify the risk of adverse outcomes. There was a significant difference in the risk of mortality between patients taking insulin compared with those who were not (HR 1.32, 95% CI: 1.01 to 1.26); however, there was no difference in the risk of MACE or mechanical ventilation.

CONCLUSIONS

Diabetes was associated with a higher risk of in-hospital all-cause mortality, MACE and need for mechanical ventilation in patients hospitalised for COVID-19. Diabetes was independently associated with adverse outcomes, particularly among those without pre-existing cardiovascular disease.

COVID-19 is associated with high blood glucose levels: diabetic neuropathy during the SARS-CoV-2 pandemic: a case report

Introduction and Importance

The nerves in the legs and feet are most frequently damaged by diabetic neuropathy. The COVID-19 infection is associated with a high risk of neuropathy symptoms.

Case Presentation

On 12 July 2022, a 58-year-old black female retiree with significant symptoms of numbness and muscle weakness in the hands and legs was brought into the emergency room. Seventeen years prior, she was diagnosed with type 2 diabetes mellitus. Metformin 1.5 g twice a day and glibenclamide 10 mg twice a day were part of her therapy regimen. When she was admitted to the emergency room, she described a one-day history of shortness of breath, frequent urination, excessive thirst, hyperglycemia, excessive appetite, fever, headache, and dehydration. A chest radiograph showed bilateral diffuse, patchy airspace opacities that could be caused by multifocal pneumonia or viral pneumonia. She started receiving 1000 ml of fluid resuscitation (0.9% normal saline) as soon as she was moved to an ICU, along with a drip-in insulin infusion.

Clinical Discussion

Diabetes, infections like COVID-19, poor vitamin levels, and other factors can all contribute to diabetic neuropathies. According to the Centers for Disease Control and Prevention, patients with type 2 diabetes mellitus are much more likely to experience severe morbidity and death from coronavirus disease.

Conclusion

Symptoms of diabetic neuropathy continued for months after a COVID-19 infection test resulted in a positive result.

The Influence of COVID-19 in Glycemic Control: Predictive Value of Inflammation and Metabolic Parameters

BACKGROUND/OBJECTIVES

Predicting post-COVID-19 diabetes is crucial for enhancing patient care and public health. This study investigates the role of metabolic factors in predicting the glycemic outcomes in patients recovering from moderate to severe COVID-19.

METHODS

We conducted a retrospective analysis of 135 patients without pre-existing diabetes, selected from a cohort of 1980 individuals hospitalized between January 2020 and December 2022. Metabolic parameters, including blood glucose, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Triglyceride/Glucose (TyG) index, and high-sensitivity C-reactive protein (hs-CRP), were assessed at discharge and followed up after 4 months (T4) and 12 months (T12).

RESULTS

Statistical analysis revealed significant correlations of initial glycemia, HOMA-IR, and hs-CRP with the subsequent glycemic levels at T4 and T12. Multiple regression analysis confirmed that initial glycemia, HOMA-IR, and hs-CRP were strong predictors of elevated glycemia, while the TyG index did not show a significant predictive value. Conventional diabetes risk factors, including body mass index (BMI) and lipid profiles, showed low predictive power for post-COVID-19 glycemia.

CONCLUSIONS

This research highlights the critical role of metabolic and inflammatory pathways in managing glycemic control in COVID-19 patients. Markers like blood glucose, HOMA-IR, and hs-CRP are significant predictors of blood glucose levels, while the TyG index appears less helpful in this context. Early, targeted interventions based on these markers can improve patient outcomes and reduce the risk of post-COVID-19 complications like diabetes.

Mesenchymal stem cell-derived extracellular vesicles reduce inflammatory responses to SARS-CoV-2 and Influenza viral proteins via miR-146a/NF-κB pathway

The risk of severe disease caused by co-infection with SARS-CoV-2 and influenza virus (IAV) raises an annual concern for global public health. Extracellular vesicles (EV) derived from mesenchymal stem cells (MSC) possess anti-inflammatory properties that can attenuate the inflammatory cytokine levels induced by viral infection. However, the effects of MSC-EV treatment on SARS-CoV-2 and IAV co-infection have not been elucidated. In the present study, we co-induced lung epithelial cells (EpiC) with SARS-CoV-2 Spike protein (S) and H1N1 influenza viral HA protein (HA) and found robust upregulation of inflammatory cytokines in comparison to those induced by either S or HA protein. Consequently, treatment of lung endothelial cells (EC) with conditioned medium from EpiC co-induced by both S and HA proteins resulted in increased apoptosis and impaired angiogenic ability, suggesting the effects of co-induction on epithelial-endothelial crosstalk. In addition, lung EpiC co-induced by both S and HA proteins showed paracrine effects on the recruitment of immune cells, including monocytes, macrophages and neutrophils. Of Note, EV derived from Wharton Jelly's MSC (WJ-EV) transferred miR-146a to recipient lung EpiC, which impaired TRAF6 and IRAK1, resulting in the downregulation of NF-κB pathway and secretion of inflammatory cytokines, rescuing the epithelial-endothelial crosstalk, and reducing the elevation of immune cell recruitment. Moreover, the anti-inflammatory properties of WJ-EV are affected by type 2 Diabetes Mellitus. WJ-EV derived from donors with type 2 Diabetes Mellitus contained less miR-146a and showed impaired ability to downregulate the NF-κB pathway and inflammatory cytokines in recipient cells. Taken together, our findings demonstrate the role of miR-146a in targeting the NF-κB pathway in the anti-inflammatory abilities of WJ-EV, which is a promising strategy to rescue the epithelial-endothelial crosstalk altered by co-infection with SARS-CoV-2 and IAV.

Severe mental illness and infectious disease mortality: a systematic review and meta-analysis

Background

Evidence from meta-analyses suggest that people with severe mental illness (SMI) are at increased risk of death from infectious diseases compared to those without SMI. However, few reviews have focused on mortality risk from specific infection types, apart from COVID-19. The aim of this systematic review and meta-analysis was to comprehensively describe and quantify the risk of death from infections (excluding COVID-19) in people with SMI, exploring specific infection types where possible.

Methods

PubMed, Web of Science, PsycINFO, and EMBASE were searched for relevant studies up to 18th June 2024. Studies were included if they assessed the impact of SMI (bipolar disorder, schizophrenia and schizoaffective disorders, other psychoses) on risk of mortality from any infectious disease excluding COVID-19. Random-effects meta-analyses of the risk of death from 'infectious diseases', respiratory infections, sepsis, and 'other' infections in SMI were performed. The review protocol was registered in PROSPERO (CRD42023422151).

Findings

Twenty-nine articles were included in the review. All were observational cohort studies carried out in high income countries and 59% were judged to be of good quality. Narrative analysis indicated that having SMI was associated with increased risk of death from infectious disease (23/29 studies), with mixed results for sepsis. People with SMI were more than twice as likely to die from 'infectious diseases' than the general population (pooled relative risk (RR) = 2.71, 95% confidence interval (CI) = 2.33-3.16, N = 739,852) and more than three times more likely to die from respiratory infections (pooled RR = 3.27, 95% CI = 2.57-4.17, N = 1,353,905). Sources of heterogeneity across studies included SMI diagnosis, gender, type of control group, and infection type.

Interpretation

People with SMI are at an increased risk of death from infection, particularly from respiratory infections like influenza and pneumonia and should be prioritised for preventative strategies including influenza and pneumococcal vaccines. More work is needed to fully understand why infection mortality risk is increased in SMI.

Funding

MQ Mental Health Research Fellowship MQF22∖12.

THE EFFECT OF URIC ACID LEVEL ON THE SEVERITY OF COVID-19

Epidemiological and clinical features of COVID-19 have been reported, but risk factors need to be determined to predict the course of the disease. In our study, we aimed to determine the effect of uric acid level on the severity of the disease. COVID-19 patients who received inpatient treatment between March 11, 2020 and May 30, 2020, and whose uric acid level was measured were included in the study. Demographic characteristics, comorbidities, symptoms, clinical course, laboratory parameters, and treatments were recorded. The study included 83 patients, of these 43 (52%) were males. The mean age was 59±17.1 years. The mean uric acid and albumin levels of the patients who needed oxygen were lower than in those who did not need oxygen (p=0.471 and p=0.057, respectively). There was a significant relationship between the presence of hypouricemia and mortality (p=0.019). In addition, the mean uric acid levels of patients who needed intensive care or died were lower than the mean uric acid levels of patients who did not need intensive care or who lived (p=0.665 and p=0.241, respectively). Oxygen need, intensive care need, and low uric acid level were found to be associated with increased length of hospital stay (p=0.00, p=0.001, p=0.012, and r=-0.276, respectively). Our study results suggest that uric acid levels may be associated with disease severity in the course of COVID-19.

[Multiplex analysis of post-Covid cardiorenal complications in patients with type 1 and type 2 diabetes mellitus according to the mobile diagnostic and treatment center (Diamobil)]

BACKGROUND

Patients with diabetes mellitus (DM) are at risk for a higher incidence and severity of COVID-19, as well as its adverse outcomes, including post-Covid syndrome.

AIM

to assess the incidence of cardiorenal complications in patients with type 1 and type 2 diabetes (T1DM/T2DM) who have had COVID-19, and to analyze the structure and severity of disorders according to examination data at the Diamobil mobile medical diagnostic and treatment center.

MATERIALS AND METHODS

a cohort of T1DM and T2DM patients examined in Diamobil (n=318), with a confirmed anamnesis of COVID-19 (n=236). The time interval between COVID-19 and the visit to Diamobil was 8.7/8.2 months for T1DM/T2DM. The parameters of the last visit before COVID-19 recorded in the Federal Register of Diabetes (FRD) were used as initial data.

RESULTS

Clinical characteristics of patients with T1DM/T2DM: age - 49.2/64.5 years, duration of DM - 22/11 years, proportion of women - 64/73%, respectively. After analysis the data from visits before and after COVID-19 there weren't statistically significant differences in HbA1c levels for both types of DM (before 9.0/8.3%; after 8.4/8.2%, respectively), there was the intensification of glucose lowering therapy (the proportion of patients with T2DM on 2 and 3 component therapy increased by 4.3% and 1.6%, the proportion of patients on insulin therapy by 16%). After COVID-19, there was a statistically significant decrease in glomerular filtration rate (GFR) in T1DM from 88.1 to 62 ml/min/1.73 m2; with T2DM from 74.7 to 54.1 ml/min/1.73 m2. When assessing acute diabetic complications, there was an increase in the frequency of coma in T1DM by 1.5 times, severe hypoglycemia in T1DM by 3 times, and in T2DM by 1.7 times. Analysis of the frequency of cardiorenal complications before and after COVID-19 showed a total increase of 8.5% in T1DM, by 13.2% in T2DM, of which myocardial infarction, ischemic heart disease, and CHF increased in T1DM in the range from 1.5 to 5 times, with T2DM by 1.3 times, the frequency of CKD with T1DM by 1.5 times, with T2DM by 5.6 times.

CONCLUSION

There was a decline of kidney filtration function (decrease in GFR) and an increase in the frequency of cardiovascular complications in both types of diabetes in post-Covid period while patients achieved a stable HbA1c levels by intensifying therapy during the COVID-19 infection. This fact reflects combined damage to the kidney and cardiovascular system as a part of the post-Covid syndrome and determines a key set of measures for the development of preventive strategies.

Effects of novel glucose-lowering drugs on the COVID-19 patients with diabetes: A network meta-analysis of clinical outcomes

Objective

This study aimed to assess the effects of sodium-glucose co-transporter inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and dipeptidyl peptidase-4 inhibitors (DPP4i) on individuals subjected to diabetes and COVID-19.

Methods

PubMed, Embase, Web of Science, and Cochrane Library were systematically searched to cover studies (except for case reports and review studies) published until August 30, 2022. The primary outcome was the mortality of people with diabetes and COVID-19. The secondary outcomes comprised the requiring intensive care unit (ICU) admission and mechanical ventilation. Two reviewers independently screened studies, abstracted data, and assessed risk-of-bias. Furthermore, the network meta-analyses (NMA) were conducted.

Results

A total of 12 trials were involved in the analysis. The OR and 95% CI of mortality for SGLT2i compared with SGLT2i + GLP-1RA and DPP4i reached 0.41 (0.17,0.97) and 0.69 (0.49,0.98), respectively. The OR and 95% CI of requiring mechanical ventilation for SGLT2i compared with the DPP4i reached 0.85 (0.75,0.97).

Conclusions

As revealed by the result of this study, SGLT2i is associated with the lower mortality rate in people with diabetes and COVID-19 among novel glucose-lowering drugs. And SGLT2i is linked to lower requiring mechanical ventilation. These findings can have a large impact on clinicians' decisions amid the COVID-19 pandemic.

COVID-19 outcomes among patients with dementia and age-matched controls who were hospitalized in 21 US health-care systems

INTRODUCTION

COVID-19 had devastating impacts worldwide. However, most research examining the impact of dementia on COVID-19 outcomes has been conducted in Europe and Asia and has not examined dementia subtypes.

METHODS

A retrospective analysis of electronic health record data from 21 US health-care systems examined relationships of all-cause dementia, Alzheimer's disease (AD), and vascular dementia with in-hospital mortality, intensive care unit (ICU) admission, and hospital stay duration.

RESULTS

All-cause dementia, but not AD or vascular dementia independently, was associated with increased mortality risk, the inclusion of discharge to hospice as a mortality equivalent increased risk for mortality for all-cause dementia, and AD and vascular dementia. Patients with all-cause dementia and AD were less likely to be admitted to the ICU than patients without. Patients with any form of dementia had longer hospital stays than patients without.

DISCUSSION

Dementia was associated with increased mortality or hospice discharge, decreased ICU admissions, and longer hospital stays.

HIGHLIGHTS

Only all-cause dementia was associated with increased mortality risk. This risk was lower than what has been published in previous research. Combining mortality and hospice discharge increased risk for all dementia subtypes. All-cause and Alzheimer's disease (AD) dementia were associated with decreased intensive care unit admissions. All-cause, vascular, and AD dementia were associated with longer hospital stays.

Disentangling the relationship between cancer mortality and COVID-19 in the US

Cancer is considered a risk factor for COVID-19 mortality, yet several countries have reported that deaths with a primary code of cancer remained within historic levels during the COVID-19 pandemic. Here, we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US. We compared pandemic-related mortality patterns from underlying and multiple cause (MC) death data for six types of cancer, diabetes, and Alzheimer's. Any pandemic-related changes in coding practices should be eliminated by study of MC data. Nationally in 2020, MC cancer mortality rose by only 3% over a pre-pandemic baseline, corresponding to ~13,600 excess deaths. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematological, 2-7%) than cancers with a poor survival rate (lung and pancreatic, 0-1%). In comparison, there was substantial elevation in MC deaths from diabetes (37%) and Alzheimer's (19%). To understand these differences, we simulated the expected excess mortality for each condition using COVID-19 attack rates, life expectancy, population size, and mean age of individuals living with each condition. We find that the observed mortality differences are primarily explained by differences in life expectancy, with the risk of death from deadly cancers outcompeting the risk of death from COVID-19.

Severe COVID-19 infection: An institutional review and literature overview

BACKGROUND

Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes.

METHODS

A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality.

RESULTS

Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%.

CONCLUSION

Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.

The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study

Background: The long-term effect of the 2019 coronavirus (COVID-19) pandemic is not fully known. Severe cases of COVID-19 have resulted in disability that can be assessed in a biopsychosocial manner with the International Classification of Functioning, Disability and Health with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. This study aimed to evaluate the long-term effects on disability of COVID-19 three years after post-acute rehabilitation using WHODAS 2.0. Methods: This single-center cohort study included patients with severe COVID-19 who underwent immediate post-discharge post-acute rehabilitation intervention. Three years later, patients were assessed via telephone using the WHODAS 2.0 questionnaire. Results: Of the 69 patients identified in the hospital database, 27 responded. A total of 16 patients refused to respond due to emotional distress. The mean age was 63.4 ± 8.6 years, 81.5% were independent in the community, 55.3% had been previously admitted to the ICU, and the median rehabilitation hospitalization duration was 18 (11.5,24) days. Comorbidities included type 2 diabetes mellitus (DM) (55.5%), grade 2 high blood pressure (62.9%), pressure ulcers (37%), peripheral neurologic deficits (62.9%), and central neurological deficits (14.8%). ICU admission was significantly correlated with advanced rehabilitation needs (measured by the level of the rehabilitation (p < 0.01) and longer hospitalizations (measured by total days in the hospital (p < 0.001). The overall disability score was 35.09%, significantly influenced by DM and central neurological deficits. Conclusions: Central neurological deficits and DM are associated with higher disability scores. Tailored rehabilitation programs, ongoing medical assessment, integrated care models, and patient education are essential for improving long-term outcomes after COVID-19 disease.

Ethics in Patients' Health Literacy: a scoping review and a critical discussion

A growing body of literature has acknowledged that a high number of populations with low Health Literacy (HL) is related to poor health outcomes, inequities in healthcare and high economic costs. Those findings have formulated the research questions of this review: (i) what ethical issues arise within the context of patients' HL and (ii) What is the relationship between HL and quality of life? This review followed the guidelines of Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) and it was conducted in five databases: PubMed, CINAHL, MEDLINE, Scopus and Science Direct between June 2022 and December 2023. Out of the 3164 titles retrieved, 285 abstracts were eligible to proceed. Following a thorough examination of the full text of 61 papers, 45 sources were identified that met the inclusion criteria. The data analysis process was guided by the research questions, employing a thematic approach. Four themes were identified: the use of language and patient understanding, human rights, the principlism approach (justice, beneficence, non-maleficence and autonomy) and quality of life. The first theme mainly focused on the relation of HL with the notion of consent forms and national action plans. Human rights in relation to HL were discussed as a minor issue. The bioethical framework by Beauchamp and Childress (Principles of Biomedical Ethics, 6th edn. Oxford University Press, New York, NY, 2009), was addressed by several studies, with a particular focus on justice and the loss of autonomy. Quality of life indicated a positive correlation with HL by most of the authors, while few studies revealed a moderate correlation.

Impact of Diabetes Mellitus On In-Hospital Mortality of COVID-19 Patients in Japan Since COVID-19 Became a Common Infectious Disease

AIM

The number of severe cases of coronavirus disease 2019 (COVID-19) has been decreasing since the emergence of the Omicron variant at the end of 2021. COVID-19 has become a common infectious disease in Japan and was downgraded to a category five infectious disease on May 8, 2023. This study aimed to compare the impact of diabetes mellitus on in-hospital mortality in COVID-19 patients since COVID-19 became a common infectious disease.

PATIENTS AND METHODS

We conducted a retrospective observational study using data from an advanced critical care center in Osaka, Japan. The study included 1,381 patients of COVID-19 admitted to the center between March 1, 2020, and May 7, 2023, before COVID-19 became a category five infectious disease in Japan. Individuals younger than 18 years and pregnant women were excluded. We divided the patients into two groups: pre- and post-Omicron epidemic groups. The primary endpoint of the study was the in-hospital mortality, and the prognostic impact of diabetes mellitus was compared between the groups.

RESULTS

The Kaplan-Meier curve showed a significantly lower rate of in-hospital mortality in the post-Omicron epidemic group than in the pre-Omicron epidemic group. The hazard ratio (HR) was 1.83 (95% CI, 1.36-2.50; p < 0.0001). Patients with diabetes mellitus had higher in-hospital mortality in both the pre- and post-Omicron epidemic groups; their HRs were 1.39 (95% CI, 1.21-1.59; p < 0.0001) and 1.45 (95% CI, 1.15-1.83; p = 0.0012), respectively. Diabetes mellitus had no significant interaction effect on the association between the post-Omicron epidemic and in-hospital mortality (p for interaction = 0.2154).

CONCLUSION

Diabetes mellitus may continue contributing to COVID-19 in-hospital mortality in the future, as the Omicron sub-strain may still be prevalent.

Novel COVID-19 biomarkers identified through multi-omics data analysis: N-acetyl-4-O-acetylneuraminic acid, N-acetyl-L-alanine, N-acetyltriptophan, palmitoylcarnitine, and glycerol 1-myristate

This study aims to apply machine learning models to identify new biomarkers associated with the early diagnosis and prognosis of SARS-CoV-2 infection.Plasma and serum samples from COVID-19 patients (mild, moderate, and severe), patients with other pneumonia (but with negative COVID-19 RT-PCR), and healthy volunteers (control) from hospitals in four different countries (China, Spain, France, and Italy) were analyzed by GC-MS, LC-MS, and NMR. Machine learning models (PCA and PLS-DA) were developed to predict the diagnosis and prognosis of COVID-19 and identify biomarkers associated with these outcomes.A total of 1410 patient samples were analyzed. The PLS-DA model presented a diagnostic and prognostic accuracy of around 95% of all analyzed data. A total of 23 biomarkers (e.g., spermidine, taurine, L-aspartic, L-glutamic, L-phenylalanine and xanthine, ornithine, and ribothimidine) have been identified as being associated with the diagnosis and prognosis of COVID-19. Additionally, we also identified for the first time five new biomarkers (N-Acetyl-4-O-acetylneuraminic acid, N-Acetyl-L-Alanine, N-Acetyltriptophan, palmitoylcarnitine, and glycerol 1-myristate) that are also associated with the severity and diagnosis of COVID-19. These five new biomarkers were elevated in severe COVID-19 patients compared to patients with mild disease or healthy volunteers.The PLS-DA model was able to predict the diagnosis and prognosis of COVID-19 around 95%. Additionally, our investigation pinpointed five novel potential biomarkers linked to the diagnosis and prognosis of COVID-19: N-Acetyl-4-O-acetylneuraminic acid, N-Acetyl-L-Alanine, N-Acetyltriptophan, palmitoylcarnitine, and glycerol 1-myristate. These biomarkers exhibited heightened levels in severe COVID-19 patients compared to those with mild COVID-19 or healthy volunteers.

The impact of diabetes mellitus on blood-tissue barrier regulation and vascular complications: Is the lung different from other organs?

Diabetes Mellitus presents a formidable challenge as one of the most prevalent and complex chronic diseases, exerting significant strain on both patients and the world economy. It is recognized as a common comorbidity among severely ill individuals, often leading to a myriad of micro- and macro-vascular complications. Despite extensive research dissecting the pathophysiology and molecular mechanisms underlying vascular complications of diabetes, relatively little attention has been paid to potential lung-related complications. This review aims to illuminate the impact of diabetes on prevalent respiratory diseases, including chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), idiopathic pulmonary fibrosis (IPF), tuberculosis (TB), pneumonia infections, and asthma, and compare the vascular complications with other vascular beds. Additionally, we explore the primary mechanistic pathways contributing to these complications, such as the expression modulation of blood-tissue-barrier proteins, resulting in increased paracellular and transcellular permeability, and compromised immune responses rendering diabetes patients more susceptible to infections. The activation of inflammatory pathways leading to cellular injury and hastening the onset of these respiratory complications is also discussed.

Prevalence, Predictors, and Outcomes of Type 2 NSTEMI in Hospitalized Patients With COVID-19

BACKGROUND

Data on the incidence of type 2 non-ST-segment-elevation myocardial infarction (T2MI) in hospitalized patients with COVID-19 has been limited to single-center studies. Given that certain characteristics, such as obesity and type 2 diabetes, have been associated with higher mortality in COVID-19 infections, we aimed to define the incidence of T2MI in a national cohort and identify pre-hospital patient characteristics associated with T2MI in hospitalized patients with COVID-19.

METHODS AND RESULTS

Using the national American Heart Association COVID-19 Cardiovascular Disease Quality Improvement Registry, we performed a retrospective 4:1 matched (age, sex, race, and body mass index) analysis of controls versus cases with T2MI. We performed (1) conditional multivariable logistic regression to identify predictive pre-hospital patient characteristics of T2MI for patients hospitalized with COVID-19 and (2) stratified proportional hazards regression to investigate the association of T2MI with morbidity and mortality. From January 2020 through May 2021, there were 709 (2.2%) out of 32 015 patients with T2MI. Five hundred seventy-nine cases with T2MI were matched to 2171 controls (mean age 70; 43% female). Known coronary artery disease, heart failure, chronic kidney disease, hypertension, payor source, and presenting heart rate were associated with higher odds of T2MI. Anti-hyperglycemic medication and anti-coagulation use before admission were associated with lower odds of T2MI. Those with T2MI had higher morbidity and mortality (hazard ratio, 1.40 [95% CI, 1.13-1.74]; P=0.002).

CONCLUSIONS

In hospitalized patients with COVID-19, those with a T2MI compared with those without had higher morbidity and mortality. Outpatient anti-hyperglycemic and anti-coagulation use were the only pre-admission factors associated with reduced odds of T2MI.

The prevalence of metabolic syndrome and associated factors among adults on antiretroviral therapy in Dar es Salaam, Tanzania

Background

Adults living with HIV (ALHIV) are at increased risk of developing metabolic syndrome (MetS). Several factors are associated with an increase in MetS in these individuals, including certain antiretroviral therapies (ART). There is limited data on the prevalence of MetS among ALHIV in sub-Saharan Africa following scale up of newer integrase inhibitor-containing ART regimens.

Objective

We assessed the prevalence and correlates of MetS among ALHIV patients receiving tenofovir, lamivudine, and dolutegravir (TLD) in Tanzania.

Methods

We conducted a retrospective cross-sectional analysis of ALHIV aged ≥18 enrolled in a cardiovascular health study at six HIV Care and Treatment Clinics from 11/2020-1/2021 in Dar es Salaam, Tanzania. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Descriptive statistics were used to summarize the results, and logistic regression was used to assess demographic, behavioral, and HIV-related risk factors associated with MetS. Covariates with a p-value <0.2 at the univariate level were included in the multivariate model.

Results

Three hundred and eighty nine participants were included in the analysis. The mean age (SD) was 43 years (±11) years, and 286 (73.5%) were female. The prevalence of MetS in this population was 21%. In univariate analysis, MetS components that were significantly higher among women vs. men included abdominal obesity (27.3% vs. 4.9%), reduced HDL (77.9% vs. 53.4%), and elevated glucose (18.5% vs. 14.6%), all p< 0.05. Age≥ 50 yrs [AOR 3.25; (95% CI 1.80-5.84), p < 0.01] and BMI [AOR 0.16; (95% CI 0.09-0.30), P ≤0.01] were both associated with an increased odds of MetS in multivariate analyses.

Conclusion

MetS. is prevalent among Tanzanian ALHIV on TLD. Routine screening for MetS and healthy lifestyle promotion, particularly among women and those aging, should be a priority to prevent against cardiovascular disease. Further studies are needed to monitor the long-term impact of these newer ART regimens on MetS and CVD.

The predictive power of data: machine learning analysis for Covid-19 mortality based on personal, clinical, preclinical, and laboratory variables in a case-control study

BACKGROUND AND PURPOSE

The COVID-19 pandemic has presented unprecedented public health challenges worldwide. Understanding the factors contributing to COVID-19 mortality is critical for effective management and intervention strategies. This study aims to unlock the predictive power of data collected from personal, clinical, preclinical, and laboratory variables through machine learning (ML) analyses.

METHODS

A retrospective study was conducted in 2022 in a large hospital in Abadan, Iran. Data were collected and categorized into demographic, clinical, comorbid, treatment, initial vital signs, symptoms, and laboratory test groups. The collected data were subjected to ML analysis to identify predictive factors associated with COVID-19 mortality. Five algorithms were used to analyze the data set and derive the latent predictive power of the variables by the shapely additive explanation values.

RESULTS

Results highlight key factors associated with COVID-19 mortality, including age, comorbidities (hypertension, diabetes), specific treatments (antibiotics, remdesivir, favipiravir, vitamin zinc), and clinical indicators (heart rate, respiratory rate, temperature). Notably, specific symptoms (productive cough, dyspnea, delirium) and laboratory values (D-dimer, ESR) also play a critical role in predicting outcomes. This study highlights the importance of feature selection and the impact of data quantity and quality on model performance.

CONCLUSION

This study highlights the potential of ML analysis to improve the accuracy of COVID-19 mortality prediction and emphasizes the need for a comprehensive approach that considers multiple feature categories. It highlights the critical role of data quality and quantity in improving model performance and contributes to our understanding of the multifaceted factors that influence COVID-19 outcomes.

Glycated albumin in the detection of diabetes during COVID-19 hospitalization

BACKGROUND

Diabetes has emerged as an important risk factor for COVID-19 adverse outcomes during hospitalization. We investigated whether the measurement of glycated albumin (GA) may be useful in detecting newly diagnosed diabetes during COVID-19 hospitalization.

METHODS

In this cross-sectional test accuracy study we evaluated HCPA Biobank data and samples from consecutive in-patients, from 30 March 2020 to 20 December 2020. ROC curves were used to analyse the performance of GA to detect newly diagnosed diabetes (patients without a previous diagnosis of diabetes and admission HbA1c ≥6.5%).

RESULTS

A total of 184 adults (age 58.6 ± 16.6years) were enrolled, including 31 with newly diagnosed diabetes. GA presented AUCs of 0.739 (95% CI 0.642-0.948) to detect newly diagnosed diabetes. The GA cut-offs of 19.0% was adequate to identify newly diagnosed diabetes with high specificity (85.0%) but low sensitivity (48.4%).

CONCLUSIONS

GA showed good performance to identify newly diagnosed diabetes and may be useful for identifying adults with the condition in COVID-19-related hospitalization.

Secondary Analysis of Fluids and Catheters Treatment Trial (FACTT) data reveal poor clinical outcomes in acute respiratory distress syndrome patients with diabetes

OBJECTIVES

Conflicting reports exist about the link between diabetes mellitus (DM) and acute respiratory distress syndrome (ARDS). Our study examines the impact of pre-existing DM on ARDS patients within the Fluid and Catheter Treatment Trial (FACTT).

DESIGN

Conducting a secondary analysis of FACTT data, we incorporated 967 participants with identified DM status (173 with DM, 794 without DM) and examined outcomes like 90-day mortality, hospital and ICU stays, and ventilator days until unassisted breathing. The primary outcome of hospital mortality at day 90 was evaluated through logistic regression using IBM SPSS software. Additionally, we assessed plasma cytokines and chemokines utilizing a human magnetic bead-based multiplex assay.

RESULTS

Patients with pre-existing DM exhibited a lower survival rate compared to non-DM patients (61.3 vs. 72.3 %, p = 0.006). Subjects with DM experienced significantly longer hospital lengths of stay (24.5 vs. 19.7 days; p = 0.008) and prolonged ICU stays (14.8 vs. 12.4 days; p = 0.029). No significant difference was found in ventilator days until unassisted breathing between the two groups (11.7 vs. 10; p = 0.1). Cytokine/chemokine analyses indicated a non-significant trend toward heightened levels of cytokines (TNF-α, IL-10, and IL-6) and chemokines (CRP, MCP-1) in DM patients compared to non-DM on both days 0 and 1. Notably, lipopolysaccharide-binding protein (LBP) exhibited significantly higher levels in DM compared to non-DM individuals.

CONCLUSIONS

ARDS patients with DM suffered worse clinical outcomes compared to non-DM patients, indicating that DM may negatively affect the respiratory functions in these subjects. Further comprehensive clinical and pre-clinical studies will strengthen this relationship.

Is COVID-19 Infection a Multiorganic Disease? Focus on Extrapulmonary Involvement of SARS-CoV-2

First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endothelial cells, and cause haemostasis, CNS, and kidney and gastrointestinal tract abnormalities that can impact in the disease course and prognosis. In fact, COVID-19 may affect almost all the organs. Hence, SARS-CoV-2 is essentially a systemic infection that can present a large number of clinical manifestations, and it is variable in distribution and severity, which means it is potentially life-threatening. The goal of this comprehensive review paper in the series is to give an overview of non-pulmonary involvement in COVID-19, with a special focus on underlying pathophysiological mechanisms and clinical presentation.

Mortality-related risk factors of inpatients with diabetes and COVID-19: A multicenter retrospective study in Belgium

BACKGROUND AND AIMS

We describe mortality-related risk factors of inpatients with diabetes and coronavirus disease 2019 (COVID-19) in Belgium.

METHODS

We conducted a multicenter retrospective study from March to May, 2020, in 8 Belgian centers. Data on admission of patients with diabetes and COVID-19 were collected. Survivors were compared to non-survivors to identify prognostic risk factors for in-hospital death using multivariate analysis in both the total population and in the subgroup of patients admitted in the intensive care unit (ICU).

RESULTS

The study included 375 patients. The mortality rate was 26.4% (99/375) in the total population and 40% (27/67) in the ICU. Multivariate analysis identified older age (HR 1.05 [CI 1.03-1.07], P<0.0001) and male gender (HR 2.01 [1.31-3.07], P=0.0013) as main independent risk factors for in-hospital death in the total population. Metformin (HR 0.51 [0.34-0.78], P=0.0018) and renin-angiotensin-aldosterone system blockers (HR 0.56 [0.36-0.86], P=0.0088) use before admission were independent protective factors. In the ICU, chronic kidney disease (CKD) was identified as an independent risk factor for death (HR 4.96 [2.14-11.5], P<0.001).

CONCLUSION

In-hospital mortality due to the first wave of COVID-19 pandemic in Belgium was high in patients with diabetes. We found that advanced age and male gender were independent risk factors for in-hospital death. We also showed that metformin use before admission was associated with a significant reduction of COVID-19-related in-hospital mortality. Finally, we showed that CKD is a COVID-19-related mortality risk factor in patients with diabetes admitted in the ICU.

The impact of type 2 diabetes and glycaemic control on mortality and clinical outcomes in hospitalized patients with COVID-19 in the capital region of Denmark

AIM

To explore the impact of type 2 diabetes (T2D), glycaemic control and use of glucose-lowering medication on clinical outcomes in hospitalized patients with COVID-19.

MATERIALS AND METHODS

For all patients admitted to a hospital in the Capital Region of Denmark (1 March 2020 to 1 December 2021) with confirmed COVID-19, we extracted data on mortality, admission to intensive care unit (ICU), demographics, comorbidities, medication use and laboratory tests from the electronic health record system. We compared patients with T2D to patients without diabetes using Cox proportional hazards models adjusted for available confounding variables. Outcomes were 30-day mortality and admission to an ICU. For patients with T2D, we also analysed the association of baseline haemoglobin A1c (HbA1c) levels and use of specific glucose-lowering medications with the outcomes.

RESULTS

In total, 4430 patients were analysed, 1236 with T2D and 2194 without diabetes. The overall 30-day mortality was 19% (n = 850) and 10% (n = 421) were admitted to an ICU. Crude analyses showed that patients with T2D both had increased mortality [hazard ratio (HR) 1.37; 95% CI 1.19-1.58] and increased risk of ICU admission (HR 1.28; 95% CI 1.04-1.57). When adjusted for available confounders, this discrepancy was attenuated for both mortality (adjusted HR 1.13; 95% CI 0.95-1.33) and risk of ICU admission (adjusted HR 1.01; 95% CI 0.79-1.29). Neither baseline haemoglobin A1c nor specific glucose-lowering medication use were significantly associated with the outcomes.

CONCLUSION

Among those hospitalized for COVID-19, patients with T2D did not have a higher risk of death and ICU admission, when adjusting for confounders.

Factors Associated with Mortality in Patients with Coronavirus Disease (COVID-19) in Babol, North of Iran

BACKGROUND

The spectrum of the clinical features of coronavirus disease 2019 (COVID-19) spans from asymptomatic or mild disease to severe respiratory failure, while different factors are related to its mortality rate. This research aimed to determine the clinical and laboratory characteristics and the associated factors of mortality in patients with COVID-19.

MATERIALS AND METHODS

Data were collected from hospitalized patients (May to June 2020), and COVID-19 was confirmed in patients by real-time polymerase chain reaction (PCR). The patient group was classified into survivor and deceased groups. The chi-square and the independent t-test with Statistical Package for the Social Sciences (SPSS) software program, version 18, were used for analysis.

RESULTS

Mean age, hemoglobin, serum C-reactive protein (CRP), alkaline phosphatase (ALP), white blood cells, and level of procalcitonin in non-survivors were significantly higher than in survivors. Serum tumour necrosis factor-alpha (TNF-a) had a significant relationship with Ddimer (p = 0.0006). The risk of mortality in patients with serum CRP ≥ 100 mg/dl was significantly higher than those with CRP < 100 mg/dl (odds ratio (OR) = 4.8 (95% CI, 1.33-12.44, p = 0.01).

CONCLUSION

COVID-19 has different clinical features and can be an asymptomatic, mild, or severe disease. Thus, findings about the disease and the consequent outcomes differ in patients. Further studies are needed to evaluate the clinical features and consequences of COVID-19 infection.