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Wang S, Zhu R, Zhang C, Guo Y, Lv M, Zhang C, Bian C, Jiang R, Zhou W, Guo L. Effects of the pre-existing coronary heart disease on the prognosis of COVID-19 patients: A systematic review and meta-analysis. PLoS One 2023; 18:e0292021. [PMID: 37815980 PMCID: PMC10564240 DOI: 10.1371/journal.pone.0292021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Although studies have shown severe Coronavirus disease 2019 (COVID-19) outcomes in patients with pre-existing coronary heart disease (CHD), the prognosis of COVID-19 patients with pre-existing CHD remains uncertain primarily due to the limited number of patients in existing studies. This study aimed to investigate the impacts of pre-existing CHD on the prognosis of COVID-19 patients. Five electronic databases were searched for eligible studies. This article focused on cohort and case-control studies involving the prognosis of COVID-19 patients with pre-existing CHD. The meta-analysis was performed using a random effects model. The odds ratios (ORs) and 95% confidence intervals (CIs) were used as valid indicators. The study was registered in PROSPERO with the identifier: CRD42022352853. A total of 81 studies, involving 157,439 COVID-19 patients, were included. The results showed that COVID-19 patients with pre-existing CHD exhibited an elevated risk of mortality (OR = 2.45; 95%CI: [2.04, 2.94], P < 0.001), severe/critical COVID-19 (OR = 2.57; 95%CI: [1.98, 3.33], P < 0.001), Intensive Care Unit or Coronary Care Unit (ICU/CCU) admission: (OR = 2.75, 95%CI: [1.61, 4.72], P = 0.002), and reduced odds of discharge/recovery (OR = 0.43, 95%CI: [0.28, 0.66], P < 0.001) compared to COVID-19 patients without pre-existing CHD. Subgroup analyses indicated that the prognosis of COVID-19 patients with pre-existing CHD was influenced by publication year, follow-up duration, gender, and hypertension. In conclusion, pre-existing CHD significantly increases the risk of poor prognosis in patients with COVID-19, particularly in those male or hypertensive patients.
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Affiliation(s)
- Saikun Wang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ruiting Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Chengwei Zhang
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yingze Guo
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Mengjiao Lv
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Changyue Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ce Bian
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ruixue Jiang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Wei Zhou
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lirong Guo
- School of Nursing, Jilin University, Changchun, Jilin, China
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2
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Dueñas-Espín I, Echeverría-Mora M, Montenegro-Fárez C, Baldeón M, Chantong Villacres L, Espejo Cárdenas H, Fornasini M, Ochoa Andrade M, Solís C. Development and validation of a scoring system to predict mortality in patients hospitalized with COVID-19: A retrospective cohort study in two large hospitals in Ecuador. PLoS One 2023; 18:e0288106. [PMID: 37459312 PMCID: PMC10351692 DOI: 10.1371/journal.pone.0288106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To develop and validate a scoring system to predict mortality among hospitalized patients with COVID-19. METHODS Retrospective cohort study. We analyzed 5,062 analyzed hospitalized patients with COVID-19 treated at two hospitals; one each in Quito and Guayaquil, from February to July 2020. We assessed predictors of mortality using survival analyses and Cox models. We randomly divided the database into two sets: (i) the derivation cohort (n = 2497) to identify predictors of mortality, and (ii) the validation cohort (n = 2565) to test the discriminative ability of a scoring system. After multivariate analyses, we used the final model's β-coefficients to build the score. Statistical analyses involved the development of a Cox proportional hazards regression model, assessment of goodness of fit, discrimination, and calibration. RESULTS There was a higher mortality risk for these factors: male sex [(hazard ratio (HR) = 1.32, 95% confidence interval (95% CI): 1.03-1.69], per each increase in a quartile of ages (HR = 1.44, 95% CI: 1.24-1.67) considering the younger group (17-44 years old) as the reference, presence of hypoxemia (HR = 1.40, 95% CI: 1.01-1.95), hypoglycemia and hospital hyperglycemia (HR = 1.99, 95% CI: 1.01-3.91, and HR = 1.27, 95% CI: 0.99-1.62, respectively) when compared with normoglycemia, an AST-ALT ratio >1 (HR = 1.55, 95% CI: 1.25-1.92), C-reactive protein level (CRP) of >10 mg/dL (HR = 1.49, 95% CI: 1.07-2.08), arterial pH <7.35 (HR = 1.39, 95% CI: 1.08-1.80) when compared with normal pH (7.35-7.45), and a white blood cell count >10 × 103 per μL (HR = 1.76, 95% CI: 1.35-2.29). We found a strong discriminative ability in the proposed score in the validation cohort [AUC of 0.876 (95% CI: 0.822-0.930)], moreover, a cutoff score ≥39 points demonstrates superior performance with a sensitivity of 93.10%, a specificity of 70.28%, and a correct classification rate of 72.66%. The LR+ (3.1328) and LR- (0.0981) values further support its efficacy in identifying high-risk patients. CONCLUSION Male sex, increasing age, hypoxemia, hypoglycemia or hospital hyperglycemia, AST-ALT ratio >1, elevated CRP, altered arterial pH, and leucocytosis were factors significantly associated with higher mortality in hospitalized patients with COVID-19. A statistically significant Cox regression model with strong discriminatory power and good calibration was developed to predict mortality in hospitalized patients with COVID-19, highlighting its potential clinical utility.
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Affiliation(s)
- Iván Dueñas-Espín
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - María Echeverría-Mora
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Camila Montenegro-Fárez
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Manuel Baldeón
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Luis Chantong Villacres
- Hospital General Norte de Guayaquil, IESS Ceibos, Instituto Ecuatoriano de Seguridad Social (IESS), Guayaquil, Ecuador
| | | | - Marco Fornasini
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Miguel Ochoa Andrade
- Hospital General del Sur de Quito, Instituto Ecuatoriano de Seguridad Social (IESS), Quito, Ecuador
| | - Carlos Solís
- Hospital General Norte de Guayaquil, IESS Ceibos, Instituto Ecuatoriano de Seguridad Social (IESS), Guayaquil, Ecuador
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3
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Infante M, Pieri M, Lupisella S, Mohamad A, Bernardini S, Della-Morte D, Fabbri A, De Stefano A, Iannetta M, Ansaldo L, Crea A, Andreoni M, Morello M. Admission eGFR predicts in-hospital mortality independently of admission glycemia and C-peptide in patients with type 2 diabetes mellitus and COVID-19. Curr Med Res Opin 2023; 39:505-516. [PMID: 36749566 DOI: 10.1080/03007995.2023.2177380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) and impaired kidney function are associated with a higher risk of poor outcomes of COVID-19. We conducted a retrospective study in hospitalized T2DM patients with COVID-19 to assess the association between in-hospital mortality and admission values of different hematological/biochemical parameters, including estimated glomerular filtration rate (eGFR), plasma glucose and C-peptide (as a marker of beta-cell function). METHODS The study included T2DM patients with confirmed SARS-CoV-2 infection who were consecutively admitted to our Institution between October 1, 2020 and April 1, 2021. RESULTS Patients (n = 74) were categorized into survivors (n = 55) and non-survivors (n = 19). Non-survivors exhibited significantly higher median WBC count, D-dimer, neutrophil-to-lymphocyte ratio, hsCRP, and procalcitonin levels, as well as significantly lower median serum 25(OH)D levels compared to survivors. Non-survivors exhibited significantly higher median admission plasma glucose (APG) values compared to survivors (210 vs 166 mg/dL; p = 0.026). There was no statistically significant difference in median values of plasma C-peptide between non-survivors and survivors (3.55 vs 3.24 ng/mL; p = 0.906). A significantly higher percentage of patients with an eGFR < 60 mL/min/1.73 m2 was observed in the non-survivor group as compared to the survivor group (57.9% vs 23.6%; p = 0.006). A multivariate analysis performed by a logistic regression model after adjusting for major confounders (age, sex, body mass index, major comorbidities) showed a significant inverse association between eGFR values and risk of in-hospital mortality (OR, 0.956; 95% CI, 0.931-0.983; p = 0.001). We also found a significant positive association between WBC count and risk of in-hospital mortality (OR, 1.210; 95% CI, 1.043-1.404; p = 0.011). CONCLUSIONS Admission eGFR and WBC count predict in-hospital COVID-19 mortality among T2DM patients, independently of traditional risk factors, APG and random plasma C-peptide. Hospitalized patients with COVID-19 and comorbid T2DM associated with impaired kidney function at admission should be considered at high risk for adverse outcomes and death.
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Affiliation(s)
- Marco Infante
- Department of Systems Medicine & Diabetes Research Institute Federation (DRIF), University of Rome Tor Vergata, Rome, Italy
- Section of Diabetes and Metabolic Disorders, UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Cell Transplant Center, Diabetes Research Institute (DRI), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Massimo Pieri
- Department of Experimental Medicine, Clinical Biochemistry and Molecular Biology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Santina Lupisella
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Ali Mohamad
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, Clinical Biochemistry and Molecular Biology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fabbri
- Department of Systems Medicine & Diabetes Research Institute Federation (DRIF), University of Rome Tor Vergata, Rome, Italy
| | - Alberto De Stefano
- Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Volunteers Association, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Marco Iannetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Lorenzo Ansaldo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Angela Crea
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Maria Morello
- Department of Experimental Medicine, Clinical Biochemistry and Molecular Biology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
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4
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Kania M, Mazur K, Terlecki M, Matejko B, Hohendorff J, Chaykivska Z, Fiema M, Kopka M, Kostrzycka M, Wilk M, Klupa T, Witek P, Katra B, Klocek M, Rajzer M, Malecki MT. Characteristics, Mortality, and Clinical Outcomes of Hospitalized Patients with COVID-19 and Diabetes: A Reference Single-Center Cohort Study from Poland. Int J Endocrinol 2023; 2023:8700302. [PMID: 36844106 PMCID: PMC9949948 DOI: 10.1155/2023/8700302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Diabetes is a risk factor for a severe course of COVID-19. We evaluated the characteristics and risk factors associated with undesirable outcomes in diabetic patients (DPs) hospitalized due to COVID-19. MATERIALS AND METHODS The data analysis of patients admitted between March 6, 2020, and May 31, 2021, to the University Hospital in Krakow (Poland), a reference center for COVID-19, was performed. The data were gathered from their medical records. RESULTS A total number of 5191 patients were included, of which 2348 (45.2%) were women. The patients were at the median age of 64 (IQR: 51-74) years, and 1364 (26.3%) were DPs. DPs, compared to nondiabetics, were older (median age: 70 years, IQR: 62-77 vs. 62, IQR: 47-72, and p < 0.001) and had a similar gender distribution. The DP group had a higher mortality rate (26.2% vs. 15.7%, p < 0.001) and longer hospital stays (median: 15 days, IQR: 10-24 vs. 13, IQR: 9-20, and p < 0.001). DPs were admitted to the ICU more frequently (15.7% vs. 11.0%, p < 0.001) and required mechanical ventilation more often (15.5% vs. 11.3%, p < 0.001). In a multivariate logistic regression, factors associated with a higher risk of death were age >65 years, glycaemia >10 mmol/L, CRP and D-dimer level, prehospital insulin and loop diuretic use, presence of heart failure, and chronic kidney disease. Factors contributing to lower mortality were in-hospital use of statin, thiazide diuretic, and calcium channel blocker. CONCLUSION In this large COVID-19 cohort, DPs constituted more than a quarter of hospitalized patients. The risk of death and other outcomes compared to nondiabetics was higher in this group. We identified a number of clinical, laboratory, and therapeutic variables associated with the risk of hospital death in DPs.
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Affiliation(s)
- Michał Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | - Michał Terlecki
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | | | | | | | - Magdalena Wilk
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Barbara Katra
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Marek Klocek
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Rajzer
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
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5
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Mittal N, Dhooria HPS, Arora S, Kumar V, Bansal E, Singh P, Kalra S, Goyal S, Mittal N, Naved K, Mohan B. The Effect of Diabetes Mellitus on Outcomes of Patients Admitted with COVID-19: A Single - Center Experience from a Tertiary Hospital in India. Indian J Endocrinol Metab 2022; 26:376-383. [PMID: 36185963 PMCID: PMC9519836 DOI: 10.4103/ijem.ijem_148_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/02/2022] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Diabetes mellitus is associated with poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics of patients with type 2 diabetes with COVID-19, and to determine the impact of type 2 diabetes on clinical outcome of patients with COVID-19. MATERIAL AND METHODS This single-center, retrospective, observational study enrolled patients admitted from March 2020 to June 2021 with COVID-19. The clinical and biochemical characteristics of patients with known type 2 diabetes, newly diagnosed diabetes, type 2 diabetes with comorbidities and those who succumbed to illness were analyzed. RESULTS Of 4,559 patients with COVID-19, 2,090 (45.8%) had type 2 diabetes. Patients with COVID-19 with diabetes were older, more likely to receive mechanical ventilation, had higher odds of mortality from COVID-19 as compared with patients without diabetes. In addition, patients with diabetes had significantly higher levels of serum creatinine, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Compared with previously diagnosed patients with diabetes, newly diagnosed patients had higher mortality (33% vs. 27%, P = 0.049). Among patients with COVID-19 and diabetes, nonsurvivors had significantly higher levels of inflammatory markers and had severe impairment of cardiac, renal, and coagulation parameters as opposed to survivors. CONCLUSION Patients with COVID-19 with diabetes were more likely to have severe disease and had higher mortality. Presence of chronic kidney disease and coronary artery disease in patients with diabetes with COVID-19 was associated with adverse outcome. Patients with newly diagnosed diabetes had higher odds of severe disease at presentation and had higher mortality.
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Affiliation(s)
- Naveen Mittal
- Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Saurabh Arora
- Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vipin Kumar
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ekta Bansal
- Department of Biochemistry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Parminder Singh
- Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Saloni Goyal
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Namit Mittal
- Kasturba Medical College, Manglore, Karnataka, India
| | - Khizar Naved
- Kasturba Medical College, Manipal, Karnataka, India
| | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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6
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Jafrin S, Aziz MA, Islam MS. Elevated Levels of Pleiotropic Interleukin-6 (IL-6) and Interleukin-10 (IL-10) are Critically Involved With the Severity and Mortality of COVID-19: An Updated Longitudinal Meta-Analysis and Systematic Review on 147 Studies. Biomark Insights 2022; 17:11772719221106600. [PMID: 35747885 PMCID: PMC9209786 DOI: 10.1177/11772719221106600] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Disruption in the natural immune reaction due to SARS-CoV-2 infection can initiate a potent cytokine storm among COVID-19 patients. An elevated level of IL-6 and IL-10 during a hyperinflammatory state plays a vital role in increasing the risk of severity and mortality. In this study, we aimed to evaluate the potential of circulating IL-6 and IL-10 levels as biomarkers for detecting the severity and mortality of COVID-19. Methods This study was conducted according to the Cochrane Handbook and PRISMA guidelines. Authorized databases were searched to extract suitable studies using specific search terms. RevMan 5.4 was applied for performing the meta-analysis. Mean differences in IL-6 and IL-10 levels were calculated among COVID-19 patients via a random-effects model. NOS scoring, publication bias and sensitivity analyses were checked to ensure study quality. Results A total of 147 studies were selected, with 31 909 COVID-19 patients under investigation. In the severity analysis, the mean concentration of IL-6 was significantly higher in the severe COVID-19 cases than in the non-severe cases (MD: 19.98; P < .001; 95% CI: 17.56, 22.40). Similar result was observed for IL-10 mean concentration in severe COVID-19 cases (MD: 1.35; P < .001; 95% CI: 0.90, 1.80). In terms of mortality analysis, circulating IL-6 showed sharp elevation in the deceased patients (MD: 42.11; P < .001; 95% CI: 36.86, 47.36). IL-10 mean concentration was higher in the dead patients than in the survived patients (MD: 4.79; P < .001; 95% CI: 2.83, 6.75). Publication bias was not found except for comparing IL-6 levels with disease severity. Sensitivity analysis also reported no significant deviation from the pooled outcomes. Conclusions Elevated levels of circulating IL-6 and IL-10 signifies worsening of COVID-19. To monitor the progression of SARS-CoV-2 infection, IL-6 and IL-10 should be considered as potential biomarkers for severity and mortality detection in COVID-19. Systematic review registration INPLASY registration number: INPLASY202240046.
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Affiliation(s)
- Sarah Jafrin
- Laboratory of Pharmacogenomics and Molecular Biology, Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Md. Abdul Aziz
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, State University of Bangladesh, Dhaka, Bangladesh
| | - Mohammad Safiqul Islam
- Laboratory of Pharmacogenomics and Molecular Biology, Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
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7
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Tzeravini E, Stratigakos E, Siafarikas C, Tentolouris A, Tentolouris N. The Role of Diabetes and Hyperglycemia on COVID-19 Infection Course-A Narrative Review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:812134. [PMID: 36992740 PMCID: PMC10012165 DOI: 10.3389/fcdhc.2022.812134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023]
Abstract
It was previously reported that subjects with diabetes mellitus (DM) are more vulnerable to several bacterial or viral infections. In the era of coronavirus disease 2019 (COVID-19) pandemic, it is reasonable to wonder whether DM is a risk factor for COVID-19 infection, too. It is not yet clear whether DM increases the risk for contracting COVID-19 infection or not. However, patients with DM when infected are more likely to develop severe or even fatal COVID-19 disease course than patients without DM. Certain characteristics of DM patients may also deteriorate prognosis. On the other hand, hyperglycemia per se is related to unfavorable outcomes, and the risk may be higher for COVID-19 subjects without pre-existing DM. In addition, individuals with DM may experience prolonged symptoms, need readmission, or develop complications such as mucormycosis long after recovery from COVID-19; close follow-up is hence necessary in some selected cases. We here present a narrative review of the literature in order to set light into the relationship between COVID-19 infection and DM/hyperglycemia.
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Affiliation(s)
- Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | | | - Chris Siafarikas
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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8
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Ganakumar V, Jethwani P, Roy A, Shukla R, Mittal M, Garg MK. Diabetic ketoacidosis (DKA) in type 1 diabetes mellitus (T1DM) temporally related to COVID-19 vaccination. Diabetes Metab Syndr 2022; 16:102371. [PMID: 34954484 PMCID: PMC8687715 DOI: 10.1016/j.dsx.2021.102371] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/26/2022]
Abstract
SARS-CoV-2 pandemic has claimed millions of lives since its first identification in December 2019. Patients with diabetes are at a high risk of adverse outcomes after COVID-19 infection, whereas infection itself can be associated with severe hyperglycemia, including hyperglycemic emergencies. While the accelerated vaccine development and rollout have considerably decreased morbidity and mortality with reasonable safety, there are emerging reports of worsening of hyperglycemia in response to vaccination, with possible shared pathophysiology with COVID-19 infection-related hyperglycemia. We hereby report two young patients with type 1 diabetes (T1DM) who presented with severe diabetic ketoacidosis (DKA) after receiving second doses of COVISHIELD (ChAdOx1 nCoV-19) and COVAXIN (BBV152- inactivated whole virion) vaccines. Though a causal link cannot be established, post-vaccination immune response can potentially explain this transient worsening of hyperglycemia and hyperglycemic emergencies. We, hence report diabetic ketoacidosis (DKA) following COVID-19 vaccination in T1DM. We suggest that people with diabetes, particularly patients with T1DM with inadequate glycemic control should ideally be closely monitored for hyperglycemia and ketonemia for at least 2 weeks after receiving vaccination for COVID 19.
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Affiliation(s)
- Vanishri Ganakumar
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Parth Jethwani
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Ayan Roy
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India.
| | - Ravindra Shukla
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Madhukar Mittal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Mahendra Kumar Garg
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
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9
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Khichar S, Samantaray S, Kumar D, Mobarsa V, Jain V, Sharma V, Soni K, Choudhury B, Goyal A, Shankar Meena D, Srinivasan S, Dutt N, Bhardwaj P, Agarwal A, Kumar Garg M, Misra S. New-onset hyperglycaemia and prolonged systemic corticosteroids therapy in mild COVID-19 patients as major risk factors for invasive mucormycosis: a preliminary study. Curr Med Mycol 2021; 7:22-28. [PMID: 35528622 PMCID: PMC9006735 DOI: 10.18502/cmm.7.3.7254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/28/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Rapid surge of invasive mucormycosis has surprised the Indian healthcare system amidst the coronavirus disease-19 (COVID-19) pandemic. Hence, there is an urgent need to find the risk factors for the sudden rise in cases of invasive mucormycosis among COVID-19 patients. This study aimed to find crucial risk factors for the sudden surge of invasive mucormycosis in India. Materials and Methods This case-control study included 77 cases of COVID-19 associated mucormycosis (CAM) who matched the controls (45 controls) in terms of age , gender, and COVID-19 disease severity. The control group included subjects that matched controls without mucormycosis confirmed by reverse transcription-polymerase chain reaction at our tertiary care center during April-May 2021. Probable predisposing factors, such as duration of diabetes mellitus (DM), history of recent hospitalization, duration of hospital stay, mode of the received oxygen supplementation, and use of steroids, zinc, vitamin c, and any other specific drugs were collected and compared between the two groups. Moreover, the laboratory parameters, like glycated hemoglobin (HbA1c), highly sensitive C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR) were analyzed to find out the significant association with CAM. Results DM (Odds ratio=7.7, 95% CI 3.30-18.12; P=<0.0001) and high glycated hemoglobin level (HbA1c>7.5 gm %) (odds ratio=6.2, 95% CI 1.4-26.7; P=0.014) were significant risk factors for the development of invasive mucormycosis among the COVID-19 cases. A higher number of mild COVID-19 cases developed CAM, compared to the moderate to severe cases (59.7% vs 40.3%). Use of systemic corticosteroids (odd ratio=5 with 95% CI 1.5-16.9; P=0.007) was found to be a risk factor for invasive mucormycosis only in mild COVID-19 cases. Use of oxygen, zinc, and vitamin C supplementation, and proprietary medicine did not lead to a significant risk of invasive mucormycosis in cases, compared to controls. Cases with invasive mucormycosis had a higher level of inflammatory markers (hs-CRP and ESR, P=<0.001 and 0.002, respectively), compared to the controls. Conclusion Uncontrolled and new-onset DM and the use of systemic corticosteroids in mild cases were significantly associated with a higher risk of invasive mucormycosis in COVID-19 cases. There should be a strong recommendation against the use of systemic corticosteroids in mild COVID-19 cases.
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Affiliation(s)
- Satyendra Khichar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Subhashree Samantaray
- Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Veena Mobarsa
- Department of Otolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhu Sharma
- Department of Otolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kapil Soni
- Department of Otolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Bikram Choudhury
- Department of Otolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit Goyal
- Department of Otolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Srikanth Srinivasan
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Ashwini Agarwal
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
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10
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Lesniak C, Ong R, Akula MS, Douedi S, Akoluk A, Soomro R, Copca-Alvarez A, Purewal T, Patel I, Upadhyaya V, Cheng J, Jain A, Asif A, Chalasani K, Hossain MA. Inpatient glycemic control and outcome of COVID-19 patients: A retrospective cohort. SAGE Open Med 2021; 9:20503121211039105. [PMID: 34422272 PMCID: PMC8375327 DOI: 10.1177/20503121211039105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: Although there have been associations between diabetes and mortality in COVID-19 patients, it is unclear whether this is driven by the disease itself or whether it can be attributed to an inability to exhibit effective glucose control. Methods: We conducted a retrospective cohort study of 292 patients admitted to a tertiary referral center to assess the association of mortality and glycemic control among COVID-19-positive patients. We used a logistic regression model to determine whether average fasting glycemic levels were associated with in-hospital mortality. Results: Among the diabetic and non-diabetic patients, there were no differences between mortality or length of stay. Mean glucose levels in the first 10 days of admission were higher on average among those who died (150–185 mg/dL) compared with those who survived (125–165 mg/dL). When controlling for multiple variables, there was a significant association between mean fasting glucose and mortality (odds ratio = 1.014, p < 0.001). The associations between glucose and mortality remained when controlled for comorbidities and glucocorticoid use. Conclusion: The results of this retrospective study show an association between mortality and inpatient glucose levels, suggesting that there may be some benefit to tighter glucose control in patients diagnosed with COVID-19.
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Affiliation(s)
- Christopher Lesniak
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Raquel Ong
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Monika S Akula
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Arda Akoluk
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Rabail Soomro
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Albino Copca-Alvarez
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Tiffany Purewal
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Ishan Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Vandan Upadhyaya
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Jennifer Cheng
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Ashali Jain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Krishna Chalasani
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
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