Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals
Open Access
- 6 January 2021
- journal article
- research article
- Published by BMJ in BMJ Open Diabetes Research & Care
- Vol. 9 (1), e001858
- https://doi.org/10.1136/bmjdrc-2020-001858
Abstract
Introduction Patients with diabetes mellitus admitted to hospital with COVID-19 have poorer outcomes. However, the drivers of poorer outcomes are not fully elucidated. We performed detailed characterization of patients with COVID-19 to determine the clinical and biochemical factors that may be drivers of poorer outcomes. Research design and methods This is a retrospective cohort study of 889 consecutive inpatients diagnosed with COVID-19 between March 9 and April 22, 2020 in a large London National Health Service Trust. Unbiased multivariate logistic regression analysis was performed to determine variables that were independently and significantly associated with increased risk of death and/or intensive care unit (ICU) admission within 30 days of COVID-19 diagnosis. Results 62% of patients in our cohort were of non-white ethnic background and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death/admission to the ICU within 30 days of COVID-19 diagnosis. Male gender, lower platelet count, advancing age and higher Clinical Frailty Scale (CFS) score (but not diabetes) independently predicted poor outcomes on multivariate analysis. Antiplatelet medication was associated with a lower risk of death/ICU admission. Factors that were significantly and independently associated with poorer outcomes in patients with diabetes were coexisting ischemic heart disease, increasing age and lower platelet count. Conclusions In this large study of a diverse patient population, comorbidity (ie, diabetes with ischemic heart disease; increasing CFS score in older patients) was a major determinant of poor outcomes with COVID-19. Antiplatelet medication should be evaluated in randomized clinical trials among high-risk patient groups.Keywords
Funding Information
- Medical Research Council (n/a)
- European Association for the Study of Diabetes (Future Leaders Mentorship Award)
- NIHR Biomedical Research Centre funding scheme (n/a)
- Biotechnology and Biological Sciences Research Council (n/a)
- NIHR Imperial Biomedical Research Centre (Imperial College-BRC IPPRF - P79696)
- Diabetes UK (Harry Keen Fellowship)
- National Institute for Health Research (DRF-2017-10-042)
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