Type II Diabetes Patients are Two to Three Times More
Likely To Enter ICU According to Composite Study Data
A new study published in Diabetologia shows a significant increase in the odds of mortality and severe illness with COVID-19 correlated strongly with diabetes, especially type 2 diabetes - the overwhelming majority (89%) of patients in this analysis had type 2 diabetes.
In a multivariable analysis, old age, sleep apnea, microvascular and macrovascular complications, various other measures of circulatory dysfunction/heart disease and the presence of active cancer prior to hospital admission were significantly associated with increased odds of mortality.
At hospital admission, old age, worsening liver function, and heightened C-reactive protein were significantly associated with increased odds of severe illness and death, while better renal function was associated with better odds of survival.
The data is from 1,300 COVID-19 patients in 53 hospitals between March 3 and March 10.
Full study here: https://link.springer.com/article/10.1007/s00125-020-05180-x
In a different, retrospective study from Wuhan, diabetes was present in 19% of 191 COVID-19 inpatients but its prevalence raised to 31% in deceased people compared with only 14% in those who survived.
Another study analyzed different comorbidities present in all patients. The need for ICU care was only associated with obesity (body mass index over 30).
The study found a clear association between obesity and basal inflammatory status characterized by higher circulating IL-6 and C-reactive protein levels. It was noted that adipose tissue in obese patients has a pro-inflammatory role, with increased expression of cytokines.
Their results mirror others in which obesity along with age has been presented as the chief risk factors for adverse disease progression in COVID-19.
Lancet Study on Hospitalized COVID-19 patients in NYC Paints Grim Picture
A new, prospective study in Lancet on hospitalized COVID-19 patients in New York City provides a grim picture, consistent with reports from both China and Italy, of the high rate of mortality associated with severe COVID-19 disease, and the details of comorbidities that influence severe disease risk, and predictive biomarker data.
Study's Key Findings
Severe disease associated with:
Advancing age (median age of all patients hospitalized, 62 years)
Male gender (67% of hospitalized patients were men)
Higher concentrations of IL-6, were associated with higher in-hospital mortality
Higher concentrations of D-dimer identified as independent risk factor for poor outcomes
In hospital disease progression:
About 20% of hospitalized patients became critically ill
Approximately 40% of these patients died
Approximately 40% of the critically ill patients remain continually hospitalized
About 80% of critically ill patients received invasive mechanical ventilation for a median of 18 days
Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study
Matthew J Cummings, Matthew R Baldwin, Darryl Abrams,Samuel D Jacobson, Benjamin J Meyer, Elizabeth M Balough, Justin G Aaron, Jan Claassen, LeRoy E Rabbani, Jonathan Hastie, Beth R Hochman, John Salazar-Schicchi, Natalie H Yip, Daniel Brodie, Max R O’Donnell
JAMA Creates Clinical Risk Score to Predict the Occurrence
of Critical Illness in Hospitalized Patients With COVID-19
A critical and evolving focus of research is identifying which patients are most at risk for progression to severe COVID-19/SARS-CoV-2.
This new study in JAMA of 1,590 patients identified 10 independent predictors of progression to severe COVID-19 disease and developed a risk score (COVID-GRAM) that predicts development of critical illness.
The risk score utilizes 10 independent predictors for the likelihood that an individual will develop severe disease, these variables are: chest radiography abnormalities, age, hemoptysis, dyspnea, unconsciousness, number of comorbidities, cancer history, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and direct bilirubin.
Your personalized risk score is available as an online calculator at: http://188.8.131.52/
Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19
Wenhua Liang, MD1,2; Hengrui Liang, MD1,2; Limin Ou, MD1; et alBinfeng Chen, MD3; Ailan Chen, MD1,4; Caichen Li, MD1; Yimin Li, MD1,5; Weijie Guan, MD1; Ling Sang, MD1,5,6; Jiatao Lu, MD4; Yuanda Xu, MD1,5,7; Guoqiang Chen, MD8; Haiyan Guo, MD9; Jun Guo, MD10; Zisheng Chen, MD1,11; Yi Zhao, MD1,2; Shiyue Li, MD1; Nuofu Zhang, MD1,4; Nanshan Zhong, MD1; Jianxing He, MD1,2; for the China Medical Treatment Expert Group for COVID-19