key: cord-0730349-ulmm28d5 authors: Zhang, Qianhui; Wei, Yanhong; Chen, Min; Wan, Qianqian; Chen, Xiaoqi title: Clinical analysis of risk factors for severe COVID-19 patients with type 2 diabetes() date: 2020-06-29 journal: J Diabetes Complications DOI: 10.1016/j.jdiacomp.2020.107666 sha: 6cef653a7ff32ac73b77031b47566845d3e9be33 doc_id: 730349 cord_uid: ulmm28d5 AIMS: To describe characteristics of COVID-19 patients with type 2 diabetes and to analyze risk factors for severity. METHODS: Demographics, comorbidities, symptoms, laboratory findings, treatments and outcomes of COVID-19 patients with diabetes were collected and analyzed. RESULTS: Seventy-four COVID-19 patients with diabetes were included. Twenty-seven patients (36.5%) were severe and 10 patients (13.5%) died. Higher levels of blood glucose, serum amyloid A (SAA), C reactive protein and interleukin 6 were associated with severe patients compared to non-severe ones (P < 0.05). Levels of albumin, cholesterol, high density lipoprotein, small and dense low density lipoprotein and CD4(+) T lymphocyte counts in severe patients were lower than those in non-severe patients (P < 0.05). Logistic regression analysis identified decreased CD4(+) T lymphocyte counts (odds ratio [OR] = 0.988, 95%Confidence interval [95%CI] 0.979–0.997) and increased SAA levels (OR = 1.029, 95%CI 1.002–1.058) as risk factors for severity of COVID-19 with diabetes (P < 0.05). CONCLUSIONS: Type 2 diabetic patients were more susceptible to COVID-19 than overall population, which might be associated with hyperglycemia and dyslipidemia. Aggressive treatment should be suggested, especially when these patients had low CD4(+) T lymphocyte counts and high SAA levels. U N C O R R E C T E D P R O O F 1 U N C O R R E C T E D P R O O F 1 tion, especially severe cases, have generated considerable concern. In a 54 retrospective cohort study from China, 6 the overall case-fatality rate 55 (CFR) of COVID-19 was 2.3% while CFR was significantly elevated 56 among those with diabetes (7.3%). FeiZhou et al. 7 test was used when data were limited. A 2-sided P b 0.05 was consid-97 ered statistically significant. A logistic regression analysis was used to 98 explore risk factors associated with severity. We tested in the model in- Data are n (%), n/N (%) and median (IQR). t1:52 P b 0.05 was considered statistically significant between severe and non-severe subgroups. 144 lymphocytes in severe patients were noticeably lower than levels in 145 non-severe cases (P b 0.05). Furthermore, severe patients showed 146 higher percentages of positive protein, glucose and ketone in routine 147 urine analysis than non-severe ones (P b 0.05). In addition, levels of 148 hemoglobulin, platelet count, glycated hemoglobin (HbA1c), triglycer-149 ide, low density lipoprotein (LDL), free fatty acid (FFA), uric acid, crea-150 tine kinase, erythrocyte sedimentation rate, NK cell count, CD8 + T 151 lymphocyte count, ACE, serum antibodies for SARS-CoV-2 didn't show 152 any significant differences between the two groups (P N 0.05). Duration Data are n (%), n/N (%) and median (IQR). Qianhui Zhang, Yanhong Wei and Min Chen collected and analyzed 274 the data, and prepared the manuscript. Xiaoqi Chen designed the study 275 and reviewed the manuscript. Xiaoqi Chen is the guarantor of this work 276 and takes responsibility for the integrity of the data and the accuracy of 277 the data analysis. Of the 74 patients, 55 (74.3%) had 109 at least one coexisting chronic diseases besides diabetes, the three 110 most common diseases were hypertension (47.3%), coronary heart dis-111 ease (17.6%) and secondary pulmonary tuberculosis (16.2%). Symptoms 112 of the patients on admission are shown in Table 1. The most common 113 experienced symptom was fever (77.0%), followed by respiratory illness 114 (70.3%, such as cough, chest tightness or dyspnea) Twenty-two (81.5%) severe pa-123 tients had pre-exiting chronic diseases besides diabetes, compared to 124 33 (70.2%) in non-severe patients. The proportion of coronary heart dis-125 ease in severe and non-severe group was 29.6% and 10.6% respectively 126 (P b 0.05), indicating that type 2 diabetic patients with coronary heart 127 disease are more prone to severe type of COVID-19. There were no sig-128 nificant differences in prevalences of hypertension between severe and 129 non-severe ones 5% (27/74) were severe cases and the mor-165 tality rate was 13.5% (10/74). Patients with elder age and male sex 166 were more prone to develop into severe type of COVID-19 (median 167 age 72 (58-81) years, 66.7% male). As statistics shown in previous 168 report 23% intensive care unit (ICU) care requirement, and a 171 11% mortality rate. In another report, 138 COVID-19 case series 10 172 characterized an ICU admission rate of 26% (36/138) with a mortality 173 of 4.3%(6/138). As compared to their results, our study, which fo-174 cused on COVID-19 patients with type 2 diabetes, showed a higher 175 tendency of ICU admission and even death than overall populations 176 Be-182 sides, positive rates of glucose and ketone in urine tests were signifi-183 cantly higher in severe group, compared with non-severe one (90.5% 184 vs 47.6%, P b 0.01), suggesting acute hyperglycemia might be associated 185 with COVID-19 deterioration. Despite that our study failed to confirm 186 hyperglycemia as a risk factor in leading to severe infections, a multi-187 centered study of 7337 cases Previous studies demon-196 strated that specific nutrients such as amino acids, lipids might affect 197 immune system by playing essential roles in immune cell triggering, in-198 teraction, differentiation and functional expression. 12 Besides, nutri-199 tional deficiencies of energy or protein were significant risk factors 200 associated with the gut dysbacteriosis which increased infection sus CRP 208 levels were observed in this study (P b 0.05). Furthermore Naming the coronavirus disease (COVID-19) and the 280 virus that causes it COVID-19) situation report -284 92 Clinical features of patients infected with 2019 novel co-287 ronavirus in Wuhan, China Characteristics of and public health responses to the coronavirus 289 disease 2019 outbreak in China Secular trends in all-cause and cause-specific mortal-291 ity rates in people with diabetes in Hong Kong, 2001-2016: a retrospective cohort 292 study Characteristics of and important lessons from the coronavirus 294 disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases 295 from the Chinese Center for Disease Control and Prevention Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Interim guidance for novel coronavirus pneumonia (trial implementation of revised 300 fifth edition). National Health and Health Commission Epidemiological and clinical characteristics of 99 cases 303 of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical characteristics of 138 hospitalized patients 306 with 2019 novel coronavirus-infected pneumonia in Wuhan Association of blood glucose control and outcomes in 309 patients with COVID-19 and pre-existing type 2 diabetes The impact of diet on immunity and respiratory 311 diseases Impact of sepsis on CD4 T cell 315 Metabolic reprogramming & inflammation: fuelling the host 317 response to pathogens Risk factors for disease severity, unimprovement, and 319 mortality in COVID-19 patients in Wuhan, China Clinical characteristics of 140 patients infected with 321 SARS-CoV-2 in Wuhan, China High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation Hypertension and COVID-19 Please check your proof carefully and mark all corrections at the appropriate place in the proof (e.g., by using on-screen annotation in the PDF file) or compile them in a separate list. 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