TY - JOUR
T1 - Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients :
T2 - a multicenter prospective observational cohort study
AU - Mayerhöfer, Timo
AU - Klein, Sebastian
AU - Wernly, Bernhard
AU - Flaatten, Hans
AU - Guidet, Bertrand
AU - De Lange, Dylan W.
AU - Fjølner, Jesper
AU - Leaver, Susannah
AU - Beil, Michael
AU - Sviri, Sigal
AU - Bruno, Raphael Romano
AU - Artigas Raventós, Antoni
AU - van Heerden, Peter Vernon
AU - Pinto, Bernardo Bollen
AU - Schefold, Joerg C.
AU - Moreno, Rui
AU - Cecconi, Maurizio
AU - Szczeklik, Wojciech
AU - Jung, Christian
AU - Joannidis, Michael
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/10
Y1 - 2023/10
N2 - Background: Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age. Methods: This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan–Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality. Results: This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06–1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis. Conclusion: Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19. Study registration: NCT04321265, registered March 19th, 2020.
AB - Background: Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age. Methods: This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan–Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality. Results: This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06–1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis. Conclusion: Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19. Study registration: NCT04321265, registered March 19th, 2020.
KW - SARS-CoV-2
KW - Intensive care unit
KW - Elderly
KW - Old
KW - Critical care
KW - Ventilation
KW - Risk factors
UR - https://www.scopus.com/pages/publications/85149123236
U2 - 10.1007/s15010-023-02001-2
DO - 10.1007/s15010-023-02001-2
M3 - Article
C2 - 36854893
SN - 0300-8126
VL - 51
SP - 1
EP - 9
JO - Infection
JF - Infection
IS - 5
ER -
