Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals
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 drive...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e001858.full |
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| author | Neil E Hill Nick S Oliver Wei Yang Christine Shi Shivani Misra Chioma Izzi-Engbeaya Walter Distaso Anjali Amin Oluwagbemiga Idowu Julia S Kenkre Ronak J Shah Evelina Woin Nael Alavi Hala Bedri Niamh Brady Sophie Blackburn Martina Leczycka Sanya Patel Elizaveta Sokol Edward Toke-Bjolgerud Ambreen Qayum Mariana Abdel-Malek David C D Hope Vasiliki Bravis Tricia M Tan Victoria Salem |
| author_facet | Neil E Hill Nick S Oliver Wei Yang Christine Shi Shivani Misra Chioma Izzi-Engbeaya Walter Distaso Anjali Amin Oluwagbemiga Idowu Julia S Kenkre Ronak J Shah Evelina Woin Nael Alavi Hala Bedri Niamh Brady Sophie Blackburn Martina Leczycka Sanya Patel Elizaveta Sokol Edward Toke-Bjolgerud Ambreen Qayum Mariana Abdel-Malek David C D Hope Vasiliki Bravis Tricia M Tan Victoria Salem |
| author_sort | Neil E Hill |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-7eb1ab04c8e4484f83b7fe832907e545 |
| institution | DOAJ |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-7eb1ab04c8e4484f83b7fe832907e5452025-08-20T02:50:23ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2020-001858Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitalsNeil E Hill0Nick S Oliver1Wei Yang2Christine Shi3Shivani Misra4Chioma Izzi-Engbeaya5Walter Distaso6Anjali Amin7Oluwagbemiga Idowu8Julia S Kenkre9Ronak J Shah10Evelina Woin11Nael Alavi12Hala Bedri13Niamh Brady14Sophie Blackburn15Martina Leczycka16Sanya Patel17Elizaveta Sokol18Edward Toke-Bjolgerud19Ambreen Qayum20Mariana Abdel-Malek21David C D Hope22Vasiliki Bravis23Tricia M Tan24Victoria Salem251 Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UK4 Nevada Center for Health Statistics and Informatics, School of Community Health Sciences, University of Nevada, Reno, USAImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKDivision of Biomedical Science, St George`s, University of London, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKImperial College Business School, Imperial College London, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKDivision of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKDepartment of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UKDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UKImperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UKIntroduction 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.https://drc.bmj.com/content/9/1/e001858.full |
| spellingShingle | Neil E Hill Nick S Oliver Wei Yang Christine Shi Shivani Misra Chioma Izzi-Engbeaya Walter Distaso Anjali Amin Oluwagbemiga Idowu Julia S Kenkre Ronak J Shah Evelina Woin Nael Alavi Hala Bedri Niamh Brady Sophie Blackburn Martina Leczycka Sanya Patel Elizaveta Sokol Edward Toke-Bjolgerud Ambreen Qayum Mariana Abdel-Malek David C D Hope Vasiliki Bravis Tricia M Tan Victoria Salem Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals BMJ Open Diabetes Research & Care |
| title | Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals |
| title_full | Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals |
| title_fullStr | Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals |
| title_full_unstemmed | Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals |
| title_short | Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals |
| title_sort | adverse outcomes in covid 19 and diabetes a retrospective cohort study from three london teaching hospitals |
| url | https://drc.bmj.com/content/9/1/e001858.full |
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