Περίληψη:
OBJECTIVE: Diabetes mellitus (DM) is a major risk factor for severe coronavirus disease 2019 (COVID-19) for reasons that are unclear. RESEARCH DESIGN AND METHODS: We leveraged the International Study of Inflammation in COVID-19 (ISIC), a multicenter observational study of 2,044 patients hospitalized with COVID-19, to characterize the impact of DM on in-hospital outcomes and assess the contribution of inflammation and hyperglycemia to the risk attributed to DM. We measured biomarkers of inflammation collected at hospital admission and collected glucose levels and insulin data throughout hospitalization. The primary outcome was the composite of in-hospital death, need for mechanical ventilation, and need for renal replacement therapy. RESULTS: Among participants (mean age 60 years, 58.2% males), those with DM (n = 686, 33.5%) had a significantly higher cumulative incidence of the primary outcome (37.8% vs. 28.6%) and higher levels of inflammatory biomarkers than those without DM. Among biomarkers, DM was only associated with higher soluble urokinase plasminogen activator receptor (suPAR) levels in multivariable analysis. Adjusting for suPAR levels abrogated the association between DM and the primary outcome (adjusted odds ratio 1.23 [95% CI 0.78, 1.37]). In mediation analysis, we estimated the proportion of the effect of DM on the primary outcome mediated by suPAR at 84.2%. Hyperglycemia and higher insulin doses were independent predictors of the primary outcome, with effect sizes unaffected by adjusting for suPAR levels. CONCLUSIONS: Our findings suggest that the association between DM and outcomes in COVID-19 is largely mediated by hyperinflammation as assessed by suPAR levels, while the impact of hyperglycemia is independent of inflammation.
Συγγραφείς:
Vasbinder, Alexi
Anderson, Elizabeth
Shadid, Husam
Berlin, Hanna
Pan, Michael
Azam, Tariq U.
Khaleel, Ibrahim
Padalia, Kishan
Meloche, Chelsea
O'Hayer, Patrick
Michaud, Erinleigh
Catalan, Tonimarie
Feroze, Rafey
Blakely, Pennelope
Launius, Christopher
Huang, Yiyuan
Zhao, Lili
Ang, Lynn
Mikhael, Monica
Mizokami-Stout, Kara
Pennathur, Subramaniam
Kretzler, Matthias
Loosen, Sven H.
Chalkias, Athanasios
Tacke, Frank
Giamarellos-Bourboulis, Evangelos J.
Reiser, Jochen
Eugen-Olsen, Jesper
Feldman, Eva L.
Pop-Busui, Rodica
Hayek, Salim S.
Hayek, Salim S.
Blakely, Pennelope
Berlin, Hanna
Azam, Tariq U.
Shadid, Husam
Pan, Michael
O'Hayer, Patrick
Meloche, Chelsea
Feroze, Rafey
Padalia, Kishan J.
Anderson, Elizabeth
Perry, Danny
Bitar, Abbas
Kaakati, Rayan
Huang, Yiyuan
Zhao, Lili
Reiser, Jochen
Samelko, Beata
Hlepas, Alex
Patel, Priya P.
Wang, Xuexiang
Eugen-Olsen, Jesper
Altintas, Izzet
Stauning, Marius
Baltzer Houlind, Morten
Lindstrøm, Mette B.
Gamst-Jensen, Hejdi
Hartmann, Line Jee
Nehlin, Jan O.
Kallemose, Thomas
Parvaiz, Imran
Rasmussen, Christian
Andersen, Ove
Tingleff, Jens
Giamarellos-Bourboulis, Evangelos J.
Adami, Maria-Evangelia
Solomonidi, Nicky
Tsilika, Maria
Saridaki, Maria
Lekakis, Vasileios
Loosen, Sven H.
Luedde, Tom
Keitel, Verena
Chalkias, Athanasios
Arnaoutoglou, Eleni
Pantazopoulos, Ioannis
Laou, Eleni
Kolonia, Konstantina
Skoulakis, Anargyros
Tacke, Frank
Tober-Lau, Pinkus
Mohr, Raphael
Kurth, Florian
Sander, Leif Erik
Jochum, Christoph
Λέξεις-κλειδιά:
Humans, *COVID-19, SARS-CoV-2, Female, Male, Biomarkers, Middle Aged, Hospital Mortality, Inflammation, Hospitalization, *Diabetes Mellitus/epidemiology, *Hyperglycemia
