Clinical Features and Risk Factors of ICU Admission for COVID-19 Patients with Diabetes
Ming Lei, Kashuai Lin, Yaoqiu Pi, Xiaomei Huang, Lixin Fan, Jun Huang, Riguang Liu, Lin Liu, Xinning Shao, Kaiyuan Hu, Liuping Yang, Shuguang Qin, Feng He
Abstract
Introduction. Previous studies of coronavirus disease 2019 (COVID-19) have focused on the general population. However, diabetes (DM) as one of the most common comorbidities is rarely studied in detail. This study is aimed at describing clinical characteristics and determining risk factors of ICU admission for COVID-19 patients with DM. Methods. Data were extracted from 288 adult patients with laboratory-confirmed COVID-19 from Guangzhou Eighth People’s Hospital. Demographic characteristics, laboratory results, radiographic findings, complications, and treatments were collected and compared between DM and non-DM groups. Binary logistic regression was used to identify the risk factors associated with ICU admission for COVID-19 patients with DM or non-DM. Results. COVID-19 patients with DM showed as older ages, higher levels of C-reactive protein (CRP), myoglobin, alanine transaminase (ALT), and aspartate transaminase (AST). They were also more prone to transfer to the intensive care unit (ICU) for treatment. Multiple regression analysis showed that the following were the independent risk factors for COVID-19 patients with DM that received ICU admission: each 1-year increase in age (odds ratio (OR), 1.07; 95% CI, 1.02-1.13; <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"><a:mi>P</a:mi><a:mo>=</a:mo><a:mn>0.007</a:mn></a:math> ), respiratory rate over 24 times per minute (OR, 5.22; 95% CI, 2.26-16.58; <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"><c:mi>P</c:mi><c:mo>=</c:mo><c:mn>0.016</c:mn></c:math> ), HbA1c greater than 7% (OR, 4.58; 95% CI, 1.82-10.55; <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"><e:mi>P</e:mi><e:mo>=</e:mo><e:mn>0.012</e:mn></e:math> ), and AST higher than 40 U/L (OR, 2.96; 95% CI, 1.58-8.85; <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"><g:mi>P</g:mi><g:mo>=</g:mo><g:mn>0.022</g:mn></g:math> ). In addition, each 1-year increase in age (OR, 1.05; 95% CI, 1.01-1.10; <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"><i:mi>P</i:mi><i:mo>=</i:mo><i:mn>0.006</i:mn></i:math> ), diarrhea (OR, 4.62; 95% CI, 2.01-9.36; <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"><k:mi>P</k:mi><k:mo>=</k:mo><k:mn>0.022</k:mn></k:math> ), respiratory rate over 24 times per minute (OR, 5.13; 95% CI, 1.18-16.82; <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"><m:mi>P</m:mi><m:mo>=</m:mo><m:mn>0.035</m:mn></m:math> ), CRP greater than 10 mg/L (OR, 5.19; 95% CI, 1.37-13.25, <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"><o:mi>P</o:mi><o:mo>=</o:mo><o:mn>0.009</o:mn></o:math> ), and TnI higher than 0.03 μg/L (OR, 6.48; 95% CI, 1.17-21.38; <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"><q:mi>P</q:mi><q:mo>=</q:mo><q:mn>0.036</q:mn></q:math> ) were risk factors for ICU admission of COVID-19 patients with non-DM. Conclusions. The older age, respiratory rate over 24 times per minute, HbA1c greater than 7%, and AST higher than 40 U/L were risk factors of ICU admission for COVID-19 patients with diabetes. Investigating and monitoring these factors could assist in the risk stratification of COVID-19 patients with DM at an early stage.