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      Is Open Access

      Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study

      , 1 , , 1 , 1 , 2 , 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 2 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 16 , 36 , 37 , 38 , 39 , 40 , 28 , 30 , 32 , 38 , for the CORONADO investigators

      Diabetologia

      Springer Berlin Heidelberg

      BMI, COVID-19, Death, Diabetes, HbA1c, Hypertension, Mechanical ventilation

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Aims/hypothesis

          Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown.

          Methods

          We conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 French centres in the period 10–31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission. Age- and sex-adjusted multivariable logistic regressions were performed to assess the prognostic value of clinical and biological features with the endpoint. ORs are reported for a 1 SD increase after standardisation.

          Results

          The current analysis focused on 1317 participants: 64.9% men, mean age 69.8 ± 13.0 years, median BMI 28.4 (25th–75th percentile: 25.0–32.7) kg/m 2; with a predominance of type 2 diabetes (88.5%). Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively. The primary outcome was encountered in 29.0% (95% CI 26.6, 31.5) of participants, while 10.6% (9.0, 12.4) died and 18.0% (16.0, 20.2) were discharged on day 7. In univariate analysis, characteristics prior to admission significantly associated with the primary outcome were sex, BMI and previous treatment with renin–angiotensin–aldosterone system (RAAS) blockers, but not age, type of diabetes, HbA 1c, diabetic complications or glucose-lowering therapies. In multivariable analyses with covariates prior to admission, only BMI remained positively associated with the primary outcome (OR 1.28 [1.10, 1.47]). On admission, dyspnoea (OR 2.10 [1.31, 3.35]), as well as lymphocyte count (OR 0.67 [0.50, 0.88]), C-reactive protein (OR 1.93 [1.43, 2.59]) and AST (OR 2.23 [1.70, 2.93]) levels were independent predictors of the primary outcome. Finally, age (OR 2.48 [1.74, 3.53]), treated obstructive sleep apnoea (OR 2.80 [1.46, 5.38]), and microvascular (OR 2.14 [1.16, 3.94]) and macrovascular complications (OR 2.54 [1.44, 4.50]) were independently associated with the risk of death on day 7.

          Conclusions/interpretations

          In people with diabetes hospitalised for COVID-19, BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days.

          Trial registration

          clinicaltrials.gov NCT04324736.

          Electronic supplementary material

          The online version of this article (10.1007/s00125-020-05180-x) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

          Related collections

          Most cited references 4

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            • Record: found
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            • Article: not found

            Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection

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              • Abstract: not found
              • Article: not found

              Multivariable regression model building by using fractional polynomials: Description of SAS, STATA and R programs

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                Author and article information

                Contributors
                bertrand.cariou@univ-nantes.fr
                samy.hadjadj@univ-nantes.fr
                Journal
                Diabetologia
                Diabetologia
                Diabetologia
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0012-186X
                1432-0428
                29 May 2020
                29 May 2020
                : 1-16
                Affiliations
                [1 ]Département d’Endocrinologie, Diabétologie et Nutrition, l’institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093 Nantes Cedex 01, France
                [2 ]GRID grid.277151.7, ISNI 0000 0004 0472 0371, CIC-EC 1413, Clinique des Données, CHU Nantes, ; Nantes, France
                [3 ]GRID grid.11162.35, ISNI 0000 0001 0789 1385, Département d’Endocrinologie, Diabétologie et Nutrition, CHU Amiens, PeriToxUMR_I 01, , Université de Picardie, ; Amiens, France
                [4 ]GRID grid.411147.6, ISNI 0000 0004 0472 0283, Département d’Endocrinologie, Diabétologie, Nutrition, , CHU de Angers, ; Angers, France
                [5 ]GRID grid.477082.e, Département de Diabétologie, , Centre Hospitalier Sud Francilien, ; Corbeil Essonne, France
                [6 ]GRID grid.440367.2, ISNI 0000 0004 0638 5597, Département d’Endocrinologie, Diabétologie et Maladies Métaboliques, , Centre Hospitalier Bretagne Atlantique, ; Vannes, France
                [7 ]GRID grid.413875.c, ISNI 0000 0004 0639 4004, Clinique d’Endocrinologique Marc-Linquette, , Hôpital Claude-Huriez, CHRU de Lille, ; Lille, France
                [8 ]GRID grid.414007.6, ISNI 0000 0004 1798 6865, Département de Diabétologie, , H.I.A. Begin, ; Saint Mandé, France
                [9 ]Fondation Francophone pour la Recherche sur le Diabète (FFRD), Paris, France
                [10 ]GRID grid.411158.8, ISNI 0000 0004 0638 9213, Département d’Endocrinologie, Diabétologie et Nutrition, , CHU de Besançon, ; Besançon, France
                [11 ]GRID grid.413738.a, ISNI 0000 0000 9454 4367, Département d’Endocrinologie, Diabétologie et Nutrition, Assistance Publique Hôpitaux de Paris, , Université Paris Saclay, Hôpital Antoine Béclère, Clamart, Hôpital Bicêtre, ; Le Kremlin Bicêtre, France
                [12 ]GRID grid.477396.8, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié Salpêtrière-Charles Foix, Inserm, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06, , Institute of Cardiometabolism and Nutrition ICAN, ; Paris, France
                [13 ]GRID grid.277151.7, ISNI 0000 0004 0472 0371, Département des Maladies Infectieuses et Tropicales, , CHU Nantes, ; Nantes, France
                [14 ]GRID grid.411162.1, ISNI 0000 0000 9336 4276, Département des Maladies Infectieuses et Tropicales, , CHU de Poitiers, INSERM U1070, ; Poitiers, France
                [15 ]Société de Pathologie Infectieuse de langue Française (SPILF), Paris, France
                [16 ]Fédération Française des Diabétiques (FFD), Paris, France
                [17 ]GRID grid.413780.9, ISNI 0000 0000 8715 2621, Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, Département d’Endocrinologie, Diabétologie et Nutrition, CRNH-IdF, CINFO, ; Bobigny, France
                [18 ]GRID grid.11318.3a, ISNI 0000000121496883, Université Paris 13, Sorbonne Paris Cité, UMR U557 Inserm / U11125 INRAE / CNAM / Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, ; Bobigny, France
                [19 ]GRID grid.411535.7, ISNI 0000 0004 0638 9491, Département d’Endocrinologie et de Diabétologie, , Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, ; Marseille, France
                [20 ]GRID grid.7849.2, ISNI 0000 0001 2150 7757, Département d’Endocrinologie, Diabétologie et Nutrition, Hospices Civils de Lyon, CarMeN Laboratory, Inserm 1060, Lyon, France, , Université Claude Bernard Lyon 1, ; Lyon, France
                [21 ]GRID grid.477015.0, ISNI 0000 0004 1772 6836, Département d’Endocrinologie et de Diabétologie, Centre Hospitalier Départemental de Vendée, ; La Roche sur Yon, France
                [22 ]GRID grid.414244.3, ISNI 0000 0004 1773 6284, Département d’Endocrinologie et de Diabétologie, , Hôpital Nord, Assistance Publique Hôpitaux de Marseille, ; Marseille, France
                [23 ]GRID grid.411149.8, ISNI 0000 0004 0472 0160, Département de Diabétologie, , CHU de Caen, ; Caen, France
                [24 ]GRID grid.411766.3, ISNI 0000 0004 0472 3249, Département d’Endocrinologie, , CHU de Brest, ; EA 3878 GETBO, Brest, France
                [25 ]Université de Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
                [26 ]Département d’Endocrinologie et de Diabétologie, Centre Hospitalier St. Joseph - St. Luc, Lyon, France
                [27 ]GRID grid.412220.7, ISNI 0000 0001 2177 138X, Département d’Endocrinologie, Diabétologie et Nutrition, , Hôpitaux Universitaires de Strasbourg, ; Strasbourg, France
                [28 ]GRID grid.5842.b, ISNI 0000 0001 2171 2558, Département d’Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Centre de Recherche des Cordeliers, Inserm, U-1138, , Université de Paris, ; Paris, France
                [29 ]GRID grid.10400.35, ISNI 0000 0001 2108 3034, Département d’Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Rouen, , Université de Rouen, ; Rouen, France
                [30 ]GRID grid.411296.9, ISNI 0000 0000 9725 279X, Département Diabète et Endocrinologie, , Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, ; Paris, France
                [31 ]Paris Diderot–Paris VII Université, Paris, France
                [32 ]GRID grid.7452.4, ISNI 0000 0001 2217 0017, Inserm UMRS 1138, Université Paris Diderot–Paris VII, Sorbonne Paris Cité, ; Paris, France
                [33 ]GRID grid.11166.31, ISNI 0000 0001 2160 6368, Université de Poitiers, CIC Inserm 1402, Poitiers, Médecine Intensive Réanimation, ; Poitiers, France
                [34 ]Centre d’Investigation Clinique CIC 1402, Université de Poitiers, Inserm, CHU de Poitiers, Poitiers, France
                [35 ]GRID grid.157868.5, ISNI 0000 0000 9961 060X, Département d’Endocrinologie, Diabète, Nutrition et CIC Inserm 1411, , CHU de Montpellier, ; Montpellier, France
                [36 ]GRID grid.7849.2, ISNI 0000 0001 2150 7757, Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Laboratoire CarMeN, Inserm, INRA, INSA, , Université Claude Bernard Lyon 1, ; Lyon, France
                [37 ]GRID grid.484642.8, ISNI 0000 0001 0807 394X, Société Francophone du Diabète (SFD), ; Paris, France
                [38 ]GRID grid.11417.32, ISNI 0000 0001 2353 1689, Département d’Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, , Université de Toulouse, ; Toulouse, France
                [39 ]GRID grid.412370.3, ISNI 0000 0004 1937 1100, Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, ; Paris, France
                [40 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, Sorbonne University, Inserm UMRS 938, Saint-Antoine Research Center, ; Paris, France
                Article
                5180
                10.1007/s00125-020-05180-x
                7256180
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                Funding
                Funded by: Fondation Francophone pour la Recherche sur le Diabète
                Award ID: CORONADO Initiative Emergency Grant
                Funded by: FundRef http://dx.doi.org/10.13039/100007542, Air Liquide;
                Award ID: CORONADO Initiative Emergency grant
                Funded by: Sociéte Francophone du Diabète
                Award ID: CORONADO Initiative Emergency Grant
                Categories
                Article

                Endocrinology & Diabetes

                covid-19, death, diabetes, hba1c, hypertension, mechanical ventilation, bmi

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