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Article Dans Une Revue Diabetologia Année : 2020

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

1 ITX - ITX - unité de recherche de l'institut du thorax
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
3 UPJV - Université de Picardie Jules Verne
4 CHU Amiens-Picardie
5 CHU Angers - Centre Hospitalier Universitaire d'Angers
6 Centre Hospitalier Sud Francilien
7 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
8 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
9 HIA Begin - Hôpital d'Instruction des Armées Begin [Saint-Mandé, France]
10 Service de Diabétologie - Endocrinologie [CHRU Besançon]
11 AP-HP - Hôpital Antoine Béclère [Clamart]
12 CHU Pitié-Salpêtrière [AP-HP]
13 Service des maladies infectieuses et tropicales [CHU Nantes]
14 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
15 PHAR [Poitiers] - Pharmacologie des anti-infectieux
16 Fédération française des diabétiques
17 UREN - Unité de Recherche en Epidémiologie Nutritionnelle
18 Centre de Recherche en Nutrition Humaine - Ile de France (CRNH - IDF)
19 USPC - Université Sorbonne Paris Cité
20 CIC Nantes - Centre d’Investigation Clinique de Nantes
21 Service d'endocrinologie, diabète, maladies métaboliques [Hôpital de la Conception - APHM]
22 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
23 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
24 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
25 Service d'endocrinologie, nutrition et maladies métaboliques [Hôpital Nord - APHM]
26 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale
27 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
28 CIC - Centre d'Investigation Clinique [Rennes]
29 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
30 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
31 HUS - Les Hôpitaux Universitaires de Strasbourg
32 Service d'endocrinologie, diabétologie, nutrition
33 DC2N - Différenciation et communication neuronale et neuroendocrine
34 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
35 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
36 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
37 CHU Saint-Antoine [AP-HP]
38 I2MC - Institut des Maladies Métaboliques et Cardiovasculaires
Coralie Amadou
Blandine Tramunt
  • Fonction : Auteur

Résumé

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
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Dates et versions

hal-02667655 , version 1 (01-06-2020)
hal-02667655 , version 2 (02-09-2020)

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Bertrand Cariou, Samy Hadjadj, Matthieu Wargny, Matthieu Pichelin, Abdallah Al-Salameh, et al.. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia, 2020, 63 (8), pp.1500-1515. ⟨10.1007/s00125-020-05180-x⟩. ⟨hal-02667655v1⟩
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