Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study
Bertrand Cariou, Samy Hadjadj, Matthieu Wargny, Matthieu Pichelin, Abdallah Al-Salameh, Ingrid Allix, Coralie Amadou, Gwénaëlle Arnault, Florence Baudoux, Bernard Bauduceau, Sophie Borot, Muriel Bourgeon-Ghittori, Olivier Bourron, David Boutoille, France Cazenave-Roblot, Claude Chaumeil, Emmanuel Cosson, Sandrine Coudol, Patrice Darmon, Emmanuel Disse, Amélie Ducet-Boiffard, Bénédicte Gaborit, Michael Joubert, Véronique Kerlan, Bruno Laviolle, Lucien Marchand, Laurent Meyer, Louis Potier, Gaëtan Prevost, Jean-Pierre Riveline, René Robert, Pierre-Jean Saulnier, Ariane Sultan, Jean-François Thébaut, Charles Thivolet, Blandine Tramunt, Camille Vatier, Ronan Roussel, Jean-François Gautier, Pierre Gourdy
doi:10.1007/s00125-020-05180
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 glucoselowering 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 A complete list of the CORONADO trial investigators is provided in the Electronic supplementary material (ESM).
Authors' relationships and activities BC reports grants and personal fees from Amgen, personal fees from AstraZeneca, personal fees from Akcea, personal fees from Genfit, personal fees from Gilead, personal fees from Eli Lilly, personal fees from Novo Nordisk, personal fees from MSD, grants and personal fees from Sanofi, and grants and personal fees from Regeneron. SH reports personal fees and non-financial support from AstraZeneca, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, grants from Dinno Santé, personal fees from Eli Lilly, non-financial support from LVL, personal fees and non-financial support from MSD, personal fees from Novartis, grants from Pierre Fabre Santé, personal fees and non-financial support from Sanofi, personal fees and non-financial support from Servier, and personal fees from Valbiotis. MP reports personal fees and non-financial support from Novo Nordisk, non-financial support from Sanofi, and non-financial support from Amgen. SB reports personal fees from Novo Nordisk, personal fees from Sanofi, personal fees from Eli Lilly, personal fees from Medtronic, and personal fees from Abbott. PD reports personal fees from Novo Nordisk, personal fees from Sanofi, personal fees from Eli Lilly, personal fees from MSD, personal fees from Novartis, personal fees from Abbott, personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, and personal fees from Mundipharma. BG reports personal fees from Eli Lilly, personal..
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'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n'
' <jats:title>Aims/hypothesis</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec><jats:sec>\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>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\xa0days 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.</jats:p>\n'
' </jats:sec><jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>The current analysis focused on 1317 participants: 64.9% men, mean '
'age 69.8\u2009±\u200913.0\xa0years, median BMI 28.4 (25th–75th percentile: 25.0–32.7) '
'kg/m<jats:sup>2</jats:sup>; 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<jats:sub>1c</jats:sub>, 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.</jats:p>\n'
' </jats:sec><jats:sec>\n'
' <jats:title>Conclusions/interpretations</jats:title>\n'
' <jats:p>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\xa0days.</jats:p>\n'
' </jats:sec><jats:sec>\n'
' <jats:title>Trial registration</jats:title>\n'
' <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" '
'ext-link-type="uri" xlink:href="http://clinicaltrials.gov">clinicaltrials.gov</jats:ext-link> '
'NCT04324736.</jats:p>\n'
' </jats:sec>',
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