Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain
Jose Manuel Ramos-Rincón, Luis M Pérez-Belmonte, Francisco Javier Carrasco-Sánchez, Sergio Jansen-Chaparro, Mercedes De-Sousa-Baena, José Bueno-Fonseca, Maria Pérez-Aguilar, Coral Arévalo Cañas, Marta Bacete Cebrian, Manuel Méndez-Bailón, Isabel Fiteni Mera, Andrés González García, Francisco Navarro Romero, Carlota Tuñón De Almeida, Gemma Muñiz Nicolás, Amara González Noya, Almudena Hernández Milian, Gema María García García, José Nicolás Alcalá Pedrajas, Virginia Herrero García, Luis Corral-Gudino, Pere Comas Casanova, Héctor Meijide Míguez, José Manuel Casas-Rojo, Ricardo Gómez-Huelgas
doi:10.21203/rs.3.rs-133358/v1
Background Advanced age and diabetes are both associated with poor prognosis in COVID-19. However, the effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well-known. This work aims to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥ 80 years with type 2 diabetes mellitus hospitalized for COVID-19.
Methods We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years with type 2 diabetes mellitus and COVID-19 hospitalized in 160 Spanish hospitals between March 1 and May 29, 2020 who were included in the SEMI-COVID-19 Registry. The primary outcome measure was inhospital mortality. A multivariate logistic regression analysis were performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality. The regression analysis values were expressed as adjusted odds ratios (AOR) with a 95% con dence interval (CI). In order to select the variables, the forward selection Wald statistic was used. Discrimination of the tted logistic model was assessed via a receiver operating characteristic (ROC) curve. The Hosmer-Lemeshow test for logistic regression was used to determine the model's goodness of t.
Declarations Ethics approval and consent to participate gave their informed consent. When there were biosafety concerns and/or when the patient had already been discharged, verbal informed consent was requested and noted on the medical record. Data con dentiality and patient anonymity were maintained at all times, in accordance with Spanish regulations on observational studies. This study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Research Ethics Committee of Málaga on March 27, 2020 (Ethics Committe code: SEMI-COVID-19 27-03-20), as per the guidelines of the Spanish Agency of Medicines and Medical Products.
Consent for publication Not applicable.
Competing interest The authors declare that they have no competing interests. Authors' contributions JMRR contributed to the conception, design of the work the acquisition, interpretation of data, writingoriginal draft preparation, writing-review and editing, and supervision. FJCS, SJC, MDSB, JBF, MPA, CAC, MBC, MMB, IFM, AGG, FNR, CTA, GMN, AGN, AHM, GMGG, JNAP, VHG, LCG, PCC, HMM, and JMCR made contributions to the acquisition of data and revised the work. LMPB contributed to interpretation of data, writing-review and editing, and supervision. RGH was a major contributor in interpretation of data, writingoriginal draft preparation, writing-review and editing, and supervision. All authors read and approved the nal manuscript.
Supplementary Files This is a list of..
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:p>Background\n'
'\n'
'Advanced age and diabetes are both associated with poor prognosis in COVID-19. However, the '
'effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, '
'especially very old patients, are not well-known. This work aims to analyze the association '
'between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, '
'and lipid-lowering drugs) and in-hospital mortality among patients\u2009≥\u200980 years with '
'type 2 diabetes mellitus hospitalized for COVID-19.\n'
'Methods\n'
'\n'
'We conducted a nationwide, multicenter, retrospective, observational study in patients\u2009'
'≥\u200980 years with type 2 diabetes mellitus and COVID-19 hospitalized in 160 Spanish '
'hospitals between March 1 and May 29, 2020 who were included in the SEMI-COVID-19 Registry. '
'The primary outcome measure was in-hospital mortality. A multivariate logistic regression '
'analysis were performed to assess the association between preadmission cardiometabolic '
'therapy and in-hospital mortality. The regression analysis values were expressed as adjusted '
'odds ratios (AOR) with a 95% confidence interval (CI). In order to select the variables, the '
'forward selection Wald statistic was used. Discrimination of the fitted logistic model was '
'assessed via a receiver operating characteristic (ROC) curve. The Hosmer-Lemeshow test for '
'logistic regression was used to determine the model’s goodness of fit.\n'
'Results\n'
'\n'
'Of the 2,763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of '
'these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of '
'dipeptidyl peptidase-4 inhibitors (AOR 0.502, 95% CI 0.309–0.815, p\u2009=\u20090.005) and '
'angiotensin receptor blockers (AOR 0.454, 95% CI 0.274–0.759, p\u2009=\u20090.003) were '
'independent protectors against in-hospital mortality whereas the use of acetylsalicylic acid '
'was associated with higher in-hospital mortality (AOR 1.761, 95% CI 1.092–2.842, p\u2009'
'=\u20090.020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins '
'showed neutral association with in-hospital mortality. The model showed an area under the '
'curve of 0.788.\n'
'Conclusions\n'
'\n'
'We found important differences between cardiometabolic drugs and in-hospital mortality in '
'older patients with type 2 diabetes mellitus hospitalized for COVID-19. Preadmission '
'treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers may reduce '
'in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors and '
'statins seem to have a neutral effect; and acetylsalicylic acid may be associated with excess '
'mortality.</jats:p>',
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