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DOI: 10.1055/a-1325-0381
Diabetes Mellitus and Hypertension as Major Risk Factors of Mortality From Covid-19 Pneumonia
Dear Editor,
Coronavirus disease 2019 (COVID-19) caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the new pandemic [1] [2]. The most vulnerable populations are patients with comorbidities, notably diabetes mellitus (DM), cardiovascular disease (CVD), hypertension, chronic kidney disease and immunosuppression [3]. DM and its complications such as CVD, chronic kidney disease, neuropathy and diabetic foot ulcers increase susceptibility to infectious diseases and morbidity [3] [4].
Medical records of 172 patients hospitalised with COVID-19 pneumonia in the Department of Infectious Diseases, University Hospital of Alexandroupolis, Greece were retrospectively analysed. The diagnosis of SARS-CoV-2 infection was confirmed with real time-polymerase chain reaction (RT-PCR) in nasopharyngeal specimens. Comorbidities including DM, hypertension, dyslipidaemia, coronary artery disease, heart failure and chronic kidney disease were identified, as based on patient’s history and medical records. The study was approved by the institutional ethics committee and all patients gave their informed consent.
The majority of patients were men (57%). Mean age was 61.1±15.8 years. Of these, 81.4% exhibited radiological and clinical findings of pneumonia, 20.9% were intubated and 18.2% died. Overall, among patients with pneumonia, the commonest comorbidities were hypertension (38.4%), DM (20.9%) and dyslipidaemia (20.9%) ([Table 1]). Specifically, among those who died from pneumonia, all comorbidities were more frequent. DM was significantly (p<0.001, odds ratio [OR]: 26.28, 95% confidence interval [CI]: 9.91–69.69) more frequent among those who died (71%) vs. those who survived (8.5%). Similarly, hypertension was significantly (p<0.001, OR: 8.66, 95% CI: 3.46–21.68) more frequent among those who died (77.4%) vs. those who survived (28.4%). The total age-standardised prevalence of diabetes in Greece was 9.1%, according to data of WHO in 2016[5]. All patients had type 2 DM. Regrettably, HbA1cwas not available to assess glycaemic control. All patients had been treated with oral hypoglycaemic agents. The majority of patients used metformin combined with dipeptidylpeptidase-4 (DPP-4) inhibitors or sodium glucose cotransporter 2 (SGLT2) inhibitors. There was no difference in treatment regimens among those who survived and those who died.
|
Hospitalised patients with confirmed COVID-19 pneumonia (n=172) |
Patients who died due to COVID-19 pneumonia (n=31) |
|
|---|---|---|
|
Age, years (mean, SD) |
61.1±15.8 |
69.2±13.8 |
|
Gender |
||
|
Male (n,%) |
98 (57%) |
18 (58%) |
|
Comorbidities (n,%) |
||
|
Hypertension |
66 (38.4%) |
24 (77.4%) |
|
Diabetes mellitus |
36 (20.9%) |
22 (71%) |
|
Coronary artery disease |
18 (10.5%) |
11 (35.5%) |
|
Dyslipidaemia |
36 (20.9%) |
16 (51.6%) |
|
Heart failure |
21 (12.2%) |
5 (16.1%) |
|
Chronic kidney disease |
11 (6.4%) |
3 (9.7%) |
Several studies have identified DM and CVD as major risk factors for the clinical outcome of COVID-19 pneumonia, in addition to advanced age [6]. In a Chinese study (N=1099), among 173 patients with severe disease 23.7% had hypertension and 16.2% DM [7]. Similarly, in Italy, among 1591 patients admitted to the intensive care unit, 49% had hypertension, 21% CVD and 17% DM [8]. In USA, hypertension was also the most common comorbidity (49.7%), followed by obesity (48.3%), DM (28.3%) and CVD (27.8%) [9]. DM is considered as a low-grade inflammation state, which may aggravate the inflammatory process caused by SARS-CoV-2 leading to poor prognosis [10]. In this context, antidiabetic agents with the potential to reduce inflammation, hypoxia, liver injury and excess cytokine release are being discussed [11] [12].
In conclusion, in our department the commonest comorbidities were hypertension, DM and dyslipidaemia. Among those who died from severe pneumonia, more than 70% had DM or hypertension. These results add to the growing concern about the vulnerability of subjects with DM [6] [7] and the need to protect them by reducing infection in the community.
Publication History
Article published online:
09 December 2020
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