Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II)

• DOI: 10.1186/s12933-020-01140-2
• Publication Date: 2020-10-01T12:03:19Z
• Authors: Ernesto Maddaloni; Luca D’Onofrio; Francesco Alessandri; Carmen Mignogna; Gaetano Leto; Giuseppe Pascarella; Ivano Mezzaroma; Miriam Lichtner; Paolo Pozzilli; Felice Eugenio Agrò; Monica Rocco; Francesco Pugliese; Andrea Lenzi; Rury R. Holman; Claudio Maria Mas...; Raffaella Buzzetti; ; Camilla Ajassa; Rugova Alban; Francesco Alessandri; Federica Alessi; Raissa Aronica; Valeria Belvisi; Raffaella Buzzetti; Matteo Candy; Alessandra Caputi; Anna Carrara; Elena Casali; Eugenio Nelson Ca...; Giancarlo Ceccarelli; Luigi Celani; Maria Rosa Ciardi; Lucia Coraggio; Ambrogio Curtolo; Claudia D’Agostino; Gabriella D’Ettorre; Luca D’Onofrio; Francesca De Giorgi; Gabriella De Giro...; Valeria Filippi; Lucio Gnessi; Cecilia Luordi; Ernesto Maddaloni; Claudio Maria Mas...; Ivano Mezzaroma; Carmen Mignogna; Chiara Moretti; Francesco Pugliese; Gregorio Recchia; Marco Ridolfi; Francesco Eugenio...; Gianluca Russo; Franco Ruberto; Giulia Savelloni; Guido Siccardi; Antonio Siena; Sara Sterpetti; Serena Valeri; Mauro Vera; Lorenzo Volpicelli; Mikiko Watanabe; Massimo Aiuti; Giuseppe Campagna; Cosmo Del Borgo; Laura Fondaco; Blerta Kertusha; Frida Leonetti; Gaetano Leto; Miriam Lichtner; Raffaella Marocco; Renato Masala; Paola Zuccalà; Felice Eugenio Agrò; Giulia Nonnis; Giuseppe Pascarella; Paolo Pozzilli; Alessandra Rigoli; Alessandro Strumia; Daniela Alampi; Monica Rocco
• Keywords: Male; Pneumonia, Viral; Betacoronavirus; 03 medical and health sciences; 0302 clinical medicine; Metabolic Diseases; Risk Factors; Diabetes Mellitus; copd; covid-19; diabetes; hypertension; sars-cov-2; aged; aged; 80 and over; cardiovascular diseases; coronavirus infections; diabetes mellitus; female; follow-up studies; humans; male; metabolic diseases; middle aged; multimorbidity; pandemics; pneumonia; viral; prognosis; retrospective studies; risk factors; betacoronavirus; COPD; Diseases of the circulatory (Cardiovascular) system; Humans; Pandemics; Original Investigation; Aged; Retrospective Studies; Aged, 80 and over; SARS-CoV-2; Diabetes; COVID-19; Multimorbidity; Middle Aged; Prognosis; 3. Good health; Cardiovascular Diseases; RC666-701; Hypertension; Female; Covid-19; Coronavirus Infections; Follow-Up Studies

Abstract Background Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity.

Methods We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders.

Results Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12–3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37–3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23–5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61–6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90–3.06, adjp = 0.10).

Conclusions Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.