Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Diabetes and COVID-19 Related Mortality in the Critical Care Setting: A Real-Time National Cohort Study in England
29 Pages Posted: 5 Jun 2020
More...Abstract
Background:The importance of diabetes as a prognostic factor in people admitted to hospital critical care with COVID-19 is poorly understood and has not been quantified.
Methods:We used a real-time national database (COVID-19 Hospitalisation in England Surveillance System; CHESS), comprising data on COVID-19 related admissions to hospital in England requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between March 1, 2020 and May 17, 2020. The objective was to describe the relationship between diabetes and all-cause in-hospital mortality in adults, using Cox proportional hazard models adjusted for age, sex, ethnicity, obesity, and other comorbidities. The primary analysis was restricted to a subset with sufficiently complete comorbidity status recording. Several sensitivity analyses, including on the unrestricted dataset, were carried out to verify the results.
Findings: Diabetes was independently associated with mortality in people admitted to critical care settings with COVID-19 in England; the proportion of 30-day mortality attributable to diabetes, after adjusting for age, sex, ethnicity, obesity, and other comorbidities, was 4·8% (95%CI 2·5-7·0). 14,639 COVID-19 related HDU and ICU admissions were reported during the study period, of which 6,142 were included in primary analysis, including 3,311 HDU (mean age 72), and 2,831 ICU admissions (mean age 58). 1,439 (23·4%) had diabetes. 1,847 individuals (30·1%) died during the study period. 30 day mortality was higher in people with diabetes than without (p < 0·001). People with diabetes were at increased risk of death (adjusted hazard ratio (HR) 1·28 [1·14, 1·42]). Results were consistent in subsets admitted to HDU only (adjusted HR 1·27 [1·09, 1·48]) and ICU (adjusted HR 1·31 [1·12, 1·54]). Sensitivity analyses were consistent with the primary analysis.
Interpretation:Diabetes is an independent prognostic factor for mortality in people with COVID-19 requiring HDU or ICU treatment. Quantification of this diabetes associated risk enables appropriate treatment decisions in people with diabetes and severe COVID-19.
Funding Statement: This study received no funding.
Declaration of Interests: APM declares previous research funding from Eli Lilly and Company, Pfizer, and AstraZeneca. SJV declares funding from IQVIA. All other authors declare no competing interests.
Ethics Approval Statement: The study was reviewed and approved by the Warwick BSREC (BSREC 119/19-20) and sponsorship is being provided by University of Warwick (SOC.28/19-20).
Keywords: Diabetes; COVID-19; Critical Care; Mortality; Intensive Care
Suggested Citation: Suggested Citation