Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals

Izzi-Engbeaya, Chioma; Distaso, Walter; Amin, Anjali; Yang, Wei; Idowu, Oluwagbemiga; Kenkre, Julia S; Shah, Ronak J; Woin, Evelina; Shi, Christine; Alavi, Nael; Bedri, Hala; Brady, Niamh; Blackburn, Sophie; Leczycka, Martina; Patel, Sanya; Sokol, Elizaveta; Toke-Bjolgerud, Edward; Qayum, Ambreen; Abdel-Malek, Mariana; Hope, David C D; Oliver, Nick S; Bravis, Vasiliki; Misra, Shivani; Tan, Tricia M; Hill, Neil E; Salem, Victoria

INTRODUCTION: Patients with diabetes mellitus admitted to hospital with COVID-19 have poorer outcomes. However, the drivers of poorer outcomes are not fully elucidated. We performed detailed characterization of patients with COVID-19 to determine the clinical and biochemical factors that may be drivers of poorer outcomes. RESEARCH DESIGN AND METHODS: This is a retrospective cohort study of 889 consecutive inpatients diagnosed with COVID-19 between March 9 and April 22, 2020 in a large London National Health Service Trust. Unbiased multivariate logistic regression analysis was performed to determine variables that were independently and significantly associated with increased risk of death and/or intensive care unit (ICU) admission within 30 days of COVID-19 diagnosis. RESULTS: 62% of patients in our cohort were of non-white ethnic background and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death/admission to the ICU within 30 days of COVID-19 diagnosis. Male gender, lower platelet count, advancing age and higher Clinical Frailty Scale (CFS) score (but not diabetes) independently predicted poor outcomes on multivariate analysis. Antiplatelet medication was associated with a lower risk of death/ICU admission. Factors that were significantly and independently associated with poorer outcomes in patients with diabetes were coexisting ischemic heart disease, increasing age and lower platelet count. CONCLUSIONS: In this large study of a diverse patient population, comorbidity (ie, diabetes with ischemic heart disease; increasing CFS score in older patients) was a major determinant of poor outcomes with COVID-19. Antiplatelet medication should be evaluated in randomized clinical trials among high-risk patient groups.