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

Maddaloni, Ernesto; D’Onofrio, Luca; Alessandri, Francesco; Mignogna, Carmen; Leto, Gaetano; Pascarella, Giuseppe; Mezzaroma, Ivano; Lichtner, Miriam; Pozzilli, Paolo; Agrò, Felice Eugenio; Rocco, Monica; Pugliese, Francesco; Lenzi, Andrea; Holman, Rury R.; Mastroianni, Claudio Maria; Buzzetti, Raffaella

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 15(th), 2020, was higher in those with diabetes (Adjusted Odds Ratio ((adj)OR) 2.04, 95%CI 1.12–3.73, p = 0.020), hypertension ((adj)OR 2.31, 95%CI: 1.37–3.92, p = 0.002) and COPD ((adj)OR 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 ((adj)OR 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 ((adj)OR 1.66, 0.90–3.06, (adj)p = 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.