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Infante M, Pieri M, Lupisella S, Mohamad A, Bernardini S, Della-Morte D, Fabbri A, De Stefano A, Iannetta M, Ansaldo L, Crea A, Andreoni M, Morello M. Admission eGFR predicts in-hospital mortality independently of admission glycemia and C-peptide in patients with type 2 diabetes mellitus and COVID-19. Curr Med Res Opin 2023; 39:505-516. [PMID: 36749566 DOI: 10.1080/03007995.2023.2177380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) and impaired kidney function are associated with a higher risk of poor outcomes of COVID-19. We conducted a retrospective study in hospitalized T2DM patients with COVID-19 to assess the association between in-hospital mortality and admission values of different hematological/biochemical parameters, including estimated glomerular filtration rate (eGFR), plasma glucose and C-peptide (as a marker of beta-cell function). METHODS The study included T2DM patients with confirmed SARS-CoV-2 infection who were consecutively admitted to our Institution between October 1, 2020 and April 1, 2021. RESULTS Patients (n = 74) were categorized into survivors (n = 55) and non-survivors (n = 19). Non-survivors exhibited significantly higher median WBC count, D-dimer, neutrophil-to-lymphocyte ratio, hsCRP, and procalcitonin levels, as well as significantly lower median serum 25(OH)D levels compared to survivors. Non-survivors exhibited significantly higher median admission plasma glucose (APG) values compared to survivors (210 vs 166 mg/dL; p = 0.026). There was no statistically significant difference in median values of plasma C-peptide between non-survivors and survivors (3.55 vs 3.24 ng/mL; p = 0.906). A significantly higher percentage of patients with an eGFR < 60 mL/min/1.73 m2 was observed in the non-survivor group as compared to the survivor group (57.9% vs 23.6%; p = 0.006). A multivariate analysis performed by a logistic regression model after adjusting for major confounders (age, sex, body mass index, major comorbidities) showed a significant inverse association between eGFR values and risk of in-hospital mortality (OR, 0.956; 95% CI, 0.931-0.983; p = 0.001). We also found a significant positive association between WBC count and risk of in-hospital mortality (OR, 1.210; 95% CI, 1.043-1.404; p = 0.011). CONCLUSIONS Admission eGFR and WBC count predict in-hospital COVID-19 mortality among T2DM patients, independently of traditional risk factors, APG and random plasma C-peptide. Hospitalized patients with COVID-19 and comorbid T2DM associated with impaired kidney function at admission should be considered at high risk for adverse outcomes and death.
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Affiliation(s)
- Marco Infante
- Department of Systems Medicine & Diabetes Research Institute Federation (DRIF), University of Rome Tor Vergata, Rome, Italy
- Section of Diabetes and Metabolic Disorders, UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Cell Transplant Center, Diabetes Research Institute (DRI), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Massimo Pieri
- Department of Experimental Medicine, Clinical Biochemistry and Molecular Biology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Santina Lupisella
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Ali Mohamad
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, Clinical Biochemistry and Molecular Biology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fabbri
- Department of Systems Medicine & Diabetes Research Institute Federation (DRIF), University of Rome Tor Vergata, Rome, Italy
| | - Alberto De Stefano
- Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Volunteers Association, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Marco Iannetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Lorenzo Ansaldo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Angela Crea
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Infectious Disease Clinic, Tor Vergata University Hospital (PTV), Rome, Italy
| | - Maria Morello
- Department of Experimental Medicine, Clinical Biochemistry and Molecular Biology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
- Clinical Biochemistry Department, Tor Vergata University Hospital (PTV), Rome, Italy
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Yanamandra U, Saxena P, Srinath R, Sawant A, Singh A, Aggarwal N, Pavan B, Duhan G, Aggarwal B, Kaur P. Assessment of Six-Minute Walk Test Among Discharge-Ready Severe COVID-19 Patients: A Cross-Sectional Study. Cureus 2022; 14:e25108. [PMID: 35733480 PMCID: PMC9205384 DOI: 10.7759/cureus.25108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 01/08/2023] Open
Abstract
Background Among patients hospitalized for severe pneumonia due to coronavirus disease (COVID-19), clinical stability and normal resting peripheral oxygen saturation (SpO2) levels are widely used as a discharge criterion after recovery. It is unknown whether a test to assess the functional exercise capacity, like a six-minute walk test (6MWT), can add to the appropriateness of discharge criteria. Methods A cross-sectional study was conducted at a tertiary care COVID-19 hospital in India from 01st to 31st May 2021. All patients considered fit for discharge after recovery from "severe" COVID-19 pneumonia were subjected to 6MWT. Fitness for discharge was assessed by clinical stability and resting SpO2 above 93% for three consecutive days. Patients were considered to have failed the 6MWT if there was ≥4% fall in SpO2 or if they could not complete the test. Serum samples were analyzed for levels of C-reactive protein (CRP), interleukin-6 (IL-6), and lactate dehydrogenase (LDH) at the time of discharge. Results Fifty-three discharge-ready patients with a mean age of 54.54 ± 14.35 years with a male preponderance (60.38%) were analyzed. Thirty-three (62.26%) patients failed the 6MWT with a median six-minute walk distance (6MWD) of 270 m (60-360). A total of 45 (84.91%) patients had a fall in SpO2 during the test. The median change in SpO2 (∆SpO2) was 5% ranging from -6% to 8%. Serum LDH was significantly higher among patients who failed the 6MWT with a median LDH of 334 IU/L (38.96-2339) versus 261 IU/L (49.2-494) (p = 0.02). The difference was not significant for CRP or IL-6. There was no statistically significant correlation between the inflammatory markers with either 6MWD or (∆SpO2). Conclusion Two-thirds of the patients considered fit for discharge after recovery from severe COVID-19 pneumonia failed 6MWT, implying reduced functional exercise capacity and exertional hypoxia. Serum LDH levels were higher in these patients but not in other inflammatory markers. None of the inflammatory markers at discharge correlated with 6MWD or ∆SpO2 of 6MWT.
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