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Wargny M, Potier L, Gourdy P, Pichelin M, Amadou C, Benhamou PY, Bonnet JB, Bordier L, Bourron O, Chaumeil C, Chevalier N, Darmon P, Delenne B, Demarsy D, Dumas M, Dupuy O, Flaus-Furmaniuk A, Gautier JF, Guedj AM, Jeandidier N, Larger E, Le Berre JP, Lungo M, Montanier N, Moulin P, Plat F, Rigalleau V, Robert R, Seret-Bégué D, Sérusclat P, Smati S, Thébaut JF, Tramunt B, Vatier C, Velayoudom FL, Vergès B, Winiszewski P, Zabulon A, Gourraud PA, Roussel R, Cariou B, Hadjadj S. Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study. Diabetologia 2021; 64:778-794. [PMID: 33599800 PMCID: PMC7890396 DOI: 10.1007/s00125-020-05351-w] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04324736.
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Affiliation(s)
- Matthieu Wargny
- l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
- CHU de Nantes, Inserm, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Louis Potier
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, Inserm, U-1138, Université de Paris, Paris, France
| | - Pierre Gourdy
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, Université de Toulouse, Toulouse, France
| | - Matthieu Pichelin
- l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Coralie Amadou
- Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
- Université Paris-Saclay, Paris, France
| | - Pierre-Yves Benhamou
- Service Endocrinologie-Diabétologie-Nutrition, CHU Grenoble, Grenoble, France
- University Grenoble-Alpes, Grenoble, France
| | - Jean-Baptiste Bonnet
- Département d'Endocrinologie, Diabète, Nutrition et CIC Inserm 1411, CHU de Montpellier, Montpellier, France
| | - Lyse Bordier
- Département de Diabétologie, H.I.A. Begin, Saint Mandé, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France
- Assistance Publique Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié Salpêtrière-Charles Foix, Paris, France
- Centre de Recherche des Cordeliers, Inserm, U-1138, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | | | | | - Patrice Darmon
- Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France
- C2VN, Inserm, INRA, Aix Marseille Université, Marseille, France
| | - Blandine Delenne
- Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, Centre Hospitalier d'Aix-en-Provence, Aix-en-Provence, France
| | - Delphine Demarsy
- Service Endocrinologie-Diabétologie, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Marie Dumas
- Service Endocrinologie-Diabétologie, Hôpital Saint Vincent de Paul Lille, Lille, France
| | - Olivier Dupuy
- Service de Diabétologie Endocrinologie, Hôpital Paris Saint-Joseph, Paris, France
| | - Anna Flaus-Furmaniuk
- Service d'Endocrinologie - Diabétologie, Site Felix Guyon, CHU de la Réunion, Saint-Denis de la Réunion, France
| | - Jean-François Gautier
- Centre de Recherche des Cordeliers, Inserm, U-1138, Université de Paris, Paris, France
- Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne-Marie Guedj
- Service des Maladies Métaboliques et Endocriniennes, CHU de Nîmes, Université de Montpellier, Nîmes, France
| | - Nathalie Jeandidier
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpitaux Universitaires de Strasbourg, UdS, Strasbourg, France
| | - Etienne Larger
- Service de Diabétologie et Immunologie Clinique, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | | | - Myriam Lungo
- Service d'Endocrinologie et de Diabétologie, Centre Hospitalier de Bastia, Bastia, France
| | | | - Philippe Moulin
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Inserm UMR 1060 Carmen, Université Claude Bernard Lyon 1, Lyon, France
| | - Françoise Plat
- Service d'Endocrinologie et Maladies Métaboliques, Centre Hospitalier d'Avignon, Avignon, France
| | - Vincent Rigalleau
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - René Robert
- Université de Poitiers; CIC Inserm 1402; Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Dominique Seret-Bégué
- Service de Diabétologie, Endocrinologie et Nutrition, Centre Hospitalier de Gonesse, Gonesse, France
| | - Pierre Sérusclat
- Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, Groupe Hospitalier Mutualiste Les Portes du Sud, Venissieux, France
| | - Sarra Smati
- l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | | | - Blandine Tramunt
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, Université de Toulouse, Toulouse, France
| | - Camille Vatier
- Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Paris, France
- Sorbonne University, Inserm UMRS 938, Saint-Antoine Research Center, Paris, France
| | - Fritz-Line Velayoudom
- Service d'Endocrinologie, Diabétologie et Métabolisme, Centre Hospitalier Universitaire de Guadeloupe, Pointe-à-Pitre, France
| | - Bruno Vergès
- Service Endocrinologie, Diabétologie et Maladies Métaboliques, Hôpital du Bocage, Dijon, France
| | - Patrice Winiszewski
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Nord Franche-Comté, Trévenans, France
| | - Audrey Zabulon
- Service d'Endocrinologie et Diabétologie, CHU de Martinique, Fort-de-France, France
| | - Pierre-Antoine Gourraud
- CHU de Nantes, Inserm, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Ronan Roussel
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, Inserm, U-1138, Université de Paris, Paris, France
| | - Bertrand Cariou
- l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Nantes, France.
| | - Samy Hadjadj
- l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Nantes, France.
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Mineur L, Sabatier R, Kirscher S, Plat F, Goubely Y, Molinari N. Are we turning to more than a first line treatment of metastatic colorectal cancer with high dose irinotecan?: A monocentric institution safety analysis of 46 patients. Clin Res Hepatol Gastroenterol 2011; 35:125-31. [PMID: 21109376 DOI: 10.1016/j.gcb.2009.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 11/02/2009] [Accepted: 11/20/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE Irinotecan (CPT11) at 180 mg/m(2) with LV5FU2 for metastatic colorectal cancer (MCRC) has response rates (RRs) of 56 and 4% as first- and second-line treatments, respectively [1-2], and higher doses of CPT11 result in higher RRs. The present cohort analysis aimed to evaluate the effect of increasing doses of this combination treatment in clinical practice. METHODS Chemo-naive and pretreated patients with MCRC received CPT11 and LV5FU2 (5FU 48-h CI 2400 mg/m(2), D1 bolus leucovorin 200 mg/m(2)), followed by 5FU 400 mg/m(2) (cycles d1-d15). CPT11 dose was increased by 20 mg/m(2) at each cycle, from 180 mg/m(2) up to 260 mg/m(2), unless grade 3 toxicities other than alopecia arose. RESULTS Between March 2002 and September 2005, 46 patients were recruited (median age: 62.3 years). A total of 512 cycles of chemotherapy were administered (median: 9 cycles/patient; range: 3-41). Median follow-up was 16.2 months. Altogether, 27 patients had received prior chemotherapy: 24 with an oxaliplatin-based regimen; seven with CPT11; and five with LV5FU2 or oral 5FU. Doses of 260 mg/m(2) were used in 17 patients, 240 mg/m(2) in seven, 220 mg/m(2) in six and 200 mg/m(2) in five, while 11 remained at 180 mg/m(2); 121 cycles used 260 mg/m(2) (24%), with 76 cycles at 240 mg/m(2) (14%), 78 cycles at 220 mg/m(2) and 58 cycles at 200mg/m(2). The objective response (OR) was 40%, with stable disease (SD) in 45% and disease progression (DP) in 11%. In the first-line therapy group, partial/complete responses were 55%, with SD in 30% and DP in 15%. In pretreated patients, OR was 30.5%, SD was 58.5% and DP was 11%. Nine patients (20%) had a therapeutic break (median: 5.1 months; range: 3-10). Overall median survival was 17 months, with 16.5 months in pretreated patients and 19.6 months in the first-line group. Toxicity grades 3-4 and overall incidence per cycle were: neutropenia, 3-22%; diarrhea, 4-22%; vomiting, 2-20%; alopecia, 20-26%; anemia, 0.2-2%; thrombocytopenia, 0-0%; and mucositis, 0.4-2.2%. CONCLUSION The toxicity of high-dose CPT11+LV5FU2 chemotherapy was well tolerated when the dose was progressively increased according to individual tolerability, with 37% of patients receiving CPT11 at 260 mg/m(2). Progression-free survival (PFS) increased with higher doses of CPT11. In the chemo-naive and pretreated subgroups, the median PFS was 10.9 and 8.8 months, respectively (P=0.698, NS). Optimization of CPT11 doses in pretreated patients appears to pave the way for new treatment options.
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Affiliation(s)
- L Mineur
- Gastrointestinal and liver oncology-radiotherapy unit, institut Sainte-Catherine, chemin du Lavarin, 84000 Avignon, France.
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