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Ciardullo S, Zerbini F, Perra S, Muraca E, Cannistraci R, Lauriola M, Grosso P, Lattuada G, Ippoliti G, Mortara A, Manzoni G, Perseghin G. Impact of diabetes on COVID-19-related in-hospital mortality: a retrospective study from Northern Italy. J Endocrinol Invest 2021; 44:843-850. [PMID: 32776197 PMCID: PMC7415410 DOI: 10.1007/s40618-020-01382-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of pre-existing diabetes on in-hospital mortality in patients admitted for Coronavirus Disease 2019 (COVID-19). METHODS This is a single center, retrospective study conducted at Policlinico di Monza hospital, located in the Lombardy region, Northern Italy. We reviewed medical records of 373 consecutive adult patients who were hospitalized with COVID-19 between February 22 and May 15, 2020. Data were collected on diabetes status, comorbid conditions and laboratory findings. Multivariable logistic regression was performed to evaluate the effect of diabetes on in-hospital mortality after adjustment for potential confounding variables. RESULTS Mean age of the patients was 72 ± 14 years (range 17-98), 244 (65.4%) were male and 69 (18.5%) had diabetes. The most common comorbid conditions were hypertension (237 [64.8%]), cardiovascular disease (140 [37.7%]) and malignant neoplasms (50 [13.6%]). In-hospital death occurred in 142 (38.0%) patients. In the multivariable model older age (Relative Risk [RR] 1.06 [1.04-1. 09] per year), diabetes (RR 1.56 [1.05-2.02]), chronic obstructive pulmonary disease (RR 1.82 [1.13-2.35]), higher values of lactic dehydrogenase and C-reactive protein were independently associated with in-hospital mortality. CONCLUSION In this retrospective single-center study, diabetes was independently associated with a higher in-hospital mortality. More intensive surveillance of patients with this condition is to be warranted.
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Affiliation(s)
- S Ciardullo
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - F Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - S Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - E Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - R Cannistraci
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - M Lauriola
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - P Grosso
- Department of Anesthesiology and Intensive Care, Policlinico di Monza, Monza, Italy
| | - G Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Ippoliti
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Mortara
- Department of Clinical Cardiology, Policlinico di Monza, Monza, Italy
| | - G Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Perseghin
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
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Ciardullo S, Ronchetti C, Muraca E, Oltolini A, Perra S, Bianconi E, Zerbini F, Cannistraci R, Manzoni G, Gastaldelli A, Lattuada G, Perseghin G. Impact of using different biomarkers of liver fibrosis on hepatologic referral of individuals with severe obesity and NAFLD. J Endocrinol Invest 2020; 43:1019-1026. [PMID: 32008185 DOI: 10.1007/s40618-020-01188-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to estimate how many individuals with severe obesity and NAFLD should be referred to hepatologists according to the EASL-EASD-EASO guidelines and whether the choice of specific indicators of liver fibrosis would significantly impact the number of referrals. METHODS This was a single-center retrospective study of 495 individuals with severe obesity screened at our institution between 2012 and 2018 for a bariatric surgery intervention. The guidelines were applied using the NAFLD Liver Fat Score (NLFS) to assess the presence of steatosis and the NAFLD fibrosis score (NFS), Fibrosis-4 (FIB-4) and Hepamet Fibrosis Score (HFS) to assess the risk of advanced fibrosis. RESULTS Three hundred and seventy-nine patients (76.6%) had evidence of liver steatosis. The application of the guidelines would lead to referral of 66.3% of patients using NFS, 31.7% using FIB-4 and 34.2% using HFS. When referrals due to abnormal liver function tests were excluded, these percentages dropped to 55.8%, 7.3% and 12.1%, respectively. The strongest inter-biomarker agreement was found between FIB-4 and HFS (κ = 0.86, 95% CI 0.815-0.910). CONCLUSION Strict application of the guidelines in individuals with severe obesity would probably lead to over-referral, although a great variability exists among the different scores.
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Affiliation(s)
- S Ciardullo
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - C Ronchetti
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - E Muraca
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Oltolini
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - S Perra
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - E Bianconi
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - F Zerbini
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - R Cannistraci
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - G Manzoni
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Gastaldelli
- Cardiometabolic Risk Laboratory, Institute of Clinical Physiology (IFC), CNR, Pisa, Italy
| | - G Lattuada
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Perseghin
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
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