Evaluation and comparison of diabetic and non-diabetic patients infected by COVID-19 and phenotypes of severity: an analytical and cross-sectional study in a reference hospital of the Federal District, Brazil
DOI:
https://doi.org/10.33448/rsd-v10i16.23658Keywords:
Diabetes mellitus; Risk factors; Indicators of morbidity and mortality; COVID-19; Systemic inflammatory response syndrome.Abstract
Introduction: In March 2020 the World Health Organization (WHO) declared a pandemic for the disease called COVID 19, caused by a new acute severe coronavirus respiratory syndrome 2 (SARS-CoV-2), being a public health emergency of international interest. Since the beginning of the pandemic, diabetes mellitus has emerged as a complicating factor, with unfavorable outcomes compared to the non-diabetic population. Thus, our study aimed to evaluate and compare, through an analytical, cross-sectional and descriptive study, the phenotypes of severity among people with diabetic and non-diabetic COVID-19 in a reference hospital in the Federal District, Brazil. Material and methods: Through an active search of data in the medical records of hospitalized patients diagnosed with COVID-19 by the"Real Time Polymerase Chain Reaction" (RT-PCR) method, 2041 individuals who, after exclusion criteria, selected a total of 762 for the proposed study were selected, comparing clinical and laboratory data between the group with diabetes and without diabetes. Descriptive statistics were performed with mean and standard deviation values, absolute frequency and relative percentage. The normality and homogeneity of the data were calculated with the Shapiro-Wilk and Levene test, respectively. The student's t-test for independent samples was used to compare the continuous variables and the chi-square test was used to compare categorical variables between diabetic and non-diabetic patients. Findings: Individuals with diabetes presented a more severe clinical picture when compared to those without the disease. Evidencing an independent risk factor for a worse prognosis. Discussion: our findings are in line with other studies already conducted, showing that the chronic inflammatory component of the disease seems to be the main trigger for unfavorable outcomes. Conclusion: Considering the epidemiological importance of diabetes, urgent research is made that elucidate the above-mentioned doubts, aiming at more appropriate therapeutic interventions and, therefore, improving outcomes in this population. In the case of a new and still little known disease, with several questions, probably many of the answers will only come over time, through more robust, prospective and randomized studies, with larger and more diverse populations.
References
Berbudi, A., Rahmadika, N., Tjahjadi, A. I., & Ruslami, R. (2019). Type 2 Diabetes and its Impact on the Immune System. Current Diabetes Reviews, 16(5), 442–449. https://doi.org/10.2174/1573399815666191024085838
Blanke, C. D. (2020). In response: Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes/Metabolism Research and Reviews, 36(7), 7834. https://doi.org/10.1002/dmrr.3331
Bonyek-Silva, I., Machado, A. F. A., Cerqueira-Silva, T., Nunes, S., Silva Cruz, M. R., Silva, J., Santos, R. L., Barral, A., Oliveira, P. R. S., Khouri, R., Serezani, C. H., Brodskyn, C., Caldas, J. R., Barral-Netto, M., Boaventura, V., & Tavares, N. M. (2021). LTB4-Driven Inflammation and Increased Expression of ALOX5/ACE2 During Severe COVID-19 in Individuals With Diabetes. Diabetes, 70(9), 2120–2130. https://doi.org/10.2337/db20-1260
Brasil. (2020). Secretaria de Vigilância em Saúde. Ministério da Saúde. Boletim Epidemiológico: Infecção Humana pelo Novo Coronavírus (2019-nCoV). Centro de Operações de Emergências Em Saúde Pública, 01, 1–17.
Brito, V. P. de, Carrijo, A. M. M., & Oliveira, S. V. de. (2020). Associação da Diabetes Mellitus com a gravidade da COVID-19 e seus potenciais fatores mediadores: uma revisão sistemática. Revista Thema, 18, 204–217. https://doi.org/10.15536/thema.v18.especial.2020.204-217.1820
Cao, Y., Su, B., Guo, X., Sun, W., Deng, Y., Bao, L., Zhu, Q., Zhang, X., Zheng, Y., Geng, C., Chai, X., He, R., Li, X., Lv, Q., Zhu, H., Deng, W., Xu, Y., Wang, Y., Qiao, L., … Xie, X. S. (2020). Potent Neutralizing Antibodies against SARS-CoV-2 Identified by High-Throughput Single-Cell Sequencing of Convalescent Patients’ B Cells. Cell, 182(1), 73-84.e16. https://doi.org/10.1016/j.cell.2020.05.025
Cariou, B., Hadjadj, S., Wargny, M., Pichelin, M., Al-Salameh, A., Allix, I., Amadou, C., Arnault, G., Baudoux, F., Bauduceau, B., Borot, S., Bourgeon-Ghittori, M., Bourron, O., Boutoille, D., Cazenave-Roblot, F., Chaumeil, C., Cosson, E., Coudol, S., Darmon, P., & Gourdy, P. (2020). Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia, 63(8), 1500–1515. https://doi.org/10.1007/s00125-020-05180-x
Corona, G., Pizzocaro, A., Vena, W., Rastrelli, G., Semeraro, F., Isidori, A. M., Pivonello, R., Salonia, A., Sforza, A., & Maggi, M. (2021). Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis. Reviews in Endocrine and Metabolic Disorders, 22(2), 275–296. https://doi.org/10.1007/s11154-021-09630-8
Fadini, G. P., Morieri, M. L., Longato, E., & Avogaro, A. (2020). Prevalence and impact of diabetes among people infected with SARS-CoV-2. Journal of Endocrinological Investigation, 43(6), 867–869. https://doi.org/10.1007/s40618-020-01236-2
Guo, W., Li, M., Dong, Y., Zhou, H., Zhang, Z., Tian, C., Qin, R., Wang, H., Shen, Y., Du, K., Zhao, L., Fan, H., Luo, S., & Hu, D. (2020). Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes/Metabolism Research and Reviews, 36(7), 1–9. https://doi.org/10.1002/dmrr.3319
Gutta, S., Grobe, N., Kumbaji, M., Osman, H., Saklayen, M., Li, G., & Elased, K. M. (2018). Increased urinary angiotensin converting enzyme 2 and neprilysin in patients with type 2 diabetes. American Journal of Physiology - Renal Physiology, 315(2), F263–F274. https://doi.org/10.1152/ajprenal.00565.2017
Guzmán, J., & López, S. (2012). Células de la inmunidad innata y adaptativa en la diabetes mellitus tipo 2 y obesidad. Gaceta Medica de Mexico, 148(4), 381–389.
Hackett, R. A., & Steptoe, A. (2016). Psychosocial Factors in Diabetes and Cardiovascular Risk. Current Cardiology Reports, 18(10). https://doi.org/10.1007/s11886-016-0771-4
Hirooka, Y., & Nozaki, Y. (2021). Interleukin-18 in Inflammatory Kidney Disease. Frontiers in Medicine, 8(March), 1–10. https://doi.org/10.3389/fmed.2021.639103
Holman, N., Knighton, P., Kar, P., O’Keefe, J., Curley, M., Weaver, A., Barron, E., Bakhai, C., Khunti, K., Wareham, N. J., Sattar, N., Young, B., & Valabhji, J. (2020). Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. The Lancet Diabetes and Endocrinology, 8(10), 823–833. https://doi.org/10.1016/S2213-8587(20)30271-0
Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocrine Reviews, 37(3), 278–316. https://doi.org/10.1210/er.2015-1137
Klein, F. (2020). Risikofaktor Komorbiditäten bei COVID-19- Erkrankung. Pneumologie, 74(10), 640. https://doi.org/10.1183/13993003.00547-2020
Kumar, A., Arora, A., Sharma, P., & Anil, S. (2020). Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19 . The COVID-19 resource centre is hosted on Elsevier Connect , the company ’ s public news and information. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(January), 535–545. https://www.sciencedirect.com/science/article/abs/pii/S1871402120301090?via%3Dihub
Li, F. (2008). Structural Analysis of Major Species Barriers between Humans and Palm Civets for Severe Acute Respiratory Syndrome Coronavirus Infections. Journal of Virology, 82(14), 6984–6991. https://doi.org/10.1128/jvi.00442-08
M. Salazar, J. Barochiner, W. E. el. E. (2020). Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-. Ann Oncol, January, 2–5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254017/pdf/main.pdf
Müller, J. A., Groß, R., Conzelmann, C., Krüger, J., Merle, U., Steinhart, J., Weil, T., Koepke, L., Bozzo, C. P., Read, C., Fois, G., Eiseler, T., Gehrmann, J., van Vuuren, J., Wessbecher, I. M., Frick, M., Costa, I. G., Breunig, M., Grüner, B., & Kleger, A. (2021). SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nature Metabolism, 3(2), 149–165. https://doi.org/10.1038/s42255-021-00347-1
Ramanathan, K., Antognini, D., Combes, A., Paden, M., Zakhary, B., Ogino, M., Maclaren, G., & Brodie, D. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(January), 497–506.
Rao, S., Lau, A., & So, H. C. (2020). Exploring Diseases/Traits and Blood Proteins Causally Related to Expression of ACE2, the Putative Receptor of SARS-CoV-2: A Mendelian Randomization Analysis Highlights Tentative Relevance of Diabetes-Related Traits. Diabetes Care, 43(7), 1416–1426. https://doi.org/10.2337/dc20-0643
Satış, H., Özger, H. S., Aysert Yıldız, P., Hızel, K., Gulbahar, Ö., Erbaş, G., Aygencel, G., Guzel Tunccan, O., Öztürk, M. A., Dizbay, M., & Tufan, A. (2021). Prognostic value of interleukin-18 and its association with other inflammatory markers and disease severity in COVID-19. Cytokine, 137(May 2020), 155302. https://doi.org/10.1016/j.cyto.2020.155302
Schlesinger, S., Neuenschwander, M., Lang, A., Pafili, K., Kuss, O., Herder, C., & Roden, M. (2021). Risk phenotypes of diabetes and association with COVID-19 severity and death: a living systematic review and meta-analysis. Diabetologia, 64(7), 1480–1491. https://doi.org/10.1007/s00125-021-05458-8
Steenblock, C., Richter, S., Berger, I., Barovic, M., Schmid, J., Schubert, U., Jarzebska, N., von Mässenhausen, A., Linkermann, A., Schürmann, A., Pablik, J., Dienemann, T., Evert, K., Rodionov, R. N., Semenova, N. Y., Zinserling, V. A., Gainetdinov, R. R., Baretton, G., Lindemann, D., … Bornstein, S. R. (2021). Viral infiltration of pancreatic islets in patients with COVID-19. Nature Communications, 12(1). https://doi.org/10.1038/s41467-021-23886-3
Tanaka, T. (2016). Immunotherapeutic implications of IL-6 blockade for cytokine storm. 8, 959–970.
Tanonaka, K., & Marunouchi, T. (2016). Angiotensin-converting enzyme 2. Folia Pharmacologica Japonica, 147(2), 120–121. https://doi.org/10.1254/fpj.147.120
Williamson, E. J., Walker, A. J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C. E., Curtis, H. J., Mehrkar, A., Evans, D., Inglesby, P., Cockburn, J., McDonald, H. I., MacKenna, B., Tomlinson, L., Douglas, I. J., Rentsch, C. T., Mathur, R., Wong, A. Y. S., Grieve, R., … Goldacre, B. (2020). OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature, 584(7821), 430–436. https://doi.org/10.1038/s41586-020-2521-4
Wysocki, J., Ye, M., Soler, M. J., Gurley, S. B., Xiao, H. D., Bernstein, K. E., Coffman, T. M., Chen, S., & Batlle, D. (2006). ACE and ACE2 activity in diabetic mice. Diabetes, 55(7), 2132–2139. https://doi.org/10.2337/db06-0033
Xu, M., Liu, P. P., & Li, H. (2019). Innate immune signaling and its role in metabolic and cardiovascular diseases. Physiological Reviews, 99(1), 893–948. https://doi.org/10.1152/physrev.00065.2017
Yang, J. K., Feng, Y., Yuan, M. Y., Yuan, S. Y., Fu, H. J., Wu, B. Y., Sun, G. Z., Yang, G. R., Zhang, X. L., Wang, L., Xu, X., Xu, X. P., & Chan, J. C. N. (2006). Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabetic Medicine, 23(6), 623–628. https://doi.org/10.1111/j.1464-5491.2006.01861.x
Zhou, F. (2020). Clinical Course And Risk Factors For Mortality Of Adult In Patients With COVID-19 In Wuhan, China: A Retrospective Cohort Study. Journal of Medicine Study & Research, 3(1), 01–02. https://doi.org/10.24966/msr-5657/100015
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Copyright (c) 2021 Marina Grazziotin Pasolini; Fernanda Silveira Tavares; Mariani Carla Prudente Batista; Amanda Sena Nunes Canabrava; Lisandra Vieira da Cruz Souza; Isabela Yumi Saito Delage; Fábio Siqueira; Hugo de Luca Correa; Thiago dos Santos Rosa
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