Older age, high C-reactive protein linked to 7-day COVID-19 mortality risk with diabetes
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Older age and high C-reactive protein were associated with an increased risk for death among people with diabetes hospitalized with COVID-19 in one region of England, according to a speaker.
“Older diabetes patients with high C-reactive protein strongly predicts death in 7 days, confirming the findings of other studies,” Daniel Kevin Llanera, MD, an internal medicine trainee at Imperial College Healthcare NHS Trust in London, told Healio. “Further studies regarding the use of intravenous insulin infusion and glycemic control and their effect on COVID-19 prognosis are recommended.”
Researchers conducted a retrospective cohort study of people with diabetes admitted to seven hospitals in the Mersey-Cheshire region of England with COVID-19 from January to June 2020. Data were obtained through medical notes. Mortality rates were calculated, and Kaplan-Meier curves used to assess COVID-19 mortality risk over time after hospital admission. Data on the impact of COVID-19 on inpatient diabetes team resources were also examined.
The findings were presented at the European Association for the Study of Diabetes virtual meeting.
Of 1,004 people with diabetes hospitalized with COVID-19 (mean age, 74.1 years; 60.7% men), 24% died within 7 days of hospital admission, 7.5% were admitted to intensive care, 9.8% required insulin infusion and 11.9% required diabetes therapy escalations. The mortality rate at 30 days was 33%.
In univariate analyses, people with type 2 diabetes had an increased risk for mortality at 7 days of hospitalization compared with no diabetes (OR = 2.52; 95% CI, 1.06-5.98). Those who received insulin infusion had a reduced risk for mortality (OR = 0.5; 95% CI, 0.28-0.9). Among those younger than 70 years, chronic kidney disease increased mortality risk (OR = 2.74; 95% CI, 1.31-5.76). No other significant associations were observed.
“Long-term glycemic control — HbA1c — obesity and deprivation were not significantly associated with death, which is very different from other population studies,” Llanera said.
In multivariate analysis, older people with diabetes and high C-reactive protein had a significantly increased risk for 7-day mortality after being hospitalized with COVID-19 compared with younger people with lower C-reactive protein. (OR = 3.44; 95% CI, 2.17-5.44).
“Since age and C-reactive protein are easily available on admission, clinicians can easily determine those who are at risk of worse outcomes early on,” Llanera said. “Hence, more aggressive interventions may be instituted appropriately.”
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Llanera DK, et al. Oral presentation 307. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 27-Oct. 1, 2021 (virtual meeting).
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