Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Aims COVID-19 is associated with diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and euglycaemic DKA (EDKA); however, evidence regarding parameters affecting outcome and mortality rates is scarce. Methods A systematic literature review was conducted using EMBASE, PubMed/Medline,...

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Bibliographic Details
Published in:Diabetology international 2021-10, Vol.12 (4), p.445-459
Main Authors: Papadopoulos, Vasileios P., Koutroulos, Marios-Vasileios, Zikoudi, Dimitra-Georgia, Bakola, Stefania-Aspasia, Avramidou, Peny, Touzlatzi, Ntilara, Filippou, Dimitrios K.
Format: Article
Language:English
Subjects:
Coexistence
Coronaviruses
COVID-19
Cross-sectional studies
Diabetes
Diabetes mellitus
Diabetic ketoacidosis
Endocrinology
Hyperglycemia
Ketoacidosis
Kidney diseases
Literature reviews
Medicine
Medicine & Public Health
Meta-analysis
Metabolic Diseases
Metabolism
Mortality
Original
Original Article
Osmotic pressure
Patients
Quality control
Renal function
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Summary:Aims COVID-19 is associated with diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and euglycaemic DKA (EDKA); however, evidence regarding parameters affecting outcome and mortality rates is scarce. Methods A systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 2020 to 7 January 2021 to identify all studies describing clinical profile, outcome and mortality rates regarding DKA, HHS, DKA/HHS and EDKA cases in COVID-19 patients. The appropriate Joanna Briggs Institute tools were used for quality assessment; quality of evidence was approached using GRADE. Univariate and multivariate analyses were used to assess correlations between clinical characteristics and outcome based on case reports. Combined mortality rates (CMR) were estimated from data reported in case report series, cross-sectional studies, and meta-analyses. The protocol was submitted to PROSPERO (ID: 229356/230737). Results From 312 identified publications, 44 were qualitatively and quantitatively analyzed. Critical COVID-19 necessitating ICU ( P  = 3 × 10 –8 ), DKA/HHS presence ( P  = 0.021), and AKI ( P  = 0.037) were independently correlated with death. Increased COVID-19 severity ( P  = 0.003), elevated lactates ( P  
ISSN:2190-1678
2190-1686
DOI:10.1007/s13340-021-00502-9