Diabetes predicts severity of COVID‐19 infection in a retrospective cohort: A mediatory role of the inflammatory biomarker C‐reactive protein

Diabetes is a risk factor for developing severe COVID‐19, but the pathogenesis remains unclear. We investigated if the association of diabetes and COVID‐19 severity may be mediated by inflammation. We also hypothesized that this increased risk may extend to prediabetes. Hospitalized patients in Sing...

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Bibliographic Details
Published in:Journal of Medical Virology 2021-05, Vol.93 (5), p.3023-3032
Main Authors: Koh, Huilin, Moh, Angela Mei Chung, Yeoh, Ester, Lin, Yi, Low, Serena Kiat Mun, Ooi, Say Tat, Tan, Seng Kiong, Lin, Jaime Hui Xian, Hoong, Caroline Wei Shan
Format: Article
Language:English
Subjects:
Adult
Biomarkers
Biomarkers - blood
Blood glucose
C-Reactive Protein - metabolism
Confidence intervals
COVID-19
COVID-19 - blood
COVID-19 - diagnosis
COVID-19 - epidemiology
Diabetes
Diabetes mellitus
Diabetes Mellitus - blood
Diabetes Mellitus - epidemiology
Dyspnea
Female
Health risks
Hospitalization - statistics & numerical data
Humans
Infections
Inflammation
Intensive care
Male
mediation
Middle Aged
Multivariate analysis
Pathogenesis
prediabetes
Prognosis
Proportional Hazards Models
Proteins
Regression analysis
Respiration
Respiratory rate
Retrospective Studies
Risk analysis
Risk Factors
SARS-CoV-2
severe COVID‐19
Severity of Illness Index
Singapore - epidemiology
Statistical analysis
Virology
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Summary:Diabetes is a risk factor for developing severe COVID‐19, but the pathogenesis remains unclear. We investigated if the association of diabetes and COVID‐19 severity may be mediated by inflammation. We also hypothesized that this increased risk may extend to prediabetes. Hospitalized patients in Singapore with COVID‐19 were subdivided into three groups in a retrospective cohort: normoglycemia (HbA1c: ≤5.6%), prediabetes (HbA1c: 5.7%–6.4%) and diabetes (HbA1c: ≥6.5%). The primary outcome of severe COVID‐19 was defined by respiratory rate ≥30, SpO2 ≤93% or intensive care unit admission. The association between clinical factors on severe COVID‐19 outcome was analyzed by cox regression. Adjusted mediation analysis of C‐reactive protein (CRP) on the relationship between diabetes and severe COVID‐19 was performed. Of 1042 hospitalized patients, mean age 39 ± 11 years, 13% had diabetes, 9% prediabetes and 78% normoglycemia. Severe COVID‐19 occurred in 4.9% of subjects. Compared to normoglycemia, diabetes was significantly associated with severe COVID‐19 on both univariate (hazard ratio [HR]: 9.94; 95% confidence interval [CI]: 5.54–17.84; p 
ISSN:0146-6615
1096-9071
DOI:10.1002/jmv.26837