糖尿病对COVID-19患者疾病严重程度和死亡率影响的Meta分析

doi:10.3969/j.issn.1004-583X.2022.05.001

摘要/Abstract

摘要：

目的糖尿病是一种慢性疾病,身体各个系统都有不同程度的损伤。大量研究指出糖尿病患者在新型冠状病毒肺炎(COVID-19)流行期间更加容易感染COVID-19并且更容易出现重症。本研究拟通过Meta分析来探明糖尿病与COVID-19严重程度和死亡率的关联性。方法使用关键词(1)“COVID-19” OR “SARS-CoV-2” OR “Coronavirus” OR “novel coronavirus” AND “clinical characteristics” (2)“COVID-19” OR “SARS-CoV-2” AND “Diabetes” 检索PubMed, Embase和中国知网的数据,筛选截至2021年2月发表的英文和中文期刊论著,提取数据后使用RevMan 5.4进行Meta分析,并使用Stata 12.0评估发表偏倚。结果共纳入82篇文献,合计35 715例患者。Meta分析结果显示,患糖尿病与COVID-19预后较差有关[OR 2.29 (2.14, 2.46), P<0.01; I²: 52%, P<0.01]。COVID-19患者中糖尿病患者相对非糖尿病患者发生重症[OR 2.40 (2.20, 2.62), P<0.01; I²: 49%, P<0.01]和死亡[OR 2.08 (1.70, 2.56 ), P<0.01; I²: 60%, P<0.01]的风险均升高。结论糖尿病是影响COVID-19患者的重症率和死亡率升高的一个重要因素,而针对糖尿病如何影响COVID-19预后的确切作用机制亟需进一步研究阐明。

关键词: 糖尿病, COVID-19, Meta分析

Abstract:

Objective Diabetes mellitus (DM) is chronic conditions with devastating multi-systemic complications and may be associated with sensitivity and severe form of Coronavirus Disease 2019 (COVID-19). Abundant studies prove that patients with DM are more vulnerable to be infected with COVID-19 and develop severe cases during the prevalence and spread of novel coronavirus pneumonia. The present study intends to conduct meta-analysis to acertain the correlation between DM and severity as well as mortality in patients with COVID-19.Methods The key words(1)“COVID-19” OR “SARS-CoV-2” OR “Coronavirus” OR “novel coronavirus” AND “clinical characteristics” (2)“COVID-19” OR “SARS-CoV-2” AND “Diabetes” were used to search the data available on PubMed, Embase and CNKI, periodicals and articles in English and Chinese published before Feb, 2021 were screened. RevMan 5.4 software was applied after data extraction to perform Meta-analysis, and the Stata 12.0 software was used to assess the publication bias. Results A total of 82 studies which included 35 715 patients were included. Meta-analysis showed that DM was associated with composite poor outcome(OR 2.29 [2.14, 2.46], P< 0.01; I²: 52%, P<0.01). The risk of severity (OR 2.40 [2.20, 2.62], P< 0.01; I²: 49%, P<0.01) and mortality(OR 2.08[1.70, 2.56], P< 0.01; I²: 60%, P<0.01) of DM patients with COVID-19 were elevated than those of patients without DM. Conclusion DM serves as a critical factor to impact the rate of severe cases of COVID-19 and mortality in patients with COVID-19. The mechanism of how DM impacting the prognosis of COVID-19 is required to be further clarified.

Key words: diabetes mellitus, COVID-19, Meta-analysis

中图分类号:

R581.7

林欣欣, 张楚涵, 孔颢霖, 何沐宸, 徐琳, 杨中汉. 糖尿病对COVID-19患者疾病严重程度和死亡率影响的Meta分析[J]. 临床荟萃, 2022, 37(5): 389-399.

Lin Xinxin, Zhang Chuhan, Kong Haolin, He Muchen, Xu Lin, Yang Zhonghan. Analysis on impacts of diabetes on the severity and mortality of patients with COVID-19: A Meta-analysis[J]. Clinical Focus, 2022, 37(5): 389-399.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.05.001

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I5/389

图/表 8

参考文献 97

[1]	Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19[J]. Lancet Diabetes Endocrinol, 2020, 8(6):546-550. doi: 10.1016/S2213-8587(20)30152-2 URL
[2]	曾文真, 刘彬, 金宇, 等. 永州市44例新型冠状病毒感染的肺炎患者临床特征分析[J]. 海南医学院学报, 2020, 26(13):967-971.
[3]	程克斌, 魏明, 沈虹, 等. 普通型和重型新型冠状病毒肺炎康复患者463例临床特征分析[J]. 上海医学, 2020, 43(4):224-232.
[4]	房晓伟, 梅清, 杨田军, 等. 2019新型冠状病毒感染的肺炎79例临床特征及治疗分析[J]. 中国药理学通报, 2020, 36(4):453-459.
[5]	李丹, 龙云铸, 黄彭, 等. 株洲地区80例新型冠状病毒肺炎患者临床特征分析[J]. 中国感染控制杂志, 2020, 19(3):227-233.
[6]	李若青, 陶静, 姚小红, 等. 新型冠状病毒肺炎重症患者相关危险因素多中心临床研究[J]. 中国药业, 2020, 29(9):15-18.
[7]	陶飞, 杨飞, 阮细祥, 等. 新型冠状病毒肺炎患者382例早期临床特征分析[J]. 实用医学杂志, 2020, 36(13):1705-1709.
[8]	王蓉, 谢伶俐, 杜鹏, 等. 新型冠状病毒肺炎96例临床分析[J]. 中国呼吸与危重监护杂志, 2020, 19(2):144-147.
[9]	向天新, 刘家明, 许飞, 等. 江西地区49例新型冠状病毒肺炎患者临床特征分析[J]. 中国呼吸与危重监护杂志, 2020, 19(2):154-160.
[10]	于洪志, 邵红霞, 邢志珩, 等. 天津地区新型冠状病毒肺炎患者临床特征分析[J]. 天津医药, 2020, 48(7):577-582.
[11]	袁婧, 孙艳雨, 左玉洁, 等. 重庆市223例新型冠状病毒肺炎患者的临床特征分析[J]. 西南大学学报: 自然科学版, 2020, 42(3):17-24.
[12]	袁小红, 秦大伟, 田峰, 等. COVID-19患者的流行病学与临床特征[J]. 分子影像学杂志, 2020, 43(3):381-386.
[13]	赵灿灿, 徐鹤, 李淑华, 等. 普通型与重型/危重型COVID-19病人的CT表现及临床特征比较[J]. 国际医学放射学杂志, 2020, 43(3):257-261.
[14]	左方田, 李长力, 董照刚, 等. 新型冠状病毒肺炎患者的临床特点及与严重程度的相关性分析[J]. 天津医药, 2020, 48(7):583-587.
[15]	Akbariqomi M, Hosseini MS, Rashidiani J, et al. Clinical characteristics and outcome of hospitalized COVID-19 patients with diabetes: A single-center, retrospective study in Iran[J]. Diabetes Res Clin Pract, 2020, 169: 108467. doi: 10.1016/j.diabres.2020.108467 URL
[16]	Aksu K, Naziroğlu T, Özkan P. Factors determining COVID-19 pneumonia severity in a country with routine BCG vaccination[J]. Clin Exp Immunol, 2020, 202(2):220-225. doi: 10.1111/cei.13507 URL
[17]	Almazeedi S, Al-Youha S, Jamal MH, et al. Characteristics, risk factors and outcomes among the first consecutive 1096 patients diagnosed with COVID-19 in Kuwait[J]. E Clinical Medicine, 2020, 24: 100448.
[18]	Amit M, Sorkin A, Chen J, et al. Clinical course and outcomes of severe covid-19: A national scale study[J]. J Clin Med, 2020, 9(7): 1-12. doi: 10.3390/jcm9010001 URL
[19]	Argenziano MG, Bruce SL, Slater CL, et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: Retrospective case series[J]. BMJ, 2020, 369: 1996.
[20]	Awano N, Inomata M, Kuse N, et al. Serum KL-6 level is a useful biomarker for evaluating the severity of coronavirus disease 2019[J]. Respir Investig, 2020, 58(6):440-447. doi: 10.1016/j.resinv.2020.07.004 URL
[21]	Bhatla A, Mayer MM, Adusumalli S, et al. COVID-19 and cardiac arrhythmias[J]. Heart Rhythm, 2020, 17(9): 1439-1444. doi: 10.1016/j.hrthm.2020.06.016 URL
[22]	Borobia AM, Carcas AJ, Arnalich F, et al. A cohort of patients with COVID-19 in a major teaching hospital in Europe[J]. J Clin Med, 2020, 9(6): 1-10. doi: 10.3390/jcm9010001 URL
[23]	Brill SE, Jarvis HC, Ozcan E, et al. COVID-19: A retrospective cohort study with focus on the over-80s and hospital-onset disease[J]. BMC Med, 2020, 18(1): 194. doi: 10.1186/s12916-020-01665-z URL
[24]	Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China[J]. Diabetes Care, 2020, 43(7): 1392-1398. doi: 10.2337/dc20-0576 URL
[25]	Cao Z, Li T, Liang L, et al. Clinical characteristics of Coronavirus Disease 2019 patients in Beijing, China[J]. PLoS One, 2020, 15(6): e0234764. doi: 10.1371/journal.pone.0234764 URL
[26]	Cen Y, Chen X, Shen Y, et al. Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study[J]. Clin Microbiol Infect, 2020, 26(9): 1242-1247. doi: 10.1016/j.cmi.2020.05.041 URL
[27]	Chang MC, Hwang JM, Jeon JH, et al. Fasting plasma glucose level independently predicts the mortality of patients with Coronavirus Disease 2019 infection: A multicenter, retrospective cohort study[J]. Endocrinol Metab (Seoul), 2020, 35(3):595-601. doi: 10.3803/EnM.2020.719 URL
[28]	Chen F, Sun W, Sun S, et al. Clinical characteristics and risk factors for mortality among inpatients with COVID-19 in Wuhan, China[J]. Clin Transl Med, 2020, 10(2):e40.
[29]	Chen Q, Zheng Z, Zhang C, et al. Clinical characteristics of 145 patients with corona virus disease 2019(COVID-19) in Taizhou, Zhejiang, China[J]. Infection, 2020, 48(4): 543-551. doi: 10.1007/s15010-020-01432-5 URL
[30]	Ciceri F, Castagna A, Rovere-Querini P, et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy[J]. Clin Immunol, 2020, 217: 108509. doi: 10.1016/j.clim.2020.108509 URL
[31]	Colaneri M, Sacchi P, Zuccaro V, et al. Clinical characteristics of coronavirus disease(COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020[J]. Eurosurveillance, 2020, 25(16): 2000460.
[32]	Ebinger JE, Achamallah N, Ji H, et al. Pre-existing traits associated with Covid-19 illness severity[J]. PLoS One, 2020, 15(7): e0236240. doi: 10.1371/journal.pone.0236240 URL
[33]	Fadini GP, Morieri ML, Boscari F, et al. Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration[J]. Diabetes Res Clin Pract, 2020, 168: 108374. doi: 10.1016/j.diabres.2020.108374 URL
[34]	Fang H, Liu Q, Xi M, et al. Impact of comorbidities on clinical prognosis in 1280 patients with different types of COVID-19[J]. J Investig Med, 2021, 69(1): 75-85. doi: 10.1136/jim-2020-001555 URL
[35]	Giorgi Rossi P, Marino M, Formisano D, et al. Characteristics and outcomes of a cohort of COVID-19 patients in the Province of Reggio Emilia, Italy[J]. PLoS one, 2020, 15(8): e0238281. doi: 10.1371/journal.pone.0238281 URL
[36]	Grasselli G, Greco M, Zanella A, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy[J]. JAMA Intern Med, 2020, 180(10): 1345-1355. doi: 10.1001/jamainternmed.2020.3539 URL
[37]	Huang R, Zhu L, Xue L, et al. Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: A retrospective, multi-center study[J]. PLoS Negl Trop Dis, 2020, 14(5): e0008280. doi: 10.1371/journal.pntd.0008280 URL
[38]	Huang Y, Cai C, Zang J, et al. Treatment strategies of hospitalized patients with coronavirus disease-19[J]. Aging(Albany NY), 2020, 12(12): 11224-11237.
[39]	Huang J, Zhu L, Bai X, et al. Multidimensional analysis of risk factors for the severity and mortality of patients with COVID-19 and diabetes[J]. Infect Dis Ther, 2020, 9(4): 981-1002. doi: 10.1007/s40121-020-00359-6 pmid: 33113119
[40]	Israelsen SB, Kristiansen KT, Hindsberger B, et al. Characteristics of patients with covid-19 pneumonia at hvidovre hospital, March-April 2020[J]. Dan Med J, 2020, 67(6): 1-4.
[41]	Jiang H, Guo W, Shi Z, et al. Clinical imaging characteristics of inpatients with coronavirus disease-2019 in Heilongjiang Province, China: A retrospective study[J]. Aging(Albany NY), 2020, 12(14): 13860-13868.
[42]	Jiang Y, He S, Zhang C, et al. Clinical characteristics of 60 discharged cases of 2019 novel coronavirus-infected pneumonia in Taizhou, China[J]. Ann Transl, 2020, 8(8):547.
[43]	Jing Z, Hao-Yu G, Zi-Yi F, et al. A retrospective analysis of the clinical and epidemiological characteristics of COVID-19 patients in Henan Provincial People's Hospital, Zhengzhou, China[J]. Front Med(Lausanne), 2020, 7: 286.
[44]	Kayina CA, Haritha D, Soni L, et al. Epidemiological & clinical characteristics & early outcome of COVID-19 patients in a tertiary care teaching hospital in India: A preliminary analysis[J]. Indian J Med Res, 2020, 152(1): 100.
[45]	Khamis F, Al-Zakwani I, Al Naamani H, et al. Clinical characteristics and outcomes of the first 63 adult patients hospitalized with COVID-19: An experience from Oman[J]. J Infect Public Health, 2020, 13(7): 906-913. doi: 10.1016/j.jiph.2020.06.002 URL
[46]	Lendorf ME, Boisen MK, Kristensen PL, et al. Characteristics and early outcomes of patients hospitalised for COVID-19 in North Zealand, Denmark[J]. Dan Med J, 2020, 67(9): A06200428.
[47]	Li G, Deng Q, Feng J, et al. Clinical characteristics of diabetic patients with COVID-19[J]. J Diabetes Res, 2020, 2020: 1652403.
[48]	Li S, Jiang L, Li X, et al. Clinical and pathological investigation of patients with severe COVID-19[J]. JCI Insight, 2020, 5(12):e138070. doi: 10.1172/jci.insight.138070 URL
[49]	Liu J, Zhang S, Wu Z, et al. Clinical outcomes of COVID-19 in Wuhan, China: A large cohort study[J]. Ann Intensive Care, 2020, 10(1): 1-21. doi: 10.1186/s13613-019-0618-4 URL
[50]	Lv Z, Cheng S, Le J, et al. Clinical characteristics and co-infections of 354 hospitalized patients with COVID-19 in Wuhan, China: A retrospective cohort study[J]. Microbes Infect, 2020, 22(4-5): 195-199. doi: 10.1016/j.micinf.2020.05.007 URL
[51]	Ming X, Mengdie L, Weiqiang Z, et al. Clinical analysis of 23 patients with coronavirus disease 2019 in Xinyang City of Henan Province[J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2020, 32(4): 421-425.
[52]	Nie Y, Li J, Huang X, et al. Epidemiological and clinical characteristics of 671 COVID-19 patients in Henan Province, China[J]. Int J Epidemiol, 2020, 49(4): 1085-1095. doi: 10.1093/ije/dyaa081 URL
[53]	Nowak B, Szymański P, Pańkowski I, et al. Clinical characteristics and short-term outcomes of patients with coronavirus disease 2019: A retrospective single-center experience of a designated hospital in Poland[J]. Pol Arch Intern Med, 2020, 130(5): 407-411.
[54]	Ortiz-Brizuela E, Villanueva-Reza M, González-Lara MF, et al. Clinical and epidemiological characteristics of patients diagnosed with COVID-19 in a tertiary care center in mexico city: A prospective cohort study[J]. Rev Invest Clin, 2020, 72(3): 165-177. doi: 10.24875/RIC.20000211 pmid: 32584326
[55]	Pellaud C, Grandmaison G, Pham Huu Thien HP, et al. Characteristics, comorbidities, 30-day outcome and in-hospital mortality of patients hospitalised with COVID-19 in a Swiss area - a retrospective cohort study[J]. Swiss Med Wkly, 2020, 150: w20314.
[56]	Qin W, Hu BZ, Zhang Z, et al. Clinical characteristics and death risk factors of severe COVID-19[J]. Zhonghua Jie He He Hu Xi Za Zhi, 2020, 43(8): 648-653.
[57]	Shabrawishi M, Al-Gethamy MM, Naser AY, et al. Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia[J]. PLoS One, 2020, 15(8): e0237130. doi: 10.1371/journal.pone.0237130 URL
[58]	Shah P, Owens J, Franklin J, et al. Demographics, comorbidities and outcomes in hospitalized Covid-19 patients in rural southwest Georgia[J]. Ann Med, 2020, 52(7):354-360. doi: 10.1080/07853890.2020.1791356 URL
[59]	Shahriarirad R, Khodamoradi Z, Erfani A, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases(COVID-19) in the South of Iran[J]. BMC Infect Dis, 2020, 20(1): 427. doi: 10.1186/s12879-020-05128-x pmid: 32552751
[60]	Shi Y, Yu X, Zhao H, et al. Host susceptibility to severe COVID-19 and establishment of a host risk score: Findings of 487 cases outside Wuhan[J]. Crit Care, 2020, 24(1): 1-4. doi: 10.1186/s13054-019-2683-3 URL
[61]	Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with Coronavirus Disease 2019 in a series of patients in Metropolitan Detroit[J]. JAMA Netw Open, 2020, 3(6): e2012270. doi: 10.1001/jamanetworkopen.2020.12270 URL
[62]	Sun L, Song F, Shi N, et al. Combination of four clinical indicators predicts the severe/critical symptom of patients infected COVID-19[J]. J Clin Virol, 2020, 128: 104431. doi: 10.1016/j.jcv.2020.104431 URL
[63]	Tabata S, Imai K, Kawano S, et al. Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: A retrospective analysis[J]. Lancet Infect Dis, 2020, 20(9): 1043-1050. doi: 10.1016/S1473-3099(20)30482-5 URL
[64]	Wan S, Xiang Y, Fang W, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing[J]. J Med Virol, 2020, 92(7): 797-806. doi: 10.1002/jmv.25783 URL
[65]	Wang D, Li R, Wang J, et al. Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: A descriptive study[J]. BMC Infect Dis, 2020, 20(1): 519. doi: 10.1186/s12879-020-05242-w pmid: 32677918
[66]	Wang W, Xin C, Xiong Z, et al. Clinical characteristics and outcomes of 421 patients with coronavirus disease 2019 treated in a mobile cabin hospital[J]. Chest, 2020, 158(3): 939-946. doi: S0012-3692(20)31391-X pmid: 32437696
[67]	Wei Y, Zeng W, Huang X, et al. Clinical characteristics of 276 hospitalized patients with coronavirus disease 2019 in Zengdu District, Hubei Province: A single-center descriptive study[J]. BMC Infect Dis, 2020, 20(1): 1-10. doi: 10.1186/s12879-019-4717-5 URL
[68]	Xu Z, Wang Z, Wang S, et al. The impact of type 2 diabetes and its management on the prognosis of patients with severe COVID-19[J]. J Diabetes, 2020, 12(12): 909-918. doi: 10.1111/1753-0407.13084 URL
[69]	Yan X, Han X, Peng D, et al. Clinical characteristics and prognosis of 218 patients with COVID-19: A retrospective study based on clinical classification[J]. Front Med(Lausanne), 2020, 7: 485.
[70]	Zhang Y, Cui Y, Shen M, et al. Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study[J]. Diabetes Res Clin Pract, 2020, 165: 108227. doi: 10.1016/j.diabres.2020.108227 URL
[71]	Yang L, Liu J, Zhang R, et al. Epidemiological and clinical features of 200 hospitalized patients with corona virus disease 2019 outside Wuhan, China: A descriptive study[J]. J Clin Virol, 2020, 129: 104475. doi: 10.1016/j.jcv.2020.104475 URL
[72]	Yao Q, Wang P, Wang X, et al. A retrospective study of risk factors for severe acute respiratory syndrome coronavirus 2 infections in hospitalized adult patients[J]. Pol Arch Intern Med, 2020, 130(5): 390-399.
[73]	Wang Y, Liao B, Guo Y, et al. Clinical characteristics of patients infected with the novel 2019 coronavirus(SARS-Cov-2) in Guangzhou, China[J]. Open Forum Infect Dis, 2020, 7(6): ofaa187. doi: 10.1093/ofid/ofaa187 URL
[74]	Yu C, Lei Q, Li W, et al. Clinical characteristics, associated factors, and predicting COVID-19 mortality risk: A retrospective study in Wuhan, China[J]. Am J Prev Med, 2020, 59(2): 168-175. doi: 10.1016/j.amepre.2020.05.002 URL
[75]	Yu X, Sun X, Cui P, et al. Epidemiological and clinical characteristics of 333 confirmed cases with coronavirus disease 2019 in Shanghai, China[J]. Transbound Emerg Dis, 2020, 67(4): 1697-1707. doi: 10.1111/tbed.13604 URL
[76]	Yu C, Lei Q, Li W, et al. Epidemiological and clinical characteristics of 1663 hospitalized patients infected with COVID-19 in Wuhan, China: A single-center experience[J]. J Infect Public Health, 2020, 13(9):1202-1209. doi: 10.1016/j.jiph.2020.07.002 URL
[77]	Liu Z, Li J, Huang J, et al. Association between diabetes and COVID-19: A retrospective observational study with a large sample of 1, 880 cases in Leishenshan Hospital, Wuhan[J]. Front Endocrinol (Lausanne), 2020, 11: 478. doi: 10.3389/fendo.2020.00478 URL
[78]	Zhang G, Hu C, Luo L, et al. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China[J]. J Clin Virol, 2020, 127: 104364. doi: 10.1016/j.jcv.2020.104364 URL
[79]	Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China[J]. Allergy, 2020, 75(7): 1730-1741. doi: 10.1111/all.14238 URL
[80]	Zhang S, Liu L, Yang B, et al. Clinical characteristics of 134 convalescent patients with COVID-19 in Guizhou, China[J]. Respir Res, 2020, 21(1): 1-10. doi: 10.1186/s12931-019-1261-1 URL
[81]	Zhao XY, Xu XX, Yin HS, et al. Clinical characteristics of patients with 2019 coronavirus disease in a non-Wuhan area of Hubei Province, China: A retrospective study[J]. BMC Infect Dis, 2020, 20(1): 311. doi: 10.1186/s12879-020-05010-w URL
[82]	Zheng Y, Xiong C, Liu Y, et al. Epidemiological and clinical characteristics analysis of COVID-19 in the surrounding areas of Wuhan, Hubei Province in 2020[J]. Pharmacological Research, 2020, 157: 104821. doi: 10.1016/j.phrs.2020.104821 URL
[83]	Zhu Q, Zhang W, Wang Q, et al. Clinical characteristics and outcome of 64 patients with severe COVID-19[J]. Zhonghua Jie He He Hu Xi Za Zhi, 2020, 43(8): 659-664.
[84]	Kumar A, Arora A, Sharma P, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis[J]. Diabetes Metab Syndr, 2020, 14(4): 535-545. doi: 10.1016/j.dsx.2020.04.044 URL
[85]	Adeshara K, G Diwan A, S Tupe R. Diabetes and complications: Cellular signaling pathways, current understanding and targeted therapies[J]. Curr Drug Targets, 2016, 17(11): 1309-1328. pmid: 26648059
[86]	Forbes JM, Cooper ME. Mechanisms of diabetic complications[J]. Physiological reviews, 2013, 93(1): 137-188. doi: 10.1152/physrev.00045.2011 URL
[87]	Karásek D, Vaverková H. Diabetic dyslipidemia and microvascular complications of diabetes[J]. Vnitr Lek, 2018, 64(1): 17-24. doi: 10.36290/vnl.2018.003 URL
[88]	Filippatos T, Tsimihodimos V, Pappa E, et al. Pathophysiology of diabetic dyslipidaemia[J]. Curr Vasc Pharmacol, 2017, 15(6):566-575.
[89]	Domingueti CP, Dusse LMSA, das Graças Carvalho M, et al. Diabetes mellitus: The linkage between oxidative stress, inflammation, hypercoagulability and vascular complications[J]. J Diabetes Complications, 2016, 30(4): 738-745. doi: 10.1016/j.jdiacomp.2015.12.018 URL
[90]	Volpe CMO, Villar-Delfino PH, Dos Anjos PMF, et al. Cellular death, reactive oxygen species (ROS) and diabetic complications[J]. Cell Death Dis, 2018, 9(2):119. doi: 10.1038/s41419-017-0135-z URL
[91]	Rendra E, Riabov V, Mossel DM, et al. Reactive oxygen species (ROS) in macrophage activation and function in diabetes[J]. Immunobiology, 2019, 224(2):242-253. doi: S0171-2985(18)30213-4 pmid: 30739804
[92]	McElvaney OJ, McEvoy NL, McElvaney OF, et al. Characterization of the inflammatory response to severe COVID-19 illness[J]. Am J Respir Crit Care Med, 2020, 202(6):812-821. doi: 10.1164/rccm.202005-1583OC URL
[93]	Jing Liang J, Liu J, Chen Y, et al. Characteristics of laboratory findings of COVID-19 patients with comorbid diabetes mellitus[J]. Diabetes Res Clin Pract, 2020, 167:108351. doi: 10.1016/j.diabres.2020.108351 URL
[94]	Zhang X, Li S, Niu S. ACE2 and COVID-19 and the resulting ARDS[J]. Postgrad Med J, 2020, 96(1137):403-407. doi: 10.1136/postgradmedj-2020-137935 URL
[95]	Obukhov AG, Stevens BR, Prasad R, et al. SARS-CoV-2 infections and ACE2: Clinical outcomes linked with increased morbidity and mortality in individuals with diabetes[J]. Diabetes, 2020, 69(9):1875-1886. doi: 10.2337/dbi20-0019 URL
[96]	Soldo J, Heni M, Königsrainer A, et al. Increased hepatic ACE2 expression in NAFL and diabetes-A risk for COVID-19 patients?[J]. Diabetes Care, 2020, 43(10): e134-e136. doi: 10.2337/dc20-1458 URL
[97]	Valencia I, Peiró C, Lorenzo Ó, et al. DPP4 and ACE2 in diabetes and COVID-19: Therapeutic targets for cardiovascular complications?[J]. Front Pharmacol, 2020, 11: 1161. doi: 10.3389/fphar.2020.01161 pmid: 32848769

研究	地区	医院	样本量	糖尿病总人数	非糖尿病总人数	结局
曾文真2020^[2]	永州,中国	永州市中心医院	44	2	42	严重/危重
程克斌2020^[3]	武汉,中国	金银潭医院	503	40	463	严重/危重
房晓伟2020^[4]	安徽,中国	安徽省立医院	79	8	71	严重/危重
李丹2020^[5]	株洲,中国	/	80	10	70	严重/危重
李若青2020^[6]	湖北,中国	大悟县中医医院,汉川市人民医院	193	27	166	严重/危重
陶飞2020^[7]	武汉,中国	华中科技大学协和江北医院济和病区/武汉济和医院	382	31	351	严重/危重
王蓉2020^[8]	武汉,中国	长江航运总医院	96	25	71	严重/危重
向天新2020^[9]	江西,中国	南昌大学第一附属医院	49	2	47	严重/危重
于洪志2020^[10]	天津,中国	天津市海河医院	135	20	115	严重/危重
袁婧2020^[11]	重庆,中国	重庆市公共卫生医疗救治中心	223	18	205	严重/危重
袁小红2020^[12]	临沂,中国	临沂市疫情网公布信息和电子病历系统	41	5	36	严重/危重
赵灿灿2020^[13]	安徽,中国	蚌埠医学院第一附属医院和阜阳市第二人民医院	189	16	173	严重/危重
左方田2020^[14]	河南,中国	南阳市中心医院	50	5	45	严重/危重
Akbariqomi 2020^[15]	Tehran, Iran	Baqiyatallah Hospital	595	148	447	严重/危重
Aksu 2020^[16]	Istanbul, Turkey	a state hospital in Istanbul, Turkey	123	31	92	严重/危重
Almazeedi 2020^[17]	Kuwait	Jaber Al-Ahmad Al-Sabah Hospital	1 096	155	941	严重/危重
Amit 2020^[18]	Israel	the Medical Corps-Israel Defense Forces	176	62	114	严重/危重
Argenziano 2020^[19]	NewYork, USA	NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC)	1 000	372	628	严重/危重
Awano 2020^[20]	Tokyo, Japan	the Japanese Red Cross Medical Center	54	11	43	严重/危重
Bhatla 2020^[21]	Pennsylvania, USA	/	700	182	518	严重/危重
Borobia 2020^[22]	Spain	La Paz University Hospital	2 226	381	1 845	严重/危重
Brill 2020^[23]	UK	Barnet Hospital	450	134	316	死亡
Cai 2020^[24]	Shenzhen, China	the Third People's Hospital of Shenzhen	298	18	280	严重/危重
Cao 2020^[25]	Beijing, China	Beijing You’an Hospital	80	6	74	严重/危重
Cen 2020^[26]	Wuhan, China	Huoshenshan Hospital, General Hospital of the Central Theatre Command of the People's Liberation Army, and mobile cabin hospitals	1 007	119	888	严重/危重
Chang 2020^[27]	Daegu, South Korea	Kyungpook National University Chilgok Hospital and Kyungpook National University Hospital	106	42	64	死亡
Chen 2020^[28]	Wuhan, China	The Central Hospital of Wuhan	660	114	546	死亡
Chen 2020a^[29]	Taizhou, China	Taizhou Public Health Medical Center	145	14	131	严重/危重
Ciceri 2020^[30]	Milan, Italy	San Raffaele Hospital	406	69	337	死亡
Colaneri 2020^[31]	Parvia,Italy	a single hospital in Pavia	44	7	37	严重/危重
Ebinger 2020^[32]	Los Angeles, USA	Cedars-Sinai Medical Center	442	84	358	严重/危重
Fadini 2020^[33]	Padova, Italy	the University Hospital of Padova	413	107	306	死亡
Fang 2021^[34]	Wuhan,China	Wuhan Third Hospital	1 280	184	1 096	严重/危重
Giorgi 2020^[35]	Reggio Emilia, Italy	/	2 653	284	2 369	死亡
Grasselli 2020^[36]	Lombardy, Italy	Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Ca' Granda Ospedale Maggiore Policlinico	3 988	514	3 474	死亡
Huang 2020^[37]	Jiangsu, China	8 designated hospitals in 8 cities of Jiangsu province	202	19	183	严重/危重
Huang 2020a^[38]	Changsha, China	the north hospital of the First Hospital	238	15	223	严重/危重
Huang 2020b^[39]	Wuhan,China	Central Hospital of Wuhan	1 443	256	1 187	严重/危重
Israelsen 2020^[40]	Denmark	Hvidovre Hospital	175	46	129	严重/危重
Jiang 2020^[41]	Heilongjiang, China	Second Affiliated Hospital of Harbin Medical University	59	9	50	严重/危重
Jiang 2020a^[42]	Taizhou, China	Taizhou Enze Medical Center	60	1	59	严重/危重
Jing 2020^[43]	Zhengzhou, China	Henan Provincial People's Hospital	29	7	22	严重/危重
Kayina 2020^[44]	New Delhi, India	All India Institute of Medical Sciences (AIIMS)	235	54	181	死亡
Khamis 2020^[45]	Oman	the Royal Hospital and Al Nahdha Hospital	63	20	43	严重/危重
Lendorf 2020^[46]	Denmark	the North Zealand Hospital	111	16	95	严重/危重
Li 2020^[47]	Wuhan, China	Wuhan Red Cross Hospital	199	76	123	死亡
Li 2020a^[48]	Beijing, China	the Fifth Medical Center of PLA General Hospital	69	8	61	严重/危重
Liu 2020^[49]	Wuhan, China	Wuhan Infectious Disease Hospital	1 190	144	1 046	死亡
Lv 2020^[50]	Wuhan, China	Renmin Hospital of Wuhan University	354	35	319	严重/危重
Ming 2020^[51]	信阳,中国	信阳市第五人民医院	23	2	21	严重/危重
Nie 2020^[52]	Henan, China	279 hospitals in Henan	655	11	644	严重/危重
Nowak 2020^[53]	Warsaw	the Central Clinical Hospital of the Ministry of the Interior and Administration	169	32	137	死亡
Ortiz-Brizuela 2020^[54]	Mexico	a tertiary-care center in Mexico City	140	32	108	严重/危重
Pellaud 2020^[55]	Fribourg, Switzerland	Fribourg hospital (HFR)	196	52	144	严重/危重
Qin 2020^[56]	Wuhan, China	江汉大学附属医院	582	69	513	死亡
Shabrawishi 2020^[57]	Saudi Arabia	the Al-Noor Specialist Hospital	150	38	112	严重/危重
Shah 2020^[58]	rural southwest Georgia	Phoebe Putney Memorial Hospital	522	221	301	死亡
Shahriarirad 2020^[59]	Shiraz, Iran	Shiraz University of Medical Sciences	113	16	97	严重/危重
Shi 2020^[60]	Zhejiang, China	/	487	29	458	严重/危重
Suleyman 2020^[61]	Southeast Michigan	Henry Ford Hospital	355	156	199	严重/危重
Sun 2020^[62]	Shanghai, China	Shanghai Public Heath Clinical Center	330	29	301	严重/危重
Tabata 2020^[63]	Tokyo, Japan	the Self-Defense Forces Central Hospital	71	2	69	严重/危重
Wan 2020^[64]	Chongqing, China	the Chongqing University Three Gorges Hospital	135	12	123	严重/危重
Wang 2020^[65]	Wuhan, China	Hubei NO.3 People’s Hospital of Jianghan University	143	13	130	严重/危重
Wang 2020a^[66]	Wuhan, China	Cabin C of Dongxihu Cabin Hospital	421	13	408	严重/危重
Wei 2020^[67]	Zengdu, China	Zengdu Hospital	276	14	262	严重/危重
Xu 2020^[68]	Wuhan, China	Renmin Hospital of Wuhan University	364	114	250	死亡
Yan 2020^[69]	Hunan, China	Shaoyang Central Hospital, Loudi Central Hospital, and Xiangtan Central Hospital	218	27	191	严重/危重
Yan 2020a^[70]	Wuhan, China	the West Court of Union Hospital	258	63	195	严重/危重
Yang 2020^[71]	Yichang, China	Yichang Central People's Hospital	200	21	179	严重/危重
Yao 2020^[72]	Huanggang, China	Dabieshan Medical Center	108	5	103	严重/危重
Wang 2020^[73]	Guangzhou, China	the Guangzhou Eighth People’s Hospital	275	17	258	严重/危重
Yu 2020^[74]	Wuhan, China	Tongji Hospital	1 464	211	1 253	死亡
Yu 2020a^[75]	Shanghai, China	Center for Disease Control and Prevention	307	23	284	严重/危重
Yu 2020b^[76]	Wuhan, China	Tongji Hospital	1 663	245	1 418	严重/危重
Liu 2020^[77]	Wuhan, China	Leishenshan Hospital	934	139	795	严重/危重
Zhang 2020^[78]	Wuhan,China	Zhongnan Hospital of Wuhan University	221	22	199	严重/危重
Zhang 2020a^[79]	Wuhan, China	No. 7 Hospital of Wuhan	140	17	123	严重/危重
Zhang 2020b^[80]	Guizhou,China	Guizhou Provincial Staff Hospital	134	10	124	严重/危重
Zhao 2020^[81]	Jingzhou, China	Jingzhou Central Hospital	91	3	88	严重/危重
Zheng 2020^[82]	Shiyan,China	Taihe Hospital	73	4	69	严重/危重
Zhu 2020^[83]	武汉,中国	武汉肺科医院	64	20	44	死亡

研究	地区	医院	样本量	糖尿病总人数	非糖尿病总人数	结局
曾文真2020^[2]	永州,中国	永州市中心医院	44	2	42	严重/危重
程克斌2020^[3]	武汉,中国	金银潭医院	503	40	463	严重/危重
房晓伟2020^[4]	安徽,中国	安徽省立医院	79	8	71	严重/危重
李丹2020^[5]	株洲,中国	/	80	10	70	严重/危重
李若青2020^[6]	湖北,中国	大悟县中医医院,汉川市人民医院	193	27	166	严重/危重
陶飞2020^[7]	武汉,中国	华中科技大学协和江北医院济和病区/武汉济和医院	382	31	351	严重/危重
王蓉2020^[8]	武汉,中国	长江航运总医院	96	25	71	严重/危重
向天新2020^[9]	江西,中国	南昌大学第一附属医院	49	2	47	严重/危重
于洪志2020^[10]	天津,中国	天津市海河医院	135	20	115	严重/危重
袁婧2020^[11]	重庆,中国	重庆市公共卫生医疗救治中心	223	18	205	严重/危重
袁小红2020^[12]	临沂,中国	临沂市疫情网公布信息和电子病历系统	41	5	36	严重/危重
赵灿灿2020^[13]	安徽,中国	蚌埠医学院第一附属医院和阜阳市第二人民医院	189	16	173	严重/危重
左方田2020^[14]	河南,中国	南阳市中心医院	50	5	45	严重/危重
Akbariqomi 2020^[15]	Tehran, Iran	Baqiyatallah Hospital	595	148	447	严重/危重
Aksu 2020^[16]	Istanbul, Turkey	a state hospital in Istanbul, Turkey	123	31	92	严重/危重
Almazeedi 2020^[17]	Kuwait	Jaber Al-Ahmad Al-Sabah Hospital	1 096	155	941	严重/危重
Amit 2020^[18]	Israel	the Medical Corps-Israel Defense Forces	176	62	114	严重/危重
Argenziano 2020^[19]	NewYork, USA	NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC)	1 000	372	628	严重/危重
Awano 2020^[20]	Tokyo, Japan	the Japanese Red Cross Medical Center	54	11	43	严重/危重
Bhatla 2020^[21]	Pennsylvania, USA	/	700	182	518	严重/危重
Borobia 2020^[22]	Spain	La Paz University Hospital	2 226	381	1 845	严重/危重
Brill 2020^[23]	UK	Barnet Hospital	450	134	316	死亡
Cai 2020^[24]	Shenzhen, China	the Third People's Hospital of Shenzhen	298	18	280	严重/危重
Cao 2020^[25]	Beijing, China	Beijing You’an Hospital	80	6	74	严重/危重
Cen 2020^[26]	Wuhan, China	Huoshenshan Hospital, General Hospital of the Central Theatre Command of the People's Liberation Army, and mobile cabin hospitals	1 007	119	888	严重/危重
Chang 2020^[27]	Daegu, South Korea	Kyungpook National University Chilgok Hospital and Kyungpook National University Hospital	106	42	64	死亡
Chen 2020^[28]	Wuhan, China	The Central Hospital of Wuhan	660	114	546	死亡
Chen 2020a^[29]	Taizhou, China	Taizhou Public Health Medical Center	145	14	131	严重/危重
Ciceri 2020^[30]	Milan, Italy	San Raffaele Hospital	406	69	337	死亡
Colaneri 2020^[31]	Parvia,Italy	a single hospital in Pavia	44	7	37	严重/危重
Ebinger 2020^[32]	Los Angeles, USA	Cedars-Sinai Medical Center	442	84	358	严重/危重
Fadini 2020^[33]	Padova, Italy	the University Hospital of Padova	413	107	306	死亡
Fang 2021^[34]	Wuhan,China	Wuhan Third Hospital	1 280	184	1 096	严重/危重
Giorgi 2020^[35]	Reggio Emilia, Italy	/	2 653	284	2 369	死亡
Grasselli 2020^[36]	Lombardy, Italy	Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Ca' Granda Ospedale Maggiore Policlinico	3 988	514	3 474	死亡
Huang 2020^[37]	Jiangsu, China	8 designated hospitals in 8 cities of Jiangsu province	202	19	183	严重/危重
Huang 2020a^[38]	Changsha, China	the north hospital of the First Hospital	238	15	223	严重/危重
Huang 2020b^[39]	Wuhan,China	Central Hospital of Wuhan	1 443	256	1 187	严重/危重
Israelsen 2020^[40]	Denmark	Hvidovre Hospital	175	46	129	严重/危重
Jiang 2020^[41]	Heilongjiang, China	Second Affiliated Hospital of Harbin Medical University	59	9	50	严重/危重
Jiang 2020a^[42]	Taizhou, China	Taizhou Enze Medical Center	60	1	59	严重/危重
Jing 2020^[43]	Zhengzhou, China	Henan Provincial People's Hospital	29	7	22	严重/危重
Kayina 2020^[44]	New Delhi, India	All India Institute of Medical Sciences (AIIMS)	235	54	181	死亡
Khamis 2020^[45]	Oman	the Royal Hospital and Al Nahdha Hospital	63	20	43	严重/危重
Lendorf 2020^[46]	Denmark	the North Zealand Hospital	111	16	95	严重/危重
Li 2020^[47]	Wuhan, China	Wuhan Red Cross Hospital	199	76	123	死亡
Li 2020a^[48]	Beijing, China	the Fifth Medical Center of PLA General Hospital	69	8	61	严重/危重
Liu 2020^[49]	Wuhan, China	Wuhan Infectious Disease Hospital	1 190	144	1 046	死亡
Lv 2020^[50]	Wuhan, China	Renmin Hospital of Wuhan University	354	35	319	严重/危重
Ming 2020^[51]	信阳,中国	信阳市第五人民医院	23	2	21	严重/危重
Nie 2020^[52]	Henan, China	279 hospitals in Henan	655	11	644	严重/危重
Nowak 2020^[53]	Warsaw	the Central Clinical Hospital of the Ministry of the Interior and Administration	169	32	137	死亡
Ortiz-Brizuela 2020^[54]	Mexico	a tertiary-care center in Mexico City	140	32	108	严重/危重
Pellaud 2020^[55]	Fribourg, Switzerland	Fribourg hospital (HFR)	196	52	144	严重/危重
Qin 2020^[56]	Wuhan, China	江汉大学附属医院	582	69	513	死亡
Shabrawishi 2020^[57]	Saudi Arabia	the Al-Noor Specialist Hospital	150	38	112	严重/危重
Shah 2020^[58]	rural southwest Georgia	Phoebe Putney Memorial Hospital	522	221	301	死亡
Shahriarirad 2020^[59]	Shiraz, Iran	Shiraz University of Medical Sciences	113	16	97	严重/危重
Shi 2020^[60]	Zhejiang, China	/	487	29	458	严重/危重
Suleyman 2020^[61]	Southeast Michigan	Henry Ford Hospital	355	156	199	严重/危重
Sun 2020^[62]	Shanghai, China	Shanghai Public Heath Clinical Center	330	29	301	严重/危重
Tabata 2020^[63]	Tokyo, Japan	the Self-Defense Forces Central Hospital	71	2	69	严重/危重
Wan 2020^[64]	Chongqing, China	the Chongqing University Three Gorges Hospital	135	12	123	严重/危重
Wang 2020^[65]	Wuhan, China	Hubei NO.3 People’s Hospital of Jianghan University	143	13	130	严重/危重
Wang 2020a^[66]	Wuhan, China	Cabin C of Dongxihu Cabin Hospital	421	13	408	严重/危重
Wei 2020^[67]	Zengdu, China	Zengdu Hospital	276	14	262	严重/危重
Xu 2020^[68]	Wuhan, China	Renmin Hospital of Wuhan University	364	114	250	死亡
Yan 2020^[69]	Hunan, China	Shaoyang Central Hospital, Loudi Central Hospital, and Xiangtan Central Hospital	218	27	191	严重/危重
Yan 2020a^[70]	Wuhan, China	the West Court of Union Hospital	258	63	195	严重/危重
Yang 2020^[71]	Yichang, China	Yichang Central People's Hospital	200	21	179	严重/危重
Yao 2020^[72]	Huanggang, China	Dabieshan Medical Center	108	5	103	严重/危重
Wang 2020^[73]	Guangzhou, China	the Guangzhou Eighth People’s Hospital	275	17	258	严重/危重
Yu 2020^[74]	Wuhan, China	Tongji Hospital	1 464	211	1 253	死亡
Yu 2020a^[75]	Shanghai, China	Center for Disease Control and Prevention	307	23	284	严重/危重
Yu 2020b^[76]	Wuhan, China	Tongji Hospital	1 663	245	1 418	严重/危重
Liu 2020^[77]	Wuhan, China	Leishenshan Hospital	934	139	795	严重/危重
Zhang 2020^[78]	Wuhan,China	Zhongnan Hospital of Wuhan University	221	22	199	严重/危重
Zhang 2020a^[79]	Wuhan, China	No. 7 Hospital of Wuhan	140	17	123	严重/危重
Zhang 2020b^[80]	Guizhou,China	Guizhou Provincial Staff Hospital	134	10	124	严重/危重
Zhao 2020^[81]	Jingzhou, China	Jingzhou Central Hospital	91	3	88	严重/危重
Zheng 2020^[82]	Shiyan,China	Taihe Hospital	73	4	69	严重/危重
Zhu 2020^[83]	武汉,中国	武汉肺科医院	64	20	44	死亡