The causes of death in 54 patients with type 2 diabetes mellitus complicated with COVID-19

doi:10.3969/j.issn.1004-583X.2023.09.006

Abstract

Abstract:

Objective To analyze the clinical characteristics and possible influencing factors for death of patients with type 2 diabetes mellitus (T2DM) complicated with coronavirus disease 2019 (COVID-19). Methods It was a retrospective analysis involving T2DM patients with COVID-19 who died during hospitalization in the Clinical Medical College of Yangzhou University from December 2022 to February 2023. General information and laboratory examination data of patients were recorded in detail, and the detection indicators in the early stage and end-stage of admission were compared. Results The mean age of 54 T2DM patients with COVID-19 who died during hospitalization was (74.31±10.64) years. There were 50 (92.6%) cases who had other underlying diseases. Among them, 74% had more than two underlying diseases. Compared with the laboratory data in the early stage of admission, the blood glucose, pH, red blood cell count, albumin, and globulin in the last laboratory testing before death significantly decreased, while the partial pressure of carbon dioxide, lactate, lactate dehydrogenase, sodium ions, myoglobin, prothrombin time, procalcitonin, C-reactive protein, and D-dimer increased significantly (P<0.05). Among the 54 patients who died, 96.3% showed large patchy shadows and ground glass shadows in both lungs on chest CT scans, and 81.5% showed pleural effusion in both lungs. Logistic regression analysis results showed that PCO₂ and LDH were independent risk factors for the mortality of T2DM patients combined with COVID-19. Conclusion T2DM patients with COVID-19 have a poor prognosis, and partial pressure of carbon dioxide and lactate dehydrogenase are independent risk factors for their death.

Key words: coronavirus disease 2019, type 2 diabetes mellitus, causes of death, partial pressure of carbon dioxide, lactate dehydrogenase, risk factors

CLC Number:

R563.12

Wei Zeng, Cao Ling, She Dunmin, Liu Yan, Wang Yan, Zhang Zhenwen. The causes of death in 54 patients with type 2 diabetes mellitus complicated with COVID-19[J]. Clinical Focus, 2023, 38(9): 806-812.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.09.006

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I9/806

Figures/Tables 3

Tab.1 Clinical manifestations of 54 T2DM patients with COVID-19 who died

临床症状	例数	百分率(%)
胸闷	27	50.00
气喘	25	46.23
咳嗽	16	29.63
咳痰	14	25.93
发热	11	20.37
乏力	8	14.81
意识不清	8	14.81
畏寒	4	7.41
腹痛	3	5.56
昏迷	2	3.70
咯血	2	3.70
呼吸困难	2	3.70
黑便	1	1.85
呼吸急促	1	1.85
头晕	1	1.85
口唇紫绀	1	1.85
胸痛	1	1.85
晕厥	1	1.85
合并临床症状
合并1种及以下临床症状	14	25.93
合并2种及以上临床症状	40	74.07

Tab.2 The detection indicators in the early-stage and end-stage of admission in 54 T2DM patients with COVID-19 who died ($bar{x} pm s$, M [ P 25 , ? P 75 ])

实验室数据	入院初期	终末期	$t$ 或 $Z$ 值	$P$ 值
血糖(mmol/L)	13.987±5.176	9.561±3.887	5.024	0
pH	7.379±0.094	7.323±0.101	2.939	0.004
PO₂(mmHg)	84.077±31.468	75.344±18.394	1.761	0.082
PCO₂(mmHg)	36.189±10.258	44.476±10.751	-4.098	0
Lac(mmol/L)	1.90( 1.38,3.00 )	3.65(2.03,9.63)	-3.965	0
SO₂(%)	96.70( 92.88,98.0)	96.30(87.3,97.5)	-1.355	0.175
RBC(×10¹²/L)	3.509±0.942	2.903±0.880	3.461	0.001
WBC(×10⁹/L)	8.94(6.46,12.19)	9.09(7.08,15.89)	-0.922	0.357
中性粒细胞(×10⁹/L)	6.94(5.21,11.10)	8.19(5.45,15.48)	-0.922	0.357
淋巴细胞(×10⁹/L)	0.60(0.44,0.96)	0.72(0.43,1.20)	-0.722	0.47
NLR	8.87(7.38,23.69)	13.11(5.75,21.58)	-0.381	0.703
单核细胞(×10⁹/L)	0.45(0.30,0.79)	0.45(0.18,0.69)	-0.593	0.553
嗜酸性粒细胞(×10⁹/L)	0.00(0,0.0225)	0.01(0.00,0.052)	-0.746	0.456
PLT(×10⁹/L)	181.667±99.349	151.666±87.670	1.664	0.099
ALB(g/L)	30.167±6.430	27.041±4.961	2.828	0.006
球蛋白(g/L)	29.546±4.957	26.213±5.028	3.469	0.001
白球比值	1.044±0.249	1.076±0.333	-0.579	0.564
ALT(U/L)	24.00(16.50,42.25)	26.50(16.00,49.25)	-0.787	0.431
AST(U/L)	44.50(22,76.25)	48.50(25.00,82.00)	-0.722	0.47
LDH(U/L)	286.50(203.5,352.75)	536(344,763)	-5.77	0
Cr(μmol/L)	166.20(102.78,349.83)	188.65(81.25,393.85)	-0.12	0.905
Ca(mmol/L)	2.055±0.215	2.061±0.311	-0.110	0.912
K(mmol/L)	4.189±0.837	4.349±0.764	-1.034	0.304
Na(mmol/L)	136.487±9.907	142.776±8.348	-3.567	0.001
CTnI(ng/ml)	0.06(0.02,0.24)	0.13(0.04,0.55)	-1.822	0.068
CKMB(ng/ml)	1.90(0.96,3.69)	2.54(1.33,4.34)	-0.719	0.472
Myo(ng/ml)	189.40(111.28,757.7)	511.05(266.63,1394.25)	-3.005	0.003
NT-ProBNP(pg/ml)	3690.00(1035,10625)	4066.50(1238.5,18900)	-1.023	0.306
PT(s)	13.45(12.68,14.7)	14.8(13.4,16.45)	-3.596	0
APTT(s)	32.65(28.05,38.6)	36.2(28.98,43.85)	-1.272	0.203
PCT(ng/ml)	0.48(0.17,2.23)	1.21(0.42,5.06)	-2.237	0.025
CRP(mg/L)	77.15(12.34,124.95)	116.37(56.23,144.80)	-2.547	0.011
DD(mg/L)	1.82(0.83,4.40)	4.6(2,10)	-3.255	0.001

Tab.2 The detection indicators in the early-stage and end-stage of admission in 54 T2DM patients with COVID-19 who died ($bar{x} pm s$, M [ P 25 , ? P 75 ])

实验室数据	入院初期	终末期	$t$ 或 $Z$ 值	$P$ 值
血糖(mmol/L)	13.987±5.176	9.561±3.887	5.024	0
pH	7.379±0.094	7.323±0.101	2.939	0.004
PO₂(mmHg)	84.077±31.468	75.344±18.394	1.761	0.082
PCO₂(mmHg)	36.189±10.258	44.476±10.751	-4.098	0
Lac(mmol/L)	1.90( 1.38,3.00 )	3.65(2.03,9.63)	-3.965	0
SO₂(%)	96.70( 92.88,98.0)	96.30(87.3,97.5)	-1.355	0.175
RBC(×10¹²/L)	3.509±0.942	2.903±0.880	3.461	0.001
WBC(×10⁹/L)	8.94(6.46,12.19)	9.09(7.08,15.89)	-0.922	0.357
中性粒细胞(×10⁹/L)	6.94(5.21,11.10)	8.19(5.45,15.48)	-0.922	0.357
淋巴细胞(×10⁹/L)	0.60(0.44,0.96)	0.72(0.43,1.20)	-0.722	0.47
NLR	8.87(7.38,23.69)	13.11(5.75,21.58)	-0.381	0.703
单核细胞(×10⁹/L)	0.45(0.30,0.79)	0.45(0.18,0.69)	-0.593	0.553
嗜酸性粒细胞(×10⁹/L)	0.00(0,0.0225)	0.01(0.00,0.052)	-0.746	0.456
PLT(×10⁹/L)	181.667±99.349	151.666±87.670	1.664	0.099
ALB(g/L)	30.167±6.430	27.041±4.961	2.828	0.006
球蛋白(g/L)	29.546±4.957	26.213±5.028	3.469	0.001
白球比值	1.044±0.249	1.076±0.333	-0.579	0.564
ALT(U/L)	24.00(16.50,42.25)	26.50(16.00,49.25)	-0.787	0.431
AST(U/L)	44.50(22,76.25)	48.50(25.00,82.00)	-0.722	0.47
LDH(U/L)	286.50(203.5,352.75)	536(344,763)	-5.77	0
Cr(μmol/L)	166.20(102.78,349.83)	188.65(81.25,393.85)	-0.12	0.905
Ca(mmol/L)	2.055±0.215	2.061±0.311	-0.110	0.912
K(mmol/L)	4.189±0.837	4.349±0.764	-1.034	0.304
Na(mmol/L)	136.487±9.907	142.776±8.348	-3.567	0.001
CTnI(ng/ml)	0.06(0.02,0.24)	0.13(0.04,0.55)	-1.822	0.068
CKMB(ng/ml)	1.90(0.96,3.69)	2.54(1.33,4.34)	-0.719	0.472
Myo(ng/ml)	189.40(111.28,757.7)	511.05(266.63,1394.25)	-3.005	0.003
NT-ProBNP(pg/ml)	3690.00(1035,10625)	4066.50(1238.5,18900)	-1.023	0.306
PT(s)	13.45(12.68,14.7)	14.8(13.4,16.45)	-3.596	0
APTT(s)	32.65(28.05,38.6)	36.2(28.98,43.85)	-1.272	0.203
PCT(ng/ml)	0.48(0.17,2.23)	1.21(0.42,5.06)	-2.237	0.025
CRP(mg/L)	77.15(12.34,124.95)	116.37(56.23,144.80)	-2.547	0.011
DD(mg/L)	1.82(0.83,4.40)	4.6(2,10)	-3.255	0.001

Tab.3 Binary logistic regression analysis of risk factors in 54 T2DM patients with COVID-19 who died

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
PCO₂	0.122	0.045	7.310	0.007	1.129	1.034~1.233
LDH	0.07	0.002	11.080	0.001	1.007	1.003~1.011

Tab.3 Binary logistic regression analysis of risk factors in 54 T2DM patients with COVID-19 who died

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
PCO₂	0.122	0.045	7.310	0.007	1.129	1.034~1.233
LDH	0.07	0.002	11.080	0.001	1.007	1.003~1.011

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