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Article Dans Une Revue Diabetologia Année : 2022

Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative

1 CHU Nantes - Centre Hospitalier Universitaire de Nantes
2 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
3 CIC Nantes - Centre d’Investigation Clinique de Nantes
4 UPS/Inserm U1297 - I2MC - Institut des Maladies Métaboliques et Casdiovasculaires
5 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
6 CHU Amiens-Picardie
7 PERITOX - Périnatalité et Risques Toxiques - UMR INERIS_I 1
8 CHU Angers - Centre Hospitalier Universitaire d'Angers
9 Centre Hospitalier Sud Francilien
10 Université Paris-Saclay
11 CESP - Centre de recherche en épidémiologie et santé des populations
12 Hôpital d'Instruction des Armées Begin
13 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
14 AP-HP - Hôpital Antoine Béclère [Clamart]
15 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
16 IHU ICAN - Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière]
17 CHU Pitié-Salpêtrière [AP-HP]
18 Hôpital Avicenne [AP-HP]
19 CRNH-IDF - Centre de Recherche en Nutrition Humaine d'Ile-de-France
20 UREN - Unité de Recherche en Epidémiologie Nutritionnelle
21 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
22 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
23 Centre Hospitalier René Dubos [Pontoise]
24 Hôpital Lariboisière-Fernand-Widal [APHP]
25 Centre hospitalier Saint Joseph - Saint Luc [Lyon]
26 HUS - Les Hôpitaux Universitaires de Strasbourg
27 Centre Hospitalier de Gonesse
28 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
29 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
30 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
31 HCL - Hospices Civils de Lyon
32 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
33 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
34 CHU Saint-Antoine [AP-HP]
35 HNFC - Hôpital Nord Franche-Comté [Hôpital de Trévenans]
36 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
37 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
Deborah Ancelle
  • Fonction : Auteur

Résumé

Aims/hypothesis: Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question.Methods: The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes.Results: A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p<0.001). After multiple adjustments for age, BMI, uCCi, clinical (time between onset of COVID-19 symptoms and dyspnoea) and biological variables (eGFR, aspartate aminotransferase, white cell count, platelet count, C-reactive protein) on admission to hospital, diabetes remained associated with a higher risk of primary composite endpoint within 7 days (adjusted HR 1.42 [95% CI 1.17, 1.72], p<0.001) and 28 days (adjusted HR 1.30 [95% CI 1.09, 1.55], p=0.003), compared with individuals without diabetes. Using the same adjustment model, diabetes was associated with the risk of IMV, but not with risk of death, within 28 days of admission to hospital.Conclusions/interpretation: Our results demonstrate that diabetes status was associated with a deleterious COVID-19 prognosis irrespective of age and comorbidity status.Trial registration: ClinicalTrials.gov NCT04324736.
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hal-03696563 , version 1 (16-06-2022)

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Bertrand Cariou, Matthieu Wargny, Anne-Sophie Boureau, Sarra Smati, Blandine Tramunt, et al.. Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative. Diabetologia, 2022, 65, pp.1436-1449. ⟨10.1007/s00125-022-05734-1⟩. ⟨hal-03696563⟩
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