COVID-19 Scan for May 29, 2020

Diabetics with COVID-19
Severe NYC COVID-19 illness

Study: 11% of diabetics die within 1 week of hospitalization for COVID-19

The first major study of diabetics hospitalized with COVID-19 shows more than 1 in 10 die within 7 days of admission, and about 1 in 5 is intubated within 1 week. The study appears today in Diabetologia.

The analysis, named the CORONADO study, was conducted across 53 French hospitals from Mar 10 through 31 and included 1,317 patients diagnosed as having COVID-19 and diabetes.  The vast majority (89%) had type 2 diabetes, and 3% had type 1. Men constituted 69% of the patients. Twenty-nine percent of patients either died (140 patients, 10.6%) or were mechanically ventilated by day 7. Only 18.0% of patients were discharged by day 7.

Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively, the authors said. Neither long-term glucose control nor current insulin use was found to increase the risk of death. Instead, as in the general population, only age and body mass index (BMI) were associated with worsening outcomes for patients.

"BMI was positively and independently associated with the primary outcome, which is largely driven by tracheal intubation," the authors said. They add that their findings could be reassuring to well-managed type 1 diabetics, as the study found no deaths among type 1 diabetics under the age of 65.
May 29 Diabetologia


New York COVID-19 case series: High kidney injury, death rates

An analysis of the first 1,000 patients treated for COVID-19 at a large teaching hospital in New York City found that patients had more underlying health conditions, longer intubations, and higher rates of kidney injury compared with similar reports from other countries. New York–based researchers reported their findings—including a 21% death rate—today in BMJ.

The authors examined the electronic medical records of patients hospitalized at New York-Presbyterian/Columbia University Irving Medical Center from Mar 1 to Apr 5. Of the 1,000 patients, 150 came in through the emergency department and 614 were admitted to the hospital, with 236 admitted or transferred to the intensive care unit (ICU).

The most common comorbidities were high blood pressure, diabetes, and obesity. ICU patients tended to be older and male, with longer stays. Acute kidney injury was seen in 78.0% of ICU patients, with 35.2% needing dialysis. The authors saw a dual pattern with regard to intubation following symptom onset, some at 3 to 4 days and another group at 9 days. As of Apr 30, 211 people (21.1%) had died, and 90 (9.0%) were still in the hospital.

The dual pattern for intubation could suggest a biphasic disease course, the researchers wrote, and the renal complication was strikingly higher than other reports, with limited intravenous fluids, toxicity from the disease process, or increased comorbidities as potential contributing factors.

The authors said the findings could help guide clinical practice, especially regarding vigilance the development of breathing problems, even after conditions appear to be stabilizing.
May 29 BMJ study

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