lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

Diabetes and COVID-19 Related Mortality in the Critical Care Setting: A Real-Time National Cohort Study in England

29 Pages Posted: 5 Jun 2020

See all articles by John M Dennis

John M Dennis

University of Exeter - Medical School

Bilal A. Mateen

University of Warwick - Social Science and Systems in Health Unit

Raphael Sonabend

University College London - Department of Statistical Science

Nicholas J. Thomas

Government of the United Kingdom - Royal Devon and Exeter Hospital

Kashyap A. Patel

Government of the United Kingdom - Royal Devon and Exeter Hospital

Andrew T. Hattersley

University of Exeter - Medical School

Spiros Denaxas

University College London

Andrew P. McGovern

Government of the United Kingdom - Royal Devon and Exeter Hospital

Sebastian J. Vollmer

The Alan Turing Institute

More...

Abstract

Background:The importance of diabetes as a prognostic factor in people admitted to hospital critical care with COVID-19 is poorly understood and has not been quantified.

Methods:We used a real-time national database (COVID-19 Hospitalisation in England Surveillance System; CHESS), comprising data on COVID-19 related admissions to hospital in England requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between March 1, 2020 and May 17, 2020. The objective was to describe the relationship between diabetes and all-cause in-hospital mortality in adults, using Cox proportional hazard models adjusted for age, sex, ethnicity, obesity, and other comorbidities. The primary analysis was restricted to a subset with sufficiently complete comorbidity status recording. Several sensitivity analyses, including on the unrestricted dataset, were carried out to verify the results.

Findings:  Diabetes was independently associated with mortality in people admitted to critical care settings with COVID-19 in England; the proportion of 30-day mortality attributable to diabetes, after adjusting for age, sex, ethnicity, obesity, and other comorbidities, was 4·8% (95%CI 2·5-7·0). 14,639 COVID-19 related HDU and ICU admissions were reported during the study period, of which 6,142 were included in primary analysis, including 3,311 HDU (mean age 72), and 2,831 ICU admissions (mean age 58). 1,439 (23·4%) had diabetes. 1,847 individuals (30·1%) died during the study period. 30 day mortality was higher in people with diabetes than without (p < 0·001). People with diabetes were at increased risk of death (adjusted hazard ratio (HR) 1·28 [1·14, 1·42]). Results were consistent in subsets admitted to HDU only (adjusted HR 1·27 [1·09, 1·48]) and ICU (adjusted HR 1·31 [1·12, 1·54]). Sensitivity analyses were consistent with the primary analysis.

Interpretation:Diabetes is an independent prognostic factor for mortality in people with COVID-19 requiring HDU or ICU treatment. Quantification of this diabetes associated risk enables appropriate treatment decisions in people with diabetes and severe COVID-19.

Funding Statement: This study received no funding.

Declaration of Interests: APM declares previous research funding from Eli Lilly and Company, Pfizer, and AstraZeneca. SJV declares funding from IQVIA. All other authors declare no competing interests.

Ethics Approval Statement: The study was reviewed and approved by the Warwick BSREC (BSREC 119/19-20) and sponsorship is being provided by University of Warwick (SOC.28/19-20).

Keywords: Diabetes; COVID-19; Critical Care; Mortality; Intensive Care

Suggested Citation

Dennis, John M and Mateen, Bilal A. and Sonabend, Raphael and Thomas, Nicholas J. and Patel, Kashyap A. and Hattersley, Andrew T. and Denaxas, Spiros and McGovern, Andrew P. and Vollmer, Sebastian J., Diabetes and COVID-19 Related Mortality in the Critical Care Setting: A Real-Time National Cohort Study in England (5/27/2020). Available at SSRN: https://ssrn.com/abstract=3615999 or http://dx.doi.org/10.2139/ssrn.3615999

John M Dennis

University of Exeter - Medical School

Exeter
United Kingdom

Bilal A. Mateen (Contact Author)

University of Warwick - Social Science and Systems in Health Unit ( email )

Coventry
United Kingdom

Raphael Sonabend

University College London - Department of Statistical Science

1-19 Torrington Place
London, WC1 7HB
United Kingdom

Nicholas J. Thomas

Government of the United Kingdom - Royal Devon and Exeter Hospital

Barrack Road
Exeter, Devon EX2 5DW
United Kingdom

Kashyap A. Patel

Government of the United Kingdom - Royal Devon and Exeter Hospital

Barrack Road
Exeter, Devon EX2 5DW
United Kingdom

Andrew T. Hattersley

University of Exeter - Medical School

Exeter
United Kingdom

Spiros Denaxas

University College London

Gower Street
London, WC1E 6BT
United Kingdom

Andrew P. McGovern

Government of the United Kingdom - Royal Devon and Exeter Hospital

Barrack Road
Exeter, Devon EX2 5DW
United Kingdom

Sebastian J. Vollmer

The Alan Turing Institute

British Library, 96 Euston Road
London, NW12DB
United Kingdom

Click here to go to TheLancet.com

Paper statistics

Abstract Views
458
Downloads
67