Download PDF
Exp Clin Endocrinol Diabetes 2022; 130(05): 351-352
DOI: 10.1055/a-1468-4296
Letter to the Editor

Diabetes Mellitus as the Major Factor of Prolonged Hospitalisation in Mild or Moderate COVID-19 Pneumonia

Vasileios Petrakis
1   Department of Infectious Diseases, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
,
Grigorios Trypsianis
2   Department of Medical Statistics, Medical School, Democritus University of Thrace, Greece
,
Periklis Panagopoulos
1   Department of Infectious Diseases, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
,
Dimitrios Papazoglou
1   Department of Infectious Diseases, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
3   Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
,
Nikolaos Papanas
3   Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Dear Editor

Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been declared by the World Health Organization (WHO) as a pandemic [1]. Diabetes mellitus (DM) belongs to the comorbidities increasing the risk of severe COVID-19 pneumonia [2]. Notably, in our department among those who died from severe pneumonia, 71% had DM [3].

We retrospectively studied medical records of 221 patients hospitalised between March and December 2020 with mild or moderate COVID-19 pneumonia in our Department of Infectious Diseases after exclusion of those who had needed intubation and/or had died. The study was approved by the institutional ethics committee and patients provided their informed consent. The diagnosis of SARS-CoV-2 infection was confirmed with real time-polymerase chain reaction (RT-PCR) in nasopharyngeal specimens. Comorbidities including DM, hypertension, dyslipidaemia, coronary artery disease, heart failure, malignancies and chronic renal failure were identified. Duration of hospitalisation was recorded. Multivariate linear regression analysis was performed to assess the independent effect of patients’ characteristics on the (log-transformed) duration of hospitalisation.

DM was the strongest independent factor (standardised beta coefficient=0.524, p<0.001) increasing length of hospitalisation ([Table 1]). Median hospitalisation was 14 days (range, 3–40 days) in DM patients vs. 9 days (6–34 days) in those without DM. In order of importance, the other significant risk factors were coronary artery disease (p=0.002), heart failure (p=0.005) and age (p=0.031).

Table 1 Comorbidities and duration of hospitalisation for patients with COVID-19 pneumonia.

Model

Unstandardised Coefficients

Standardised Coefficients

t

p value

B

Standard Error

Beta

(Constant)

1.065

0.049

21.649

<0.001

Age

−0.002

0.001

−0.138

−2.178

0.031

Sex

−0.032

0.021

−0.087

−1.518

0.131

Diabetes mellitus

0.195

0.022

0.524

8.944

<0.001

Hypertension

0.012

0.022

0.032

0.554

0.580

Dyslipidaemia

0.024

0.023

0.062

1.061

0.290

Coronary artery disease

0.089

0.028

0.184

3.175

0.002

Heart failure

0.102

0.036

0.170

2.814

0.005

Malignancies

0.010

0.063

0.009

0.156

0.876

Chronic renal failure

0.110

0.062

0.098

1.764

0.079

a. Dependent Variable: LOG_HS.

Our findings agree with other reports identifying DM among the factors prolonging hospitalisation in COVID-19 pneumonia [4] [5]. However, in our series, DM was the most important factor. Generally, the deleterious impact of DM may, perhaps, be attributable to the immunosuppressive effects of DM on macrophages, lymphocytes, T-cells and interferon γ production [6].

In conclusion, in our department DM was the major factor prolonging hospitalisation for mild or moderate COVID-19 pneumonia. These results highlight the risk conferred by DM in the event of COVID-19 and suggest caution in the management of patients with both conditions.



Publication History

Received: 28 February 2021
Received: 19 March 2021

Accepted: 26 March 2021

Article published online:
23 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Mahase E. Covid-19: WHO declares pandemic because of “alarming levels” of spread, severity, and inaction. BMJ 2020; 368: m1036
    CrossrefPubMedGoogle Scholar
  • 2 McGurnaghan SJ, Weir A, Bishop J. et al. Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland. Lancet Diabetes Endocrinol 2021; 9: 82-93
    CrossrefPubMedGoogle Scholar
  • 3 Petrakis V, Panagopoulos P, Papazoglou D. et al. Diabetes Mellitus and hypertension as major risk factors of mortality from Covid-19 pneumonia. Exp Clin Endocrinol Diabetes 2020; DOI: 10.1055/a-1325-0381. Online ahead of print
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Wu S, Xue L, Legido-Quigley H. et al. Understanding factors influencing the length of hospital stay among non-severe COVID-19 patients: A retrospective cohort study in a Fangcang shelter hospital. PLoS One 2020; 15: e0240959
    CrossrefPubMedGoogle Scholar
  • 5 Wang D, Hu B, Hu CJ. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069
    CrossrefPubMedGoogle Scholar
  • 6 Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: Convergence of two epidemics. Lancet Infect Dis 2009; 9: 737-746
    CrossrefPubMedGoogle Scholar