Abstract
Background: Based on recent evidence on the importance of the presence of diabetes mellitus (DM) and fibrosis-4 (FIB-4) index in coronavirus disease 2019 (COVID-19) mortality, we analyzed whether these factors could additively predict such mortality.
Methods: This multicenter observational study included 1,019 adult inpatients admitted to university hospitals in Daegu. The demographic and laboratory findings, mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM and/or a high FIB-4 index. The mortality risk and corresponding hazard ratio (HR) were analyzed using the Kaplan-Meier method and Cox proportional hazard models.
Results: The patients with DM (n=217) exhibited significantly higher FIB-4 index and mortality compared to those without DM. Although DM (HR, 2.66; 95% confidence interval [CI], 1.63 to 4.33) and a high FIB-4 index (HR, 4.20; 95% CI, 2.21 to 7.99) were separately identified as risk factors for COVID-19 mortality, the patients with both DM and high FIB-4 index had a significantly higher mortality (HR, 9.54; 95% CI, 4.11 to 22.15). Higher FIB-4 indices were associated with higher mortality regardless of DM. A high FIB-4 index with DM was more significantly associated with a severe clinical course with mortality (odds ratio, 11.24; 95% CI, 5.90 to 21.41) than a low FIB-4 index without DM, followed by a high FIB-4 index alone and DM alone. The duration of quarantine and hospital stay also tended to be longer in those with both DM and high FIB-4 index.
Conclusion: Both DM and high FIB-4 index are independent and additive risk factors for COVID-19 mortality.
Keywords: COVID-19; Diabetes mellitus; Mortality; Non-alcoholic fatty liver disease.
【저자키워드】 COVID-19, Mortality, Diabetes Mellitus, Non-alcoholic fatty liver disease, 【초록키워드】 coronavirus disease, quarantine, risk factor, Laboratory, Prevalence, Clinical course, Patient, Fatty liver, disease, predict, Evidence, mortality risk, COVID-19 mortality, Odds ratio, severe disease, Hospital stay, Inpatient, Factor, 95% CI, 95% confidence interval, hazard ratio, university hospital, FIB-4, independent, multicenter observational study, analyzed, significantly, the patient, exhibited, significantly higher, the Kaplan-Meier method, 【제목키워드】 clinical, index, Fibrosis-4,