Abstract
Background and objectives
Type 2 diabetes mellitus (T2DM) patients with Coronavirus Disease 2019 (COVID-19) have poorer prognosis. Inconclusive evidence suggested dipeptidyl peptidase-4 inhibitors (DPP4i) might reduce inflammation and prevent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) entry, hence further evaluation on DPP4i is needed.
Methods
1214 Patients with T2DM were admitted with COVID-19 between 21st January 2020 and 31st January 2021 in Hong Kong. Exposure was DPP4i use within the 90 days prior to admission for COVID-19. Assessed outcomes included clinical deterioration, clinical improvement, low viral load, positive Immunoglobulin G (IgG) antibody, hyperinflammatory syndrome, proportion of IgG antibody, clinical status and length of hospitalization. Multivariable logistic and linear regression models were performed to estimate odds ratios (OR) and their 95% confidence intervals (CI) of event outcomes and continuous outcomes, respectively.
Results
DPP4i users (N = 107) was associated with lower odds of clinical deterioration (OR=0.71, 95%CI 0.54 to 0.93, P = 0.013), hyperinflammatory syndrome (OR=0.56, 95%CI 0.45 to 0.69, P < 0.001), invasive mechanical ventilation (OR=0.30, 95%CI 0.21 to 0.42, P < 0.001), reduced length of hospitalization (-4.82 days, 95%CI –6.80 to –2.84, P < 0.001), proportion of positive IgG antibody on day-3 (13% vs 8%, p = 0.007) and day-7 (41% vs 26%, P < 0.001), despite lack of association between DPP4i use and in-hospital mortality.
Conclusion
DPP4i use was associated with reduced odds of clinical deterioration and hyperinflammatory syndrome. Prospective studies are warranted to elucidate the role of DPP4i in T2DM and COVID-19.
【저자키워드】 COVID-19, viral clearance, Hyperinflammatory syndrome, In-hospital death, DPP4i, 【초록키워드】 SARS-CoV-2, IgG, Inflammation, Prognosis, Hospitalization, antibody, Diabetes Mellitus, outcome, coronavirus 2, clinical status, Dipeptidyl peptidase-4, outcomes, Immunoglobulin G, IgG antibody, Viral load, Prospective, Patient, Clinical improvement, respiratory, Hong Kong, inhibitor, Admission, in-hospital mortality, association, Evidence, Invasive mechanical ventilation, exposure, Odds ratio, Clinical deterioration, Logistic, 95%CI, 95% confidence interval, positive, Linear regression model, Prevent, Result, performed, lack, proportion, reduced, suggested, reduce, Type, with COVID-19, 【제목키워드】 Cohort, Hong Kong, Propensity score, Analysis, COVID-19 patient, Clinical deterioration, reduced,