Abstract
Background: To determine the risk-assessment role of the immune-inflammatory biomarkers on myocardial damage in COVID-19 patients with diabetes mellitus (DM).
Methods: This retrospective study was conducted on 822 COVID-19 inpatients from 1 January to 10 March 2020 at Renmin Hospital of Wuhan University. The demographic data, clinical data, and immune-inflammatory parameters of participants were collected. The predictors of cardiac injury were assessed by Logistics regression analysis.
Results: A total of 246 COVID-19 inpatients were diagnosed with DM (29.9%). The incidence of cardiac injury was higher in patients with DM than in non-DM cases (28.9% vs 9.0%, p < 0.001), even grouped by age, gender, and the level of fasting plasma glucose (FPG). The mortality in diabetic COVID-19 patients with cardiac injury and without cardiac injury was 42.9% and 3.4%, respectively (p < 0.001). COVID-19 patients with DM and cardiac injury presented a decreased number of immunocyte subsets, lower C3 concentration, and a higher level of interleukin-6 (IL-6) and immunoglobulin A (IgA). The independent risk factors for cardiac injury in COVID-19 patients with DM were CD3 + CD4 + T cells counts ≤ 288 cells/μl (adjusted Odds ratio (OR), 2.501; 95% confidence interval (CI) 1.282-4.877; p = 0.007) and IL-6 > 25.68mpg/ml (adjusted OR, 4.345; 95% CI 2.192-10.374; p < 0.001) (all P interaction < 0.05).
Conclusions: For diabetic patients with COVID-19, cardiac injury not only induce severer immune-inflammatory responses, but also increase in-hospital mortality. The decreased number of CD3 + CD4 + T cells and increased IL-6 are recommended to distinguish the people who refer to high risk of cardiac injury and mortality from those persons. However, it remains a testable theory whether decision-making strategies based on the risk status of cardiac injury in COVID-19 patients, especially with DM, would be expected to get better outcomes.
Keywords: COVID-19; Cardiac injury; Diabetes mellitus; Immune-inflammatory biomarkers; Mortality.
【저자키워드】 COVID-19, Diabetes Mellitus, mortality., cardiac injury, Immune-inflammatory biomarkers, 【초록키워드】 Biomarker, Mortality, IL-6, interleukin-6, Gender, risk, CD4, outcomes, Retrospective study, T cell, IgA, myocardial damage, Wuhan, Patient, plasma, age, predictor, incidence, immunoglobulin A, university, in-hospital mortality, Glucose, COVID-19 patients, Interaction, Concentration, cardiac, Injury, COVID-19 patient, high risk, regression analysis, Inpatient, Diabetic, 95% CI, 95% confidence interval, Clinical data, demographic data, Renmin Hospital, participant, independent risk factor, logistics, parameter, responses, CD3, diabetic patient, collected, diagnosed, conducted, adjusted, determine, induce, expected, were assessed, with COVID-19, 【제목키워드】 Biomarker, risk, Injury, COVID-19 patient, retrospective cohort study,