key: cord-339902-tsd6sjcx
authors: Lagunas-Rangel, F. A.; Chavez-Valencia, V.
title: Laboratory findings that predict a poor prognosis in COVID-19 patients with diabetes: A meta-analysis
date: 2020-07-04
journal: nan
DOI: 10.1101/2020.07.02.20145391
sha: 
doc_id: 339902
cord_uid: tsd6sjcx

Diabetes is one of the main comorbidities in patients infected with the SARS-CoV-2 virus, the causative agent of the new coronavirus disease 2019 (COVID-19). Because the presence of diabetes and COVID-19 in the same patient is related to a poor clinical prognosis and a high probability of death, it is necessary to determine what findings allow us to predict a good or bad resolution of the disease in order to opt for a traditional treatment or a more incisive one. In this way, in the present work we analyze which laboratory parameters showed differences in patients with COVID-19 and diabetes who recovered and in those who had complications or died.

The new coronavirus disease 2019 

CoV-2 coronavirus. Severe cases of COVID-19 can rapidly progress to acute respiratory 29 distress syndrome (ARDS), septic shock, multiple organ dysfunction syndrome (MODS), 30 and ultimately patient death. 1 In COVID-19 patients, diabetes mellitus (DM) is one of the 31 main comorbidities associated with severe disease, ARDS, and increased mortality. 2 This 32 relationship is due, in part, to the fact that patients with diabetes have a permanent pro-33 inflammatory state that makes them more susceptible to an inflammatory cytokine storm, 34 often their innate immune system is compromised, and they also have an underlying 35 hypercoagulable pro-thrombotic state. Meanwhile, COVID-19 can worsen insulin resistance, 36 making it difficult to control glucose in people with diabetes, and also promotes strong 37 inflammatory and coagulation processes. 3, 4 Since establishing an early prognosis in patients 38 with diabetes infected with SARS-CoV-2 could help in their treatment decisions, in the 39 present work we analyzed which laboratory parameters showed differences that could predict 40 a good or bad resolution of the disease. 41

We carry out an electronic search using different search engines such as Medline (PubMed 43 interface), Scopus, Web of Science via Raven and Google Scholar, using the keywords 44 "Diabetes + COVID-19" OR "Diabetes + SARS-CoV-2 ", without any date (until June 30, 45 2020) or language restrictions. The titles, abstracts and full texts of all the articles identified 46 according to these criteria were analyzed, considering for our meta-analysis only those that 47 reported prognostic data in patients with COVID-19 and diabetes (defined as with and 48 without the need to enter the intensive care unit, survivors and non-survivors or alive and 49 deceased). 50

Only four studies were considered in our meta-analysis 5-8 and only the laboratory parameters 51 that appear in all articles were analyzed. The mean and standard deviation were extrapolated 52 from the median, range, and sample size as previously described. 9 We analyzed whether there 53 are significant differences (p < 0.05) in the values of age, glycated hemoglobin (HbA1c), 54 white blood cell (WBC) count, neutrophils (NEU), lymphocytes (LYM), platelets (PLT), D-55 dimer, cardiac troponin I (cTnI), alanine aminotransferase (ALT), creatinine (Cr), C-reactive 56 protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and procalcitonin (PCT) between 57 patients who survived and those who presented complications or died. Meta-analysis was 58 performed using Comprehensive Meta-Analysis Software version 3 (2013, Biostat, 59

Englewood, NJ) calculating the standardized mean difference (SMD) and the 95% 60 confidence interval (95% CI) of all parameters. 61

All the studies were conducted in the Chinese population, considering a total of 303 patients 63 with COVID-19 and diabetes, of whom 192 (63.36%) recovered without complications and 64 111 (36.63%) had complications or died. Samples between studies ranged from 28 to 153 65 patients. The SMD for each parameter is summarized in Figure 1 . For most of the parameters, 66 a random effects model was used since its heterogeneity (I 2 statistics) exceeded 50%, with 67 the exception of WBC and Cr where it was less and, therefore, a fixed effects model was 68 were the ones that presented the greatest differences between the groups. 79

Diabetes mellitus has been significantly associated with the mortality risk of patients with 80 -19. 10,11 In general, patients with COVID-19 and diabetes who presented a poor 81 prognosis showed higher levels of the inflammatory parameters, but at the same time an 82 immunocompromise due to the significant reduction in the number of lymphocytes. 83

Likewise, the parameters associated with coagulation and cardiac activity were increased in 84 patients who had complications or died. No parameter could be identified that was clearly 85 different between COVID-19 patients with diabetes and those without. Although blood 86 glucose control has been reported to reduce the risk of death and detrimental complications 1 , 87

we found no significant difference in HbA1c values, possibly due to good patient control 88 prior to SARS-CoV-2 infection. The CORONADO study reported that prior glucose control 89

does not have an impact on the severity of COVID-19 in people with diabetes. 12 It is 90 important to mention that the presence of obesity was not reported in any of the studies 91 analyzed and the influence of BMI could not be investigated or included. Data on antidiabetic 92 therapy at baseline and during treatment are not considered, and it is unknown what 93 percentage of the population has uncontrolled diabetes. 94

FALR is recipient of a doctoral scholarship (Application number 2018-000012-01NACF-96 07226) from the National Council of Science and Technology, CONACyT. 97

The authors declare no conflict of interest. 99

This research did not receive any specific grant from funding agencies in the public, 101 commercial, or not-for-profit sectors. 

Association of Blood Glucose Control

Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes

Diabetes is a risk factor for the progression and 108 prognosis of COVID-19

COVID-19 and diabetes mellitus: An unholy interaction of two 111 pandemics