Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Data Collection
2.3. Aim of the Study
2.4. Endpoints
2.5. Statistical Analysis
2.5.1. Development of a Risk–Score Model
2.5.2. External Validation of the Risk–Score Model
3. Results
3.1. Population
3.2. Differences in Demographic and Diabetes-Related Characteristics between Hospitalized and Outpatients
3.3. Characteristics of COVID-19 during First Examination, and Differences between In- and Outpatients
3.4. Predictive Criteria for Hospitalization and Model Development of an Easy-to-Use Pragmatic Score for Clinicians
3.5. Secondary Endpoints
3.6. External Validation of the Diabscore in Two Other Cohorts
3.6.1. External Validation of the Diabscore in Another Period of Time
3.6.2. External Validation of the Diabscore in the Whole CORONADO Cohort
4. Discussion
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Data Available | All (n = 344) | Outpatients (n = 159) | Inpatients (n = 185) | p |
---|---|---|---|---|---|
Sex male/female | 344 | 204/140 (59.3%) | 89/70 (56%) | 115/70 (62.1%) | NS |
Age (years) | 344 | 62.1 ± 14.0 | 55.2 ± 12.6 | 68 ± 12.6 | <0.0001 |
<55 years | 100 (29.1%) | 77 (48.4%) | 23 (12.4%) | <0.0001 | |
55–64 years | 94 (27.3%) | 46 (28.9%) | 48 (25.9%) | ref | |
65–74 years | 82 (23.8%) | 29 (18.2%) | 53 (28.6%) | 0.07 | |
≥75 years | 68 (19.8%) | 7 (4.4%) | 61 (33%) | <0.0001 | |
BMI (kg/m2) | 308 | 29.5 ± 6.6 | 29 ± 5.3 | 29.8 ± 7.5 | NS |
<25 kg/m2 | 72 (23.4%) | 31 (21.7%) | 41 (24.8%) | NS | |
25–29.9 kg/m2 | 114 (37%) | 58 (40.6%) | 56 (33.9%) | NS | |
30–39.9 kg/m2 | 101 (32.8%) | 49 (34.3%) | 52 (31.5%) | NS | |
≥40 kg/m2 | 21 (6.8%) | 5 (3.5%) | 16 (9.7%) | 0.030 | |
Autonomy | 344 | <0.0001 | |||
Autonomous | 307 (89.2%) | 159 (100%) | 148 (80%) | ||
Non-autonomous | 37 (10.8%) | 0 (0%) | 37 (20%) | ||
Ethnicity | 292 | 0.010 | |||
EU | 103 (35.3%) | 43 (28.3%) | 60 (42.9%) | ref | |
MENA | 123 (42.1%) | 75 (49.3%) | 48 (34.3%) | 0.004 | |
AC | 64 (21.9%) | 34 (22.4%) | 30 (21.4%) | 0.153 | |
AS | 2 (0.7%) | 0 (0%) | 2 (0.7%) | NA | |
Hypertension | 343 | 221 (64.4%) | 70 (44.3%) | 151 (81.6%) | <0.0001 |
Dyslipidemia | 342 | 139 (40.6%) | 49 (30.8%) | 90 (49.2%) | 0.001 |
Tobacco use | 320 | <0.0001 | |||
Never | 236 (73.8%) | 136 (85.5%) | 100 (62.1%) | ||
Former | 56 (17.5%) | 6 (3.8%) | 50 (31.1%) | ||
Current | 28 (8.8%) | 17 (10.7%) | 11 (6.8%) | ||
Type of diabetes | 344 | <0.0001 | |||
Type 1 | 20 (5.8%) | 18 (11.3%) | 2 (1.1%) | ||
Type 2 | 324 (94.2%) | 141 (88.7%) | 183 (98.9%) | ||
Diabetes duration | 267 | 10.8 ± 8.8 | 9.1 ± 8 | 12.4 ± 9.2 | 0.002 |
HbA1c (%) | 229 | 7.7 ± 1.7 | 7.5 ± 1.6 | 7.8 ± 1.7 | 0.100 |
Severe hypoglycemia | 285 | 12 (4.2%) | 1 (0.7%) | 12 (4.2%) | 0.006 |
Microvascular complications | 315 | 109 (34.6%) | 23 (16.7%) | 86 (48.6%) | <0.0001 |
Severe diabetic retinopathy | 294 | 14 (4.7%) | 6 (4.7%) | 8 (4.8%) | NS |
Diabetic kidney disease | 344 | 104 (30.2%) | 21 (13.2%) | 83 (44.9%) | <0.0001 |
History of diabetic foot ulcer | 344 | 6 (1.7%) | 2 (1.3%) | 4 (2.2%) | NS |
Macrovascular complications | 342 | 71 (20.8%) | 14 (8.9%) | 57 (31%) | <0.0001 |
Ischemic heart disease | 342 | 58 (17%) | 10 (6.3%) | 48 (26.2%) | <0.0001 |
Cerebrovascular disease | 338 | 21 (6.1%) | 5 (3.2%) | 16 (8.7%) | 0.040 |
Peripheral artery disease | 340 | 14 (4.1%) | 2 (1.3%) | 12 (6.5%) | 0.020 |
Comorbidities | |||||
CKD * | 331 | 49 (13.8%) | 1 (0.7%) | 48 (26%) | <0.0001 |
Dialysis | 344 | 8 (2.3%) | 0 (0%) | 8 (4.3%) | 0.010 |
Heart failure | 340 | 22 (6.5%) | 5 (3.1%) | 17 (9.4%) | 0.030 |
Sleep apnea | 321 | 37 (11.5%) | 9 (6.2%) | 37 (11.5%) | 0.010 |
Respiratory failure | 342 | 21 (6.1%) | 3 (1.9%) | 18 (9.8%) | 0.003 |
COPD | 343 | 16 (4.7%) | 2 (1.3%) | 14 (7.6%) | 0.005 |
Active cancer | 341 | 12 (3.5%) | 1 (0.6%) | 11 (6%) | 0.007 |
Transplant | 344 | 4 (1.2%) | 1 (0.6%) | 3 (1.6%) | NS |
NAFLD or liver cirrhosis | 337 | 24 (7%) | 12 (7.5%) | 12 (6.7%) | NS |
Bariatric surgery | 344 | 3 (0.9%) | 2 (1.3%) | 1 (0.5%) | NS |
Treatments | |||||
Insulin | 337 | 104 (30.9%) | 37 (23.7%) | 67 (37%) | 0.010 |
Basal bolus regimen | 333 | 66 (19.8%) | 26 (16.9%) | 40 (22.3%) | 0.012 |
Metformin | 339 | 214 (63.1%) | 104 (67.1%) | 110 (59.8%) | NS |
DPP4-Inhibitors | 340 | 79 (23.2%) | 37 (23.7%) | 42 (22.8%) | NS |
GLP1-RA | 340 | 38 (11.2%) | 17 (10.9%) | 21 (11.4%) | NS |
Glinides | 339 | 35 (10.3%) | 13 (8.4%) | 22 (12%) | NS |
Sulfonylurea | 339 | 72 (21.2%) | 33 (21.3%) | 39 (21.2%) | NS |
Anti-platelet agent | 341 | 92 (27%) | 19 (12.1%) | 73 (39.7%) | <0.0001 |
ACE inhibitors and/or ARBs | 341 | 172 (50.4%) | 53 (33.8%) | 119 (64.7%) | <0.0001 |
Diuretics | 340 | 76 (22.4%) | 23 (14.7%) | 53 (28.8%) | 0.003 |
Statins | 341 | 115 (33.7%) | 40 (25.5%) | 75 (40.8%) | 0.004 |
Anticoagulant | 341 | 28 (8.1%) | 4 (2.6%) | 24 (13%) | 0.001 |
Variable | Data Available | All (n = 344) | Oupatients (n = 159) | Inpatients (n = 185) | p |
---|---|---|---|---|---|
Positive SARS-CoV-2-PCR | 344 | 330 (96%) | 158 (99.4%) | 172 (93%) | 0.002 |
Typical CT signs | 288 | 246 (85.4%) | 96 (78%) | 150 (88%) | |
limited | 87 (35.3%) | 59 (61.5%) | 28 (19%) | <0.05 | |
limited to intermediate | 4 (1.6%) | 0 (0%) | 4 (2.6%) | NS | |
intermediate | 96 (39%) | 35 (36.5%) | 61 (41%) | NS | |
intermediate to severe | 8 (3.2%) | 0 (0%) | 8 (5.3%) | NS | |
severe | 51 (2.2%) | 2 (2%) | 49 (32.1%) | <0.05 | |
COVID-19 symptoms | 343 | 324 (94.5%) | 144 (90.6%) | 180 (97.8%) | 0.004 |
Fever | 340 | 165 (48.5%) | 47 (29.6%) | 118 (65.2%) | <0.0001 |
Cough | 340 | 217 (63.8%) | 92 (57.9%) | 125 (69.1%) | 0.040 |
Dyspnea | 343 | 133 (38.8%) | 27 (17%) | 106(57.6%) | <0.0001 |
Cephalalgia | 339 | 77 (22.7%) | 51 (32.1%) | 26 (14.4%) | <0.0001 |
Anosmia and/or agueusia | 340 | 115 (33.4%) | 85 (53.5%) | 30 (16.6%) | <0.0001 |
Fatigue | 340 | 205 (60.3%) | 80 (50.3%) | 125 (69.1%) | 0.001 |
Rhinitis and/or pharyngeal symptoms | 340 | 69 (20.3%) | 55 (34.6%) | 14 (7.7%) | <0.0001 |
Digestive disorder | 340 | 77 (22.6%) | 31 (19.5%) | 46 (25.4%) | NS |
Time between symptoms and first day hospital or consultations | 332 | 6 ± 4.6 | 5.8 ± 4.5 | 6.2 ± 4.6 | 0.002 |
Secondary infection | 336 | 19 (5.7%) | 0 (0%) | 19 (10.7%) | <0.0001 |
Ketosis | 340 | 7 (2.1%) | 2 (1.3%) | 5 (2.8%) | NS |
Peripheral oxygen saturation (%) | 313 | 94.3 ± 6.7 | 97.3 ± 1.5 | 91.6 ± 8.3 | <0.0001 |
Biology at admission | |||||
Hemoglobin (g/dL) | 330 | 13.4 ± 1.8 | 13.8 ± 1.5 | 13.1 ± 2.0 | <0.0001 |
White cell count (G/L) | 330 | 6.6 ± 2.7 | 6.0 ± 1.7 | 7.0 ± 3.2 | <0.0001 |
Lymphocyte count (G/L) | 311 | 1.5 ± 0.9 | 1.8 ± 0.8 | 1.2 ± 0.9 | <0.0001 |
Neutrophil count (G/L) | 311 | 4.4 ± 2.4 | 3.6 ± 1.5 | 5.1 ± 2.8 | <0.0001 |
Eosinophil count (G/L) | 311 | 0.02 (0–0.07) | 0.07 ± 0.1 | 0.04 ± 0.144 | NS |
Platelet count (103/mm3) | 330 | 225 ± 85 | 244 ± 83 | 211 ± 84 | <0.0001 |
eGFR (/min) | 331 | 77 ± 28.8 | 91.8 ± 21.7 | 66.2 ± 28.7 | <0.0001 |
Admission plasma glucose (mmol/L) | 324 | 10 ± 5.2 | 9.2 ± 4.2 | 10.7 ± 5.8 | 0.010 |
ASAT (UI/L) | 292 | 44 ± 30 | 34 ± 18 | 50 ± 35 | <0.0001 |
ALAT (UI/L) | 292 | 38 ± 28 | 39 ± 26 | 37 ± 30 | NS |
GGT (UI/L) | 292 | 44 (26–69) | 57 ± 58 | 73 ± 123 | NS |
CRP (mg/L) | 299 | 32 (5.8–87) | 18.9 ± 33.6 | 88. ± 81.8 | <0.0001 |
CPK (UI/L) | 280 | 100 (59–191) | 77 (56–134) | 121 (67–257) | 0.001 |
LDH (UI/L) | 269 | 304 ± 138 | 232.6 ± 56 | 351.2 ± 155 | <0.0001 |
Albumin (g/L) | 211 | 38 ± 6 | 43 ± 4 | 37 ± 5 | <0.0001 |
AUC | OR | 95% CI | β Coefficient | p | |
---|---|---|---|---|---|
Model 1—Basic medical history | 0.814 | ||||
Age | 1.07 | (1.04–1.10) | 0.07 | <0.001 | |
Sex | 0.71 | (0.41–1.23) | −0.34 | 0.22 | |
Type of diabetes | 2.99 | (0.58–15.44) | 1.10 | 0.19 | |
Hypertension | 2.94 | (1.65–5.25) | 1.09 | <0.001 | |
COPD | 5.18 | (0.94–28.43) | 1.64 | 0.06 | |
BMI (< or ≥ 40) | 3.83 | (1.20–12.22) | 1.34 | 0.02 | |
Model 2—Medical history and biological data at first examination | 0.860 | ||||
Age | 1.07 | (1.05–1.10) | 0.07 | <0.001 | |
Sex | 0.63 | (0.35–1.14) | −0.45 | 0.13 | |
Type of diabetes (T2D vs T1D) | 3.94 | (0.68–22.9) | 1.37 | 0.13 | |
Hypertension | 3.91 | (2.08–7.35) | 1.36 | <0.001 | |
BMI (< or ≥ 40) | 4.39 | (1.28–15.01) | 1.48 | 0.02 | |
CKD | 28.1 | (3.55–222.33) | 3.34 | 0.002 | |
Plasma glucose at admission | 1.14 | (1.07–1.22) | 0.13 | <0.001 | |
Model 3—Medical history and long-term plasma glucose | 0.830 | ||||
Age | 1.08 | (1.04–1.12) | 0.08 | <0.001 | |
Sex | 0.62 | (0.30–1.28) | −0.47 | 0.2 | |
Type of diabetes | 3.83 | (0.77–82.54) | 2.08 | 0.08 | |
Hypertension | 3.82 | (1.79–8.15) | 1.34 | <0.001 | |
BMI (< or ≥ 40) | 5.43 | (0.81–36.45) | 1.69 | 0.08 | |
HbA1c | 1.02 | (0.80–1.29) | 0.02 | 0.88 | |
Plasma glucose at admission | 1.12 | (1.02–1.24) | 0.18 | 0.02 | |
Model 4—Medical history and antidiabetic treatment characteristics | 0.825 | ||||
Age | 1.07 | (1.03–1.09) | 0.06 | <0.001 | |
Sex | 0.67 | (0.37–1.21) | −0.41 | 0.18 | |
Type of diabetes | 24.51 | (1.95–307.56) | 3.20 | 0.01 | |
Hypertension | 2.68 | (1.43–5.05) | 0.99 | 0.002 | |
BMI | 4.72 | (1.26–17.65) | 1.55 | 0.02 | |
Severe hypoglycemia | 7.12 | (0.55–91.58) | 1.96 | 0.13 | |
Insulin treatment | 2.49 | (1.20–5.17) | 0.91 | 0.01 | |
Model 5—Medical history and diabetes complications | 0.831 | ||||
Age | 1.05 | (1.03–1.08) | 0.05 | <0.001 | |
Sex | 0.83 | (0.46–1.49) | −0.19 | 0.53 | |
Type of diabetes | 4.24 | (0.78–23) | 1.44 | 0.09 | |
Hypertension | 2.29 | (1.23–4.28) | 0.83 | 0.01 | |
BMI (< or ≥ 40) | 4.07 | (1.26–13.14) | 1.40 | 0.02 | |
Microangiopathy | 2.11 | (1.10–4.05) | 0.74 | 0.02 | |
Macroangiopathy | 3.35 | (1.50–7.52) | 1.21 | 0.003 | |
Model 6—Medical history and data at first examination | 0.910 | ||||
Age | 1.03 | (1.00–1.06) | 0.03 | 0.03 | |
Sex | 0.92 | (0.46–1.84) | −0.08 | 0.82 | |
Type of diabetes | 45.34 | (2.96–7033.84) | 3.81 | <0.001 | |
Hypertension | 3.51 | (1.63–7.90) | 1.25 | <0.001 | |
BMI (< or ≥ 40) | 4.14 | (0.92–21.17) | 1.42 | 0.06 | |
Peripheral oxygen saturation | 0.58 | (0.47–0.69) | −0.54 | <0.001 | |
Insulin treatment | 3.98 | (1.82–9.02) | 1.38 | <0.001 | |
Model 7- Clinical model simplified | 0.910 | ||||
Age | 1.03 | (1.01–1.06) | 0.03 | 0.01 | |
Type of diabetes | 52.39 | (3.42–8067.31) | 3.95 | <0.001 | |
Hypertension | 3.35 | (1.66–7) | 1.21 | <0.001 | |
Peripheral oxygen saturation | 0.56 | (0.46–0.66) | −0.59 | <0.001 | |
Insulin treatment | 3.70 | (1.75–8.09) | 1.31 | <0.001 |
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Lasbleiz, A.; Cariou, B.; Darmon, P.; Soghomonian, A.; Ancel, P.; Boullu, S.; Houssays, M.; Romain, F.; Lagier, J.C.; Boucekine, M.; et al. Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study. J. Clin. Med. 2020, 9, 3726. https://doi.org/10.3390/jcm9113726
Lasbleiz A, Cariou B, Darmon P, Soghomonian A, Ancel P, Boullu S, Houssays M, Romain F, Lagier JC, Boucekine M, et al. Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study. Journal of Clinical Medicine. 2020; 9(11):3726. https://doi.org/10.3390/jcm9113726
Chicago/Turabian StyleLasbleiz, Adèle, Bertrand Cariou, Patrice Darmon, Astrid Soghomonian, Patricia Ancel, Sandrine Boullu, Marie Houssays, Fanny Romain, Jean Christophe Lagier, Mohamed Boucekine, and et al. 2020. "Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study" Journal of Clinical Medicine 9, no. 11: 3726. https://doi.org/10.3390/jcm9113726