Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II)
Authors: Maddaloni Ernesto , D’Onofrio Luca , Alessandri Francesco , Mignogna Carmen , Leto Gaetano , Pascarella Giuseppe , Mezzaroma Ivano , Lichtner Miriam , Pozzilli Paolo , Agrò Felice Eugenio , Rocco Monica , Pugliese Francesco , Lenzi Andrea , Holman Rury R. , Mastroianni Claudio Maria , Buzzetti Raffaella ,   the CoViDiab Study Group, Ajassa Camilla , Alban Rugova , Alessandri Francesco , Alessi Federica , Aronica Raissa , Belvisi Valeria , Buzzetti Raffaella , Candy Matteo , Caputi Alessandra , Carrara Anna , Casali Elena , Cavallari Eugenio Nelson , Ceccarelli Giancarlo , Celani Luigi , Ciardi Maria Rosa , Coraggio Lucia , Curtolo Ambrogio , D’Agostino Claudia , D’Ettorre Gabriella , D’Onofrio Luca , De Giorgi Francesca , De Girolamo Gabriella , Filippi Valeria , Gnessi Lucio , Luordi Cecilia , Maddaloni Ernesto , Mastroianni Claudio Maria , Mezzaroma Ivano , Mignogna Carmen , Moretti Chiara , Pugliese Francesco , Recchia Gregorio , Ridolfi Marco , Romani Francesco Eugenio , Russo Gianluca , Ruberto Franco , Savelloni Giulia , Siccardi Guido , Siena Antonio , Sterpetti Sara , Valeri Serena , Vera Mauro , Volpicelli Lorenzo , Watanabe Mikiko , Aiuti Massimo , Campagna Giuseppe , Del Borgo Cosmo , Fondaco Laura , Kertusha Blerta , Leonetti Frida , Leto Gaetano , Lichtner Miriam , Marocco Raffaella , Masala Renato , Zuccalà Paola , Agrò Felice Eugenio , Nonnis Giulia , Pascarella Giuseppe , Pozzilli Paolo , Rigoli Alessandra , Strumia Alessandro , Alampi Daniela , Rocco Monica 
Published: October 2020

Abstract
Background
Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity.

Methods
We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders.

Results
Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12–3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37–3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23–5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61–6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90–3.06, adjp = 0.10).

Conclusions
Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.