Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study
Authors: Cariou Bertrand , Hadjadj Samy , Wargny Matthieu , Pichelin Matthieu , Al-Salameh Abdallah , Allix Ingrid , Amadou Coralie , Arnault Gwénaëlle , Baudoux Florence , Bauduceau Bernard , Borot Sophie , Bourgeon-Ghittori Muriel , Bourron Olivier , Boutoille David , Cazenave-Roblot France , Chaumeil Claude , Cosson Emmanuel , Coudol Sandrine , Darmon Patrice , Disse Emmanuel , Ducet-Boiffard Amélie , Gaborit Bénédicte , Joubert Michael , Kerlan Véronique , Laviolle Bruno , Marchand Lucien , Meyer Laurent , Potier Louis , Prevost Gaëtan , Riveline Jean-Pierre , Robert René , Saulnier Pierre-Jean , Sultan Ariane , Thébaut Jean-François , Thivolet Charles , Tramunt Blandine , Vatier Camille , Roussel Ronan , Gautier Jean-François , Gourdy Pierre ,   for the CORONADO investigators
Published: May 2020

Abstract
Aims/hypothesis
Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown.

Methods
We conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 French centres in the period 10–31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission. Age- and sex-adjusted multivariable logistic regressions were performed to assess the prognostic value of clinical and biological features with the endpoint. ORs are reported for a 1 SD increase after standardisation.

Results
The current analysis focused on 1317 participants: 64.9% men, mean age 69.8 ± 13.0 years, median BMI 28.4 (25th–75th percentile: 25.0–32.7) kg/m2; with a predominance of type 2 diabetes (88.5%). Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively. The primary outcome was encountered in 29.0% (95% CI 26.6, 31.5) of participants, while 10.6% (9.0, 12.4) died and 18.0% (16.0, 20.2) were discharged on day 7. In univariate analysis, characteristics prior to admission significantly associated with the primary outcome were sex, BMI and previous treatment with renin–angiotensin–aldosterone system (RAAS) blockers, but not age, type of diabetes, HbA1c, diabetic complications or glucose-lowering therapies. In multivariable analyses with covariates prior to admission, only BMI remained positively associated with the primary outcome (OR 1.28 [1.10, 1.47]). On admission, dyspnoea (OR 2.10 [1.31, 3.35]), as well as lymphocyte count (OR 0.67 [0.50, 0.88]), C-reactive protein (OR 1.93 [1.43, 2.59]) and AST (OR 2.23 [1.70, 2.93]) levels were independent predictors of the primary outcome. Finally, age (OR 2.48 [1.74, 3.53]), treated obstructive sleep apnoea (OR 2.80 [1.46, 5.38]), and microvascular (OR 2.14 [1.16, 3.94]) and macrovascular complications (OR 2.54 [1.44, 4.50]) were independently associated with the risk of death on day 7.

Conclusions/interpretations
In people with diabetes hospitalised for COVID-19, BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days.

Trial registration
clinicaltrials.gov NCT04324736.