Clinical evolution of COVID-19 patients with hypertension and/or diabetes in the intensive care units: a systematic review

Abstract

We aimed to evaluate the association of hypertension and diabetes with the severity prognosis of COVID-19 in ICU hospitalization by analyzing significant differences in epidemiological, clinical and laboratory aspects when compared with non-diabetic and non-hypertensive patients. This review was conducted according to PRISMA, registered on PROSPERO, guided for 4 independent researchers, we used 5 different database and Newcastle-Ottawa scale was the bias analysis applied. A total of 26 articles were included in this review. Diabetics patients admitted to the ICU were older than non-diabetics, about 10 years. Males were associated with a higher chance of death compared to females. Patients with newly diagnosed diabetes and poorly controlled HBA1C had a higher risk of death compared to long-term and controlled patients. Diabetic patients presented evidence that this population tends to have more symptoms in the lower respiratory tract than upper respiratory tract. Procalcitonin levels and CRP proved to be determinant for the patient’s evolution. Hypertensive and diabetics patients who died presented higher d-dimer levels, troponin and NT-proBNP on ICU admission in comparison to patients who survived. Creatinine was higher and this was a marker of severity as it was associated with death. Gender plays an important role in mortality, also advanced age. Diabetes is an independent risk factor for mortality of COVID-19 and mortality, but hypertension is not. We conclude that hypertension and diabetes were significantly associated with COVID-19 patient’s admission to the ICU.