Markers of Coagulation Dysfunction and Inflammation in Diabetic and Non Diabetic COVID-19 Patients- A Retrospective Study

Abstract

Introduction: Since the end of 2019, a novel Coronavirus Disease 2019 (COVID-19), declared a pandemic by World Health Organization (WHO) has ravaged the world. Diabetic patients have been reported to be more susceptible to intensive care admissions, and deaths due to COVID-19. Diabetes Mellitus (DM) and COVID-19, both associated with chronic and acute inflammation respectively can impact each other in terms of clinical progression and outcome. Given the novelty of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pathogen, there is need to update and increase the limited evidence on the probability of DM acting as a risk factor and influencing disease severity and progression. Aim: To compare the markers of inflammation and coagulation dysfunction between COVID-19 patients with and without DM as co-morbidity and thereby to study the effect DM has on the prognosis of COVID-19. Materials and Methods: This was a retrospective, observational, single-centre study, conducted Department of Biochemistry at Gauhati Medical College and Hospital, Guwahati, Assam, India, from January 2021 to June 2021. Clinical and laboratory data of 500 laboratory confirmed COVID-19 patients were reviewed in this study. The patients were grouped as diabetic case group and non diabetic control group. Data was presented as percentages for categorical variables and median (interquartile range) for continuous variables. Chi-square test was used to see the association of different qualitative information and MannWhitney U test was used to see the association of quantitative data and all p-values were given for justification. A p-value <0.05 was considered statistically significant. Results: The sample included 300 diabetic and 200 non diabetic COVID-19 patients. The mean age non diabetic patients (47.5 years) was significantly less as compared to the diabetic group (54.5 years), p-value <0.001. The serum level of inflammatory biomarkers, C-Reactive Protein (CRP), ferritin, and markers of hypercoagulable state, D-dimer, was found to be significantly high (p-value <0.001) in diabetic patients as compared to non diabetic patients. Diabetics had a poor prognosis with 231 (77%) receiving oxygen as compared to 51 (25.5%) of non diabetic patients. Total 173 (57.7%) of diabetic COVID-19 patients had to be shifted to ICU, 201 (67%) suffered from post COVID-19 complications and the mortality rate was higher at 18% in diabetics as compared to 1.5% in non diabetic subjects. Conclusion: Diabetic patients are at higher risk of uncontrolled inflammation and hypercoagulable state which eventually leads to deterioration of COVID-19 infection status.