MO629: The Baseline Risk Factors of Covid-19 Adverse Outcomes in Patients with Advanced Stages of Diabetic Kidney Disease: The Single Center Experience

Abstract

BACKGROUND AND AIMSThe patients with diabetic kidney disease (DKD) due to type 2 diabetes mellitus (T2DM) are at a high risk of adverse outcomes of COVID-19. The causes of high mortality in this cohort are the subject of debate.Identification of the risk factors (RF) of adverse COVID-19 outcomes in patients with T2DM and advanced stages of DKD at hospital admission.METHODThe patients with laboratory-confirmed COVID-19 were included in the retrospective observational study during the hospitalization in MCCH №52, the observation period being 04 January 2020 to 31 October 2020. The study endpoints were the outcomes of hospitalization—discharge or lethal outcome. Data were collected from electronic medical database. The following independent variables were analyzed at hospital admission: gender, age, duration of T2DM, general comorbidity (Charlson Index, CCI), the insulin demand (InsD), fasting blood glucose (FBG), body mass index (BMI), NEWS scale points, white blood cell (WBC), lymphocytes and platelet count, CPR, serum albumin (SA), ferritin, LDH, and GFR.RESULTSA total of 120 patients were included. Mediana age was 69 years (IQR 63.5–79.5), females 53%. The observation group was divided into subgroups: (i) patients with advanced DKD according to GFR values not requiring maintenance hemodialysis (MHD) and (ii) patients on MHD. All patients were distinguished by high general comorbidity and duration of T2DM more than 10 years. The mortality in both subgroups was high (38.2% versus 38.5%, respectively). The results are presented in Table 1.CONCLUSIONThe patients with T2DM and advanced DKD are very vulnerable to adverse outcomes of COVID-19. High FBG, lymphopenia and high ferritin value on admission seem to be the most significant RF of lethal outcome regardless of MHD.1 subgroup (n = 55)2 subgroup (n = 65)Parameters(+) n = 34(−) n = 21P-value(+) n = 40(−) n = 25P-valueAge, y Me (IQR)69 (64; 80)77 (69; 82)*P = 0.06067 (61; 75)67 (63; 71)*P = 0.685Gender,n (F) (%)20 (59)12 (57)χ²P = 0.90218 (45)13 (52)χ²P = 0.582GFR, mL/min/1.73 m2Me (IQR)22 (16; 28)22 (14; 27)*P = 0.649–––ССI, pointsMe (IQR)9.0 (8.0; 10.0)10.0(10.0; 11.0)*P = 0.0048.0(7.0; 9.0)9.0 (8.0; 10.0)*P = 0.027InsD, n (%)11 (32)11 (52)*P = 0.14028 (70)20 (80)*P = 0.372BMI, kg/m2М ± SD33.2 ± 5.632.8 ± 6.5 t-testP = 0.85032.7 ± 6.131.2 ± 6.2 t-testP = 0.340NEWS, pointsMe (IQR)2.0 (1.0; 3.0)5.0 (2.0–8.0)*P = 0.0033.0 (2.0; 5; 0)4.0 (2.0; 6,0)*P = 0.214Hb, g/L116 (101; 124)117 (89; 127)*P = 0.936103 (93; 113)101 (92; 106)*P = 0.569WBC count, × 109/LMe (IQR)7.1 (4.9; 8.9)5.2 (6.2; 13.5)*P = 0.0125.7 (4.7; 6.7)5.5 (4.0; 6.7)*P = 0.804Lymph count, × 109/LMe (IQR)1.0 (0.8; 1.8)0.6 (0.4; 1.1)*P = 0.0151.0 (0.6; 1.3)0.6 (0.5; 1.2)*P = 0.049Platelet count, × 109/L215 (166; 257)180 (143; 232)*p = 0.129173 (152; 210)161 (128; 215)*P = 0.344LDH, mmol/LMe (IQR)282 (214; 310)354 (227; 543)*P = 0.055242(224; 305)249 (211; 283)*P = 0.606СРR, mg/LMe (IQR)96 (27; 144)158 (43; 193)*P = 0.02569 (39; 133)90 (33; 156)*P = 0.246Ferritin, mcg/LMe (IQR)186 (101; 463)381 (188; 650)*P = 0.034534 (287; 708)639 (559; 786)*P = 0.006D-dimer, mmol/LMe (IQR)640 (394; 1500)835 (485; 1614)*P = 0.533530 (355; 847)876 (519; 1330)*P = 0.036FBG, mmol/LMe (IQR)7.7 (6.7; 9.0)11.0(9.0; 15.0) *P < 0.0016.6(5.8; 8.5)12.8 (9.6; 14.9) *P < 0.001SA, g/LMe (IQR)37.0(32.0; 38.5)30.0(29.6; 33.0)*P < 0.00134.8 (32.0;3 7.0)33.0 (28.0; 35.0)*P = 0.084(+) survivors; (−) nonsurvivors. *Mann–Whitney U-test; IQR, interquartile range; Me, mediana.