1887
Volume 2023, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Diabetes mellitus is a well-recognized contributor to increased COVID-19 severity. Endothelial dysfunction has been implicated in the pathogenesis of COVID-19, while thrombocytopenia has been identified as a potential risk factor for severe COVID-19. In this study, we evaluated the combined effect of thrombocytopenia and other markers of endothelial dysfunction on disease outcomes in patients with type 2 diabetes and active COVID-19 infection. Our aim was to risk stratify patients with COVID-19 and type 2 diabetes mellitus, which can help identify patients with high-risk features who will benefit the most from hospital admission and a high level of care. This cross-sectional study was performed after reviewing secondary data of 932 patients with COVID-19 and type 2 diabetes mellitus in the outpatient and inpatient settings across Qatar between March 1, 2020 and May 7, 2020. Univariate and multivariate analyses, with adjustment for low platelet counts, were performed for the following variables: age, hemoglobin, white blood cells (WBC), lymphocytes, monocytes, eosinophils, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, ferritin, D-dimer, and interleukin 6. Increasing age was associated with an increased risk for death and/or intensive care unit admission in diabetic patients with COVID-19 who have low platelet counts. These findings support the evidence found in the literature and give special attention to COVID-19 patients with low platelet counts and diabetes mellites. These results can guide physicians in making clinical decisions regarding hospital admission and escalation of care during follow-up in this population of patients.

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2022-12-28
2024-11-08
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References

  1. Rodríguez C, Luque N, Blanco I, Sebastian L, Barberà JA, Peinado VI, et al. (2021). Pulmonary endothelial dysfunction and thrombotic complications in patients with COVID-19. Am J Respir Cell Mol Biol. 64:(4), 407–415. https://doi.org/10.1165/rcmb.2020-0359PS.
    [Google Scholar]
  2. Nagashima S, Mendes MC, Camargo Martins AP, Borges NH, Godoy TM, Miggiolaro AFRDS, et al. (2020). Endothelial dysfunction and thrombosis in patients with COVID-19—Brief report. Arterioscler Thromb Vasc Biol. 40:(10), 2404–2407. https://doi.org/10.1161/ATVBAHA.120.314860.
    [Google Scholar]
  3. Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, et al. (2020). ST-segment elevation in patients with Covid-19 — A case series. N Engl J Med. 382:(25), 2478–2480. https://doi.org/10.1056/NEJMc2009020.
    [Google Scholar]
  4. Goshua G, Pine AB, Meizlish ML, Chang CH, Zhang H, Bahel P, et al. (2020). Endotheliopathy in COVID-19-associated coagulopathy: Evidence from a single-centre, cross-sectional study. Lancet Haematol. 7:(8), e575–e582. https://doi.org/10.1016/S2352-3026(20)30216-7.
    [Google Scholar]
  5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 395:(10229), 1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3.
    [Google Scholar]
  6. Zhang J, Tecson KM, McCullough PA. (2020). Endothelial dysfunction contributes to COVID-19-associated vascular inflammation and coagulopathy. Rev Cardiovasc Med. 21:(3), 315. https://doi.org/10.31083/j.rcm.2020.03.126.
    [Google Scholar]
  7. Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M. (2020). Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect. 81:(4), 647–679.
    [Google Scholar]
  8. Nägele MP, Haubner B, Tanner FC, Ruschitzka F, Flammer AJ. (2020). Endothelial dysfunction in COVID-19: Current findings and therapeutic implications. Atherosclerosis, 314, 58–62. https://doi.org/10.1016/j.atherosclerosis.2020.10.014.
    [Google Scholar]
  9. Bellido V, Pérez A. (2021). COVID-19 and diabetes. J Clin Med., 10:(22). https://doi.org/10.3390/jcm10225341.
    [Google Scholar]
  10. Pranata R, Lim MA, Yonas E, Huang I, Nasution SA, Setiati S, et al. (2021). Thrombocytopenia as a prognostic marker in COVID-19 patients: Diagnostic test accuracy meta-analysis. Epidemiol Infect. 149:, e40. https://doi.org/10.1017/S0950268821000236.
    [Google Scholar]
  11. Bonetti PO, Lerman LO, Lerman A. (2003). Endothelial dysfunction: A marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol. 23:(2), 168–175. https://doi.org/10.1161/01.atv.0000051384.43104.fc.
    [Google Scholar]
  12. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. (2020). Endothelial cell infection and endotheliitis in COVID-19. Lancet. 395:(10234), 1417–1418. https://doi.org/10.1016/S0140-6736(20)30937-5.
    [Google Scholar]
  13. Tran TN, Eubanks SK, Schaffer KJ, Zhou CY, Linder MC. (1997). Secretion of ferritin by rat hepatoma cells and its regulation by inflammatory cytokines and iron. Blood. 90:(12), 4979–4986. PMID: 9389717.
    [Google Scholar]
  14. Adam SS, Key NS, Greenberg CS. (2009). D-dimer antigen: Current concepts and prospects. Blood. 113:(13), 2878–2887.
    [Google Scholar]
  15. Düz ME, Balcı A, Menekşe E. (2020). D-dimer levels and COVID-19 severity: Systematic review and meta-analysis. Tuberk Toraks. 68:(4), 353–360. https://doi.org/10.5578/tt.70351.
    [Google Scholar]
  16. Lazzaroni MG, Piantoni S, Masneri S, Garrafa E, Martini G, Tincani A, et al. (2021). Coagulation dysfunction in COVID-19: The interplay between inflammation, viral infection and the coagulation system. Blood Rev. 46:, 100745. doi: 10.1016/j.blre.2020.100745.
    [Google Scholar]
  17. CDC COVID-19 Response Team. (2020). Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 - United States, February 12-March 28, 2020. MMWR. Morb Mortal Wkly Rep. 69(13), 382–386. https://doi.org/10.15585/mmwr.mm6913e2.
    [Google Scholar]
  18. Lima-Martínez MM, Carrera Boada C, Madera-Silva MD, Marín W, Contreras M. (2021). COVID-19 and diabetes: A bidirectional relationship. Clin Investig Arterioscler. 33:(3), 151–157. https://doi.org/10.1016/j.arteri.2020.10.001.
    [Google Scholar]
  19. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. (2021). Predictors of COVID-19 severity: A literature review. Rev Med Virol. 31:(1), 1–10. https://doi.org/10.1002/rmv.2146.
    [Google Scholar]
  20. Wang D, Li R, Wang J, Jiang Q, Gao C, Yang J, et al. (2020). Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: a descriptive study. BMC Infect Dis. 20:(1), 519. https://doi.org/10.1186/s12879-020-05242-w.
    [Google Scholar]
  21. Greco M, de Corte T, Ercole A, Antonelli M, Azoulay E, Citerio G, et al. (2022). Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study. Intensive Care Med. 48:(6), 690–705. https://doi.org/10.1007/s00134-022-06705-1.
    [Google Scholar]
  22. Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, et al. (2020). Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 31:(4), 490–496. https://doi.org/10.1080/09537104.2020.1754383.
    [Google Scholar]
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  • Article Type: Research Article
Keyword(s): COVID-19Diabetes MellitusEndothelial Dysfunction and thrombocytopenia
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