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Research ArticleOriginal Article
Open Access

Impact of diabetes mellitus and co-morbidities on mortality in patients with COVID-19

A single-center retrospective study

Anees A. Sindi, Wail A. Tashkandi, Mohammed W. Jastaniah, Mohammed A. Bashanfar, Ahmed F. Fakhri, Fahad S. Alsallum, Hamdan B. Alguydi, Alyaa Elhazmi, Talal A. Al-Khatib, Maha M. Alawi and Ibrahim Abushoshah
Saudi Medical Journal January 2023, 44 (1) 67-73; DOI: https://doi.org/10.15537/smj.2023.44.1.20220462
Anees A. Sindi
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
FACP, FRCPC
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  • For correspondence: [email protected]
Wail A. Tashkandi
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
FABS, FCCMC
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Mohammed W. Jastaniah
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical Intern
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Mohammed A. Bashanfar
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical Intern
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Ahmed F. Fakhri
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical Intern
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Fahad S. Alsallum
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical Intern
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Hamdan B. Alguydi
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical Intern
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Alyaa Elhazmi
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
MD
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Talal A. Al-Khatib
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
MHPEd, FRCSC
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Maha M. Alawi
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
FRCPC, CIC
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Ibrahim Abushoshah
From the Department of Anesthesia and Critical Care (Sindi, Abushoshah), from the Department of Surgery (Tashkandi), from the Department of Otolaryngology-Head Neck Surgery (Al-Khatib), from the Unit of Infection Control & Environmental Health (Alawi), Department of Medical Microbiology & Parasitology (Alawi), Faculty of Medicine (Jastaniah, Bashanfar, Fakhri, Alguydi, Alsallum), King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from the College of Medicine (Elhazmi), Alfaisal University, and from the Research Center (Elhazmi), Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
MBBS
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    Figure 1

    - Survival time for diabetic and non-diabetic patients.

Tables

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    Table 1

    - Characteristics of all the study subjects (N=198).

    Variablesn (%)
    Gender
    Male139 (70.2)
    Female59 (29.8)
    Health care worker
    Yes19 (9.4)
    No179 (90.6)
    Age, mean±SD54±14.89
    17-35 years22 (11.1)
    36-50 years51 (25.8)
    >50 years125 (63.1)
    DM
    Yes86 (43.4)
    No112 (56.6)
    Active smokers9 (4.5)
    Body mass index, mean±SD31.38±30.14
    Normal74 (37.8)
    Underweight1 (0.5)
    Overweight75 (37.9)
    Obese48 (24.2)
    Co-morbidities present prior to admission
    Hypertension95 (48.0)
    Ischemic heart disease35 (17.7)
    Chronic kidney disease19 (9.6)
    Asthma10 (5.1)
    Chronic obstructive pulmonary disease3 (1.5)
    Chronic liver disease3 (1.5)
    Chronic Lung disease2 (1.0)
    HbA1c (mmol/mol), mean±SD8.65±3.19
    Oxygen therapy (on hospital arrival)
    Required96 (48.5)
    Not required102 (51.5)

    Values are presented as numbers and precentages (%). SD: standard deviation, DM: diabetes mellitus, HbA1c: hemoglobin A1C

      • View popup
      Table 2

      - Demographic and clinical profile of diabetic and non-diabetic patients at the time of admission.

      VariablesDiabetic (n=86)Non-diabetic (n=112)P-values
      Age in years, mean±SD60.89±12.0049.43±15.03<0.001
      Male60 (69.7)79 (70.5)0.907
      Active smoker3 (3.5)6 (5.3)0.531
      Fever66 (76.8)86 (76.8)0.995
      Cough58 (67.4)74 (66.1)0.839
      Dyspnea62 (72.1)64 (58.9)0.030
      Headache6 (7.2)13 (11.6)0.273
      Altered consciousness8 (9.3)6 (5.3)0.283
      Hypertension69 (83.1)26 (23.2)<0.001
      Ischemic heart disease28 (32.6)7 (6.3)<0.001
      Chronic kidney disease17 (19.8)2 (1.8)<0.001
      Length of hospital stay13 (10.0)11 (9.0)0.027
      Mean arterial pressure, mean±SD80.51±20.0192.71±15.760.001
      Systolic blood pressure, mean±SD139.58±23.98132.31±21.480.059
      Diastolic blood pressure, mean±SD74.68±12.8879.25±13.110.040
      Heart rate, mean±SD92.64±21.0690.85±16.620.535
      Respiratory rate, mean±SD25.31±7.3921.967±4.7<0.001
      Oxygen saturation, mean±SD90.23±13.1693.8±10.200.041
      PCO2, mean±SD36.42±13.7540.27±18.00.325
      HbA1C, mean±SD9.64±3.326.56±1.89<0.001
      Hemoglobin, mean±SD12.21±23712.96±2.650.056
      Ph value, mean±SD7.31±0.137.37±0.100.047

      Values are presented as numbers and precentages (%). SD: standard deviation, PCO2: partial pressure of carbon dioxide, HbA1C: hemoglobin A1c, pH: potential of hydrogen

        • View popup
        Table 3

        - Laboratory parameters on hospital arrival among diabetic and non-diabetic group.

        Laboratory parametersDiabeticNon-diabeticP-values
        WBC (X109/L)8.05 (5.7)6.26 (3.87)0.006
        Neutrophils (X109/L)6.49 (5.18)4.09 (3.85)<0.001
        Lymphocytes (X109/L)1.46 (.74)1.17 (0.93)0.154
        Platelet count (X109/L)252 (176.25)216.5 (128)0.045
        CRP (mg/L)100.85 (0)56.3 (31.05)0.004
        AST (U/L)51 (0)37.5 (39.5)0.479
        (g/L)170 (0)77.88 (42.5)<0.001
        LDH (U/L)561 (0)295 (340.8)0.691
        Bilirubin15.5 (0)7.5 (6.0)0.425
        Lactate1.3 (0)1.15 (0.61)0.429
        Procalcitonin0.49 (0)0.06 (0.25)<0.001
        Creatinine-kinase965 (0)76.5 (58.5)0.212
        D-dimer1.39 (0)1.79 (2.98)0.008
        Ferritin5320.16 (0)237.7 (1326.3)0.052
        Troponin0.34 (0)0.015 (0.016)0.009

        Values are presented as medians and interquartile ranges (IQR). WBC: white blood count, CRP: C-reactive protein, AST: aspartate aminotransferase, LDH: lactate dehydrogenase

          • View popup
          Table 4

          - Risk factors analysis.

          Risk factorsUnadjusted analysisAdjusted analysis
          OR (95% CI)P-valuesOR (95% CI)P-values
          Age0.941 (0.919-0.964)<0.0010.936 (0.887-0.988)0.017
          Hypertension0.074 (0.037-0.148)<0.0010.255 (0.055-1.171)0.079
          Shortness of breath0.516 (0.283-0.942)0.0310.964 (0.172-5.410)0.967
          Ischemic heart disease0.138 (0.057-0.336)<0.0010.237 (0.023-2.427)0.225
          Chronic kidney disease0.074 (0.017-0.329)<0.0010.0000.999
          C-reactive protein0.993 (0.988-0.998)0.0060.998 (0.985-1.010)0.694
          Procalcitonin0.369 (0.205-0.665)0.0110.539 (0.204-1.424)0.213

          OR: odds ratio, CI: confidence interval

            • View popup
            Table 5

            - Mortality analysis with age group and comorbidities.

            ParametersTotalOutcomesDeath percentagesP-values
            AliveDeath
            Age group (years)
            17-35222029.1%0.006
            36-5051351631.4%
            ≥51125715443.2%
            Diabetes86464046.5%0.009
            Hypertension95504547.4%0.002
            Ischemic heart disease35171851.4%0.041
            COPD32133.3%0.912
            CKD1991052.6%0.121

            COPD: chronic obstructive pulmonary disease, CKD: chronic kidney disease

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            Impact of diabetes mellitus and co-morbidities on mortality in patients with COVID-19
            Anees A. Sindi, Wail A. Tashkandi, Mohammed W. Jastaniah, Mohammed A. Bashanfar, Ahmed F. Fakhri, Fahad S. Alsallum, Hamdan B. Alguydi, Alyaa Elhazmi, Talal A. Al-Khatib, Maha M. Alawi, Ibrahim Abushoshah
            Saudi Medical Journal Jan 2023, 44 (1) 67-73; DOI: 10.15537/smj.2023.44.1.20220462

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            Impact of diabetes mellitus and co-morbidities on mortality in patients with COVID-19
            Anees A. Sindi, Wail A. Tashkandi, Mohammed W. Jastaniah, Mohammed A. Bashanfar, Ahmed F. Fakhri, Fahad S. Alsallum, Hamdan B. Alguydi, Alyaa Elhazmi, Talal A. Al-Khatib, Maha M. Alawi, Ibrahim Abushoshah
            Saudi Medical Journal Jan 2023, 44 (1) 67-73; DOI: 10.15537/smj.2023.44.1.20220462
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