Predictors of adverse outcomes in COVID-19: A retrospective cohort study comparing the first two waves of COVID-19 hospital admissions in London, with a focus on diabetes

Durreshahwar Hashmi; Yusuf Shaikhali; Rebecca Cassin-Scott; Pei Eng; Walter Distaso; Tricia Tan; Victoria Salem; Chioma Izzy-Engbeaya

doi:10.1530/endoabs.77.P186

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Endocrine Abstracts (2021) 77 P186 | DOI: 10.1530/endoabs.77.P186

SFEBES2021 Poster Presentations Metabolism, Obesity and Diabetes (78 abstracts)

Predictors of adverse outcomes in COVID-19: A retrospective cohort study comparing the first two waves of COVID-19 hospital admissions in London, with a focus on diabetes

Durreshahwar Hashmi ¹ , Yusuf Shaikhali ¹ , Rebecca Cassin-Scott ² , Pei Eng ² , Walter Distaso ¹ , Tricia Tan ¹ , Victoria Salem ¹ & Chioma Izzy-Engbeaya ¹

Err

Author affiliations

¹Imperial College London, London, United Kingdom; ²Imperial College Healthcare NHS Trust, London, United Kingdom

Introduction: Diabetes has been associated with poorer outcomes with COVID-19 infection, but precise predictors of mortality in patients with diabetes remain unclear. We assessed predictors of adverse outcomes in patients hospitalised with COVID-19 in Imperial College Healthcare NHS Trust (ICHNT) hospitals during the first and second waves of COVID-19 to determine if outcomes for patients with diabetes have evolved with new variants and treatments.

Methods: Data were collected from all 1372 patients hospitalised with COVID-19 between 01/11/2020 and 31/01/2021 (Wave 2) and from all 889 patients admitted between 09/03/2020 to 22/04/2020 (Wave 1). The composite primary outcome was death or ICU admission within 30 days of COVID-19 diagnosis. Multivariate proportional odds analyses were performed to determine the independent predictors for the primary outcome in all patients and patients with diabetes.

Findings: Demographic/clinical characteristics were similar in both waves, with 61% of patients from non-White ethnic backgrounds as is representative of the community served in London. 37% (331/889 in wave 1) and 33% (456/1372 in wave 2) of patients admitted with COVID-19 had diabetes (97% Type 2 over both waves). In wave 2, patients with diabetes had reduced odds of the primary outcome (OR 0.75, 95% CI 0.56-1.00, P = 0 .04). The OR for primary outcome in patients without diabetes in wave 2 vs wave 1 was 0.14 (95%CI 0.09-0.19), P < 0.01). Renal impairment was the strongest independent predictor (out of 19 clinical variables) of poor outcome in all patients (n = 2265) and in patients with diabetes (n = 787). Dexamethasone (OR 0.42 (95%CI 0.31-0.56, P < 0.01)) and tocilizumab (OR 0.44 (95%CI 0.24-0.77), P < 0.01) use, independently reduced risk of death in all patients.

Conclusions: Patients with diabetes and associated complications remained at risk of poorer outcomes throughout the COVID pandemic. However patients with diabetes significantly benefitted from the advances in treatment options available during wave 2.