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Clinical characteristics, outcomes and risk factors for mortality in hospitalized diabetes and chronic kidney disease patients after COVID-19 infection following widespread vaccination

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Abstract

Background

COVID-19 poses a significant threat to patients with comorbidities, such as diabetes and chronic kidney disease (CKD). China experienced a nationwide COVID-19 endemic from December 2022 to January 2023, which is the first occurrence of such an outbreak following China’s widespread administration of COVID-19 vaccinations.

Methods

A total of 338 patients with diabetes and CKD combined with COVID-19 infection between December 7, 2022 and January 31, 2023 were included in this study. The end follow-up date was February 10, 2023. Univariate analysis and multivariate Cox analysis were used to analyze risk factors for death.

Results

During the 50-day median follow-up period, 90 patients in the study cohort died, for a mortality rate of 26.63%. The median age of the study cohort was 74 years, with a male predominance of 74%. During hospitalization, 21% of patients had incident AKI, 17% of patients experienced stroke, and 40% of patients experienced respiratory failure. Cox proportional hazard regression showed that older age, a diagnosis of severe or critically severe COVID-19 infection, incident AKI and respiratory failure, higher level of average values of fasting glucose during hospitalization, UA, and total bilirubin were independent risk factors for death in our multivariate model.

Conclusions

These findings highlight the critical importance of identifying and managing comorbid risk factors for COVID-19, especially among the elderly, in order to optimize clinical outcomes, even after COVID-19 vaccination.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

The authors thank AiMi Academic Services (www.aimieditor.com) for English language editing and review services.

Funding

This study was supported by Health Commission of Sichuan Province Program (No.21ZD001), and Key Research and Development Projects of Sichuan Province (No. 2021YFS0368).

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Authors and Affiliations

  1. Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China

    Y. Zou, C. Qin, Q. Yang, Y. Lang, K. Liu & Fang Liu

  2. Department of Clinical Medicine, Southwest Medical University, Luzhou, China

    F. Yang

  3. Department of Clinical Research Management, West China Hospital of Sichuan University, Chengdu, China

    X. Li, Y. Zhao, L. Chen & Fang Liu

  4. Information Center, West China Hospital of Sichuan University, Chengdu, China

    T. Zheng, M. Wang & R. Shi

  5. Engineering Research Center of Medical Information Technology, Ministry of Education, Chengdu, China

    T. Zheng, M. Wang & R. Shi

  6. Division of Project Design and Statistics, West China Hospital of Sichuan University, Chengdu, China

    W. Yang

  7. Integrated Care Management Center, West China Hospital of Sichuan University, Chengdu, China

    Y. Zhou

  8. Division of Neurology, West China Hospital of Sichuan University, Chengdu, China

    L. Chen

Authors
  1. Y. Zou
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  2. C. Qin
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  4. Y. Lang
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  5. K. Liu
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  7. X. Li
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  9. T. Zheng
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  12. W. Yang
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  14. L. Chen
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  15. Fang Liu
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Contributions

YZ conceived and designed the study, collected and analyzed the data, and drafted the manuscript. CQ, QY, YL, KL, FY, and XL assisted with the study design and data collection. YZ, TZ, MW, RS, and WY provided statistical expertise and contributed to the data analysis and interpretation. YZ and LC contributed to the study design, data interpretation, and critically revised the manuscript for important intellectual content. FL provided guidance on the study design and data interpretation and contributed to the critical revisions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fang Liu.

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Conflict of interest

The authors declare no conflicts of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the West China Medical Center of Sichuan University (No. 2023R30).

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Informed consent was assigned.

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Zou, Y., Qin, C., Yang, Q. et al. Clinical characteristics, outcomes and risk factors for mortality in hospitalized diabetes and chronic kidney disease patients after COVID-19 infection following widespread vaccination. J Endocrinol Invest 47, 619–631 (2024). https://doi.org/10.1007/s40618-023-02180-7

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  • DOI: https://doi.org/10.1007/s40618-023-02180-7

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