Predictors of in-hospital mortality in COVID 19 patients with type 2 diabetes mellitus in South India: A cross sectional study

Introduction: Evidence suggests that patients with diabetes who developed the COVID-19 infection are known to have glycaemic instability, impaired immunity and associated comorbidities such as heart diseases and obesity leading to increased risk of mortality. Hence the current study was planned to assess the factors affecting mortality in diabetic COVID-19 patients admitted in tertiary care hospitals in South India. Methods: This was a retrospective study involving diabetic COVID-19 patients hospitalized in South India, data was collected from hospital records using pre-tested semi-structured validated questionnaire from January 2021 to February 2022. Results: Out of 397 study patients, 66% (263) them were males. Mean age of the patients was 61± 11.6, male 60.6±11.8, and female was 61.5±11.3. Most common presenting symptoms were fever 62% (235), cough 47% (172), breathlessness 42% (149), followed by weakness 29% (114). 46% (184) patients had uncontrolled diabetes. Co-morbidity like hypertension etc., were seen in 63% (250) of the patients. Saturation below 93% was seen in 20% (75) patients. 26% (69) were on ventilators, 48(42%) were admitted in intensive care unit. Laboratory profile showed high C-reactive protein in (86%) 264, elevated D-dimer in 86% (240), low lymphocyte in 46% (182), elevated ferritin in 63% (177), high neutrophil in 30% (118) and low Hb in 24% (85). Radiological finding shows interstitial opacity in 58 % (148) and CT-ground glass opacity in 21% (86). Complications like acute kidney injury were seen in 29% (115) and acute respiratory distress in 10% (39). The case fatality rate was 14% (56). Elevated neutrophil, elevated aspartate aminotransferase, low oxygen saturation was found to be significantly associated with mortality in COVID-19 diabetic patients. Conclusion: In diabetic COVID 19 patients elevated aspartate alanine transaminase, neutrocytosis and oxygen saturation below 93% are independent risk factors for mortality.