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Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study

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Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, 13005 Marseille, France
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Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France
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L’institut du Thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Département d’Endocrinologie, Diabétologie et Nutrition, Hôpital Guillaume et René Laennec, 44093 Nantes, France
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Assistance-Publique Hôpitaux de Marseille, Medical Evaluation Department, CIC-CPCET, 13005 Marseille, France
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Public Health and Medical Information Department, APHM, 13005 Marseille, France
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Aix Marseille University, IRD, AP-HM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France
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Aix-Marseille University, EA 3279 CEReSS—Health Service Research and Quality of Life Center, 13005 Marseille, France
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Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
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Département d’Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, Université de Toulouse, 31432 Toulouse, France
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CIC-EC 1413, Clinique des Données, CHU de Nantes, 44000 Nantes, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(11), 3726; https://doi.org/10.3390/jcm9113726
Received: 15 October 2020 / Revised: 12 November 2020 / Accepted: 18 November 2020 / Published: 20 November 2020
(This article belongs to the Section Endocrinology & Metabolism)
Diabetes mellitus (DM) has been identified as a risk factor for severe COVID-19. DM is highly prevalent in the general population. Defining strategies to reduce the health care system burden and the late arrival of some patients thus seems crucial. The study aim was to compare phenotypic characteristics between in and outpatients with diabetes and infected by COVID-19, and to build an easy-to-use hospitalization prediction risk score. This was a retrospective observational study. Patients with DM and laboratory- or CT-confirmed COVID-19, who did (n = 185) and did not (n = 159) require hospitalization between 10 March and 10 April 2020, were compared. Data on diabetes duration, treatments, glycemic control, complications, anthropometrics and peripheral oxygen saturation (SpO2) were collected from medical records. Stepwise multivariate logistic regressions and ROC analyses were performed to build the DIAB score, a score using no more than five easy-to-collect clinical parameters predicting the risk of hospitalization. The DIAB score was then validated in two external cohorts (n = 132 and n = 2036). Hospitalized patients were older (68.0 ± 12.6 vs. 55.2 ± 12.6 years, p < 0.001), with more class III obesity (BMI ≥ 40 kg/m2, 9.7 vs. 3.5%, p = 0.03), hypertension (81.6 vs. 44.3%, p < 0.0001), insulin therapy (37% vs. 23.7%, p = 0.009), and lower SpO2 (91.6 vs. 97.3%, p < 0.0001) than outpatients. Type 2 DM (T2D) was found in 94% of all patients, with 10 times more type 1 DM in the outpatient group (11.3 vs. 1.1%, p < 0.0001). A DIAB score > 27 points predicted hospitalization (sensitivity 77.7%, specificity 89.2%, AUC = 0.895), and death within 28 days. Its performance was validated in the two external cohorts. Outpatients with diabetes were found to be younger, with fewer diabetic complications and less severe obesity than inpatients. DIAB score is an easy-to-use score integrating five variables to help clinicians better manage patients with DM and avert the saturation of emergency care units. View Full-Text
Keywords: COVID-19; diabetes; outpatients; hospitalization risk score; DIABSCORE COVID-19; diabetes; outpatients; hospitalization risk score; DIABSCORE
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MDPI and ACS Style

Lasbleiz, A.; Cariou, B.; Darmon, P.; Soghomonian, A.; Ancel, P.; Boullu, S.; Houssays, M.; Romain, F.; Lagier, J.C.; Boucekine, M.; Resseguier, N.; Gourdy, P.; Pichelin, M.; Wargny, M.; Dutour, A.; Gaborit, B. Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study. J. Clin. Med. 2020, 9, 3726. https://doi.org/10.3390/jcm9113726

AMA Style

Lasbleiz A, Cariou B, Darmon P, Soghomonian A, Ancel P, Boullu S, Houssays M, Romain F, Lagier JC, Boucekine M, Resseguier N, Gourdy P, Pichelin M, Wargny M, Dutour A, Gaborit B. Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study. Journal of Clinical Medicine. 2020; 9(11):3726. https://doi.org/10.3390/jcm9113726

Chicago/Turabian Style

Lasbleiz, Adèle, Bertrand Cariou, Patrice Darmon, Astrid Soghomonian, Patricia Ancel, Sandrine Boullu, Marie Houssays, Fanny Romain, Jean C. Lagier, Mohamed Boucekine, Noémie Resseguier, Pierre Gourdy, Matthieu Pichelin, Matthieu Wargny, Anne Dutour, and Bénédicte Gaborit. 2020. "Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study" Journal of Clinical Medicine 9, no. 11: 3726. https://doi.org/10.3390/jcm9113726

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