The correlation between diabetes mellitus (DM) and outcomes in COVID-19 is mainly mediated by hyperinflammation, as assessed by soluble urokinase plasminogen activator receptor (suPAR) levels, according to a study published online in the March issue of Diabetes Care.
Alexi Vasbinder, PhD, RN, from the University of Michigan in Ann Arbor, and colleagues characterized the impact of DM on in-hospital outcomes using the multicenter observational International Study of Inflammation in COVID-19, which included 2044 patients hospitalized with COVID-19. The composite of in-hospital death, need for mechanical ventilation, and need for renal replacement therapy was assessed as the primary outcome.
The researchers found that compared with those without DM, the 686 participants with DM had a significantly higher cumulative incidence of the primary outcome (37.8 vs 28.6%), and they had higher levels of inflammatory biomarkers. In a multivariate analysis, DM was only associated with higher suPAR levels. The correlation between DM and the primary outcome was attenuated after adjustment for suPAR levels (adjusted odds ratio, 1.23). The proportion of the effect of DM on the primary outcome that was mediated by suPAR was estimated at 84.2%. Independent predictors of the primary outcome included hyperglycemia and higher insulin doses.
“COVID-19-related in-hospital outcomes in individuals with DM are driven by a hyperinflammatory state reflected best by suPAR levels,” the authors write. “Further study is needed to determine whether suPAR and hyperglycemia are therapeutic targets for the management of COVID-19 in individuals with DM.”