Investigation of Risk Factors for Hospitalization of COVID-19 Patients with Diabetes in Najaf, Iraq

Document Type : Original Articles


1 Department of Clinical and Laboratory Sciences‏, Faculty of Pharmacy, University of Kufa, Najaf, Iraq

2 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Kufa, Najaf, Iraq


Preliminary findings indicate that patients with diabetes mellitus (DM) are at additional risk of infecting with COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is associated with increased mortality in these patients. Hyperglycemia can affect inflammatory and immune responses, which leads patients to severe COVID-19 consequences. The present study investigated risk factors for hospitalized COVID-19 patients with DM in Najaf, Iraq. 127 patients with positive PCR tests were selected from Al-Hakeem Hospital and Al-Sadr Teaching Hospital. Demographic characteristics and laboratory data were collected to compare patients with and without DM. Chi-squared test followed by odds ratio calculations were used to investigate the risk factors associated with hospitalization of COVID-19 patients with or without DM in the ICU and RCU. Analysis of the relationship between risk factors indicated that age above 65 years, high BMI, hypertension, respiratory rate> 24 BPM, CVD, blood sugar> 180 mg/dl, D-dimer> 1000, ALT> 50 and AST> 40 U/L were independent risk factors for hospitalized COVID-19 patients with DM (P≤0.05). Therefore, investigating these factors may detect the risk of infection with COVID-19 in patients with DM in advance. Physicians should further consider risk factors to discover a targeted intervention to improve clinical efficacy.


Main Subjects

  1. Silveira L, Guerreiro GP, Lisboa LAF, Mejía OAV, Dallan LRP, Dallan LAO, et al. Coronary Artery Bypass Graft During the COVID-19 Pandemic. Braz J Cardiovasc Surg. 2020;35(6):1003-6
  2. Yang X, Yu Y, Xu J, Shu H, Xia Ja, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81.
  3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
  4. Korbel L, Spencer JD. Diabetes mellitus and infection: an evaluation of hospital utilization and management costs in the United States. J Diabetes Complications. 2015;29(2):192-5.
  5. Zhang Q, Bastard P, Liu Z, Le Pen J, Moncada-Velez M, Chen J, et al. Inborn errors of type I IFN immunity in patients with life-threatening COVID-19. Science. 2020;370(6515).
  6. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020;14(4):303-10.
  7. Al-Salameh A, Lanoix JP, Bennis Y, Andrejak C, Brochot E, Deschasse G, et al. Characteristics and outcomes of COVID-19 in hospitalized patients with and without diabetes. Diabetes Metab Res Rev. 2021;37(3): 3388.
  8. Li K, Zhang C, Qin L, Zang C, Li A, Sun J, et al. A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study. Dis Markers. 2021;2021:5598824.
  9. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-8.
  10. Liu Z, Bai X, Han X, Jiang W, Qiu L, Chen S, et al. The association of diabetes and the prognosis of COVID-19 patients: A retrospective study. Diabetes Res Clin Pract. 2020;169:108386.
  11. Lei M, Lin K, Pi Y, Huang X, Fan L, Huang J, et al. Clinical Features and Risk Factors of ICU Admission for COVID-19 Patients with Diabetes. J Diabetes Res. 2020;2020:5237840.
  12. Singh AK, Singh R. Hyperglycemia without diabetes and new-onset diabetes are both associated with poorer outcomes in COVID-19. Diabetes Res Clin Pract. 2020;167:108382.
  13. Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab. 2020;31(6): 1068-1077.
  14. Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020;16(6):297-8.
  15. Li MY, Li L, Zhang Y, Wang XS. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020;9(1):45.
  16. Sardu C, D'Onofrio N, Balestrieri ML, Barbieri M, Rizzo MR, Messina V, et al. Outcomes in Patients With Hyperglycemia Affected by COVID-19: Can We Do More on Glycemic Control? Diabetes Care. 2020;43(7):1408-15.
  17. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  18. Wang M, Yan W, Qi W, Wu D, Zhu L, Li W, et al. Clinical characteristics and risk factors of liver injury in COVID-19: a retrospective cohort study from Wuhan, China. Hepatol Int. 2020;14(5):723-32.
  19. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol. Hepatol. 2020;5(5):428-30.
  20. Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324-9.
  21. Gupta N, Zhao YY, Evans CE. The stimulation of thrombosis by hypoxia. Thromb Res. 2019;181:77-83.
  22. Giovannelli J, Trouiller P, Hulo S, Cherot-Kornobis N, Ciuchete A, Edme JL, et al. Low-grade systemic inflammation: a partial mediator of the relationship between diabetes and lung function. Ann Epidemiol. 2018;28(1):26-32.
  23. Chen H, Liu C, Cheng C, Zheng L, Huang K. Effects of Apelin Peptides on Diabetic Complications. Curr Protein Pept Sci. 2018;19(2):179-89.
  24. Kumar V, Kanakasabapathi R, S.Mahalakshmi, Kandasamy M. Comparison of Inflammatory Markers and Lung Involvement Between Diabetic And Non Diabetic Covid-19 Patients. J Med Dent Sci. 2021; 20: 1-6.
  25. Sandooja R, Vura N, Morocco M. Heightened ACE Activity and Unfavorable Consequences in COVID-19 Diabetic Subjects. Int J Endocrinol. 2020;2020:7847526.
  1. Chakrabarti SS, Kaur U, Banerjee A, Ganguly U, Banerjee T, Saha S, et al. COVID-19 in India: Are Biological and Environmental Factors Helping to Stem the Incidence and Severity? Aging Dis.2020;2020: 7847526.
  2. Mbengue A, Diaw M, Coly MS, Sow,, A.K. F, S.H. B, F., , SAR F, et al. Evaluation of the ventilatory function of Senegalese patients with type 2 diabetes. J Physiol Pathophysiol. 2019 10(2):34-41.