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Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico.
J Clin Endocrinol Metab. 2020 08 01; 105(8)JC

Abstract

BACKGROUND

The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction.

METHODS

We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality.

RESULTS

Among the 177 133 subjects at the time of writing this report (May 18, 2020), we observed 51 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included age ≥ 65 years, diabetes, early-onset diabetes, obesity, age < 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statistic = 0.823).

CONCLUSIONS

Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario.

Authors+Show Affiliations

Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico.Plan de Estudios Comcinados en Medicina (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Plan de Estudios Comcinados en Medicina (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Plan de Estudios Comcinados en Medicina (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.Centro de Estudios en Antropología, Facultad de Ciencias Políticas y Sociales, Universidad Nacional Autónoma de México, Mexico City, Mexico.Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico. Plan de Estudios Comcinados en Medicina (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Plan de Estudios Comcinados en Medicina (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.Department of Physicochemistry, Instituto de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico.Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Department of Endocrinolgy and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32474598

Citation

Bello-Chavolla, Omar Yaxmehen, et al. "Predicting Mortality Due to SARS-CoV-2: a Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico." The Journal of Clinical Endocrinology and Metabolism, vol. 105, no. 8, 2020.
Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, et al. Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. J Clin Endocrinol Metab. 2020;105(8).
Bello-Chavolla, O. Y., Bahena-López, J. P., Antonio-Villa, N. E., Vargas-Vázquez, A., González-Díaz, A., Márquez-Salinas, A., Fermín-Martínez, C. A., Naveja, J. J., & Aguilar-Salinas, C. A. (2020). Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. The Journal of Clinical Endocrinology and Metabolism, 105(8). https://doi.org/10.1210/clinem/dgaa346
Bello-Chavolla OY, et al. Predicting Mortality Due to SARS-CoV-2: a Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. J Clin Endocrinol Metab. 2020 08 1;105(8) PubMed PMID: 32474598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. AU - Bello-Chavolla,Omar Yaxmehen, AU - Bahena-López,Jessica Paola, AU - Antonio-Villa,Neftali Eduardo, AU - Vargas-Vázquez,Arsenio, AU - González-Díaz,Armando, AU - Márquez-Salinas,Alejandro, AU - Fermín-Martínez,Carlos A, AU - Naveja,J Jesús, AU - Aguilar-Salinas,Carlos A, PY - 2020/04/28/received PY - 2020/05/28/accepted PY - 2020/6/1/pubmed PY - 2020/7/10/medline PY - 2020/6/1/entrez KW - COVID-19 KW - Mexico KW - SARS-CoV-2 KW - diabetes KW - lethality KW - obesity JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 105 IS - 8 N2 - BACKGROUND: The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction. METHODS: We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality. RESULTS: Among the 177 133 subjects at the time of writing this report (May 18, 2020), we observed 51 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included age ≥ 65 years, diabetes, early-onset diabetes, obesity, age < 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statistic = 0.823). CONCLUSIONS: Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/32474598/Predicting_Mortality_Due_to_SARS_CoV_2:_A_Mechanistic_Score_Relating_Obesity_and_Diabetes_to_COVID_19_Outcomes_in_Mexico_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/clinem/dgaa346 DB - PRIME DP - Unbound Medicine ER -