RESUMEN
BACKGROUND: The impact of type 2 diabetes mellitus (T2DM) on acute respiratory distress syndrome (ARDS) is debatable. T2DM was suspected to reduce the risk and complications of ARDS. However, during coronavirus disease 2019 (COVID-19), T2DM predisposed patients to ARDS, especially those who were on insulin at home. AIM: To evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes. METHODS: We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database. Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus (DM) (IDDM) and non-insulin-dependent DM (NIDDM) groups. After applying exclusion criteria and matching over 20 variables, we compared cohorts for mortality, duration of mechanical ventilation, incidence of acute kidney injury (AKI), length of stay (LOS), hospitalization costs, and other clinical outcomes. RESULTS: Following 1:1 propensity score matching, the analysis included 274 patients in each group. Notably, no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates (32.8% vs 31.0%, P = 0.520), median hospital LOS (10 d, P = 0.537), requirement for mechanical ventilation, incidence rates of sepsis, pneumonia or AKI, median total hospitalization costs, or patient disposition upon discharge. CONCLUSION: Compared to alternative anti-diabetic medications, outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.
RESUMEN
BACKGROUND: COVID-19 may have a role in myocardial injury in some patients, which can lead to multiple cardiovascular consequences. Electrocardiography (ECG) is useful to detect cardiac involvement of COVID-19. OBJECTIVE: In this study, we aimed to identify the pattern of ECG findings in COVID-19 patients. METHODS: We retrospectively evaluated the clinical data of 176 patients diagnosed with COVID-19 along with their ECG findings on admission and during hospitalization. RESULTS: Out of 176 patients, 56.8% were males. The mean age of the patients was 64.4 (SD: 15.4) years. Twenty-five patients were obese (Body mass index "BMI" > 30). Comorbidities including hypertension, diabetes mellitus, and coronary artery disease were found in 70.5%, 52.3%, and 24.4% of patients, respectively. Only 17% of patients had normal ECG readings, and the rest had abnormalities of various types. Heart rate was normal in 67.6% of patients, the rest were tachycardiac (29.0%) or bradycardiac (3.4%). Findings included a widened QRS complex in 6.2% of patients, 79.0% of patients had a prolonged PR interval, and 9.1% had a prolonged QT interval. The most common ECG abnormalities were sinus tachycardia (20.5%) and atrial fibrillation (18.2%). We found a correlation between mortality and atrial fibrillation (p=0.021) and ventricular premature contraction (p=0.007). As for complications, atrial fibrillation and sinus tachycardia were significantly correlated with major complications including death, need for positive pressure ventilation (PPV), intensive care unit (ICU) admission, myocardial infarction, and acute respiratory distress syndrome (ARDS). CONCLUSION: ECG is a robust indicator of myocardial involvement of the COVID-19 patients. This study highlighted the diagnostic and prognostic importance of conducting ECG on admission and during hospitalization for COVID-19 patients. More investigation is required to determine the diagnostic accuracy and prognostic value of this modality.