Usefulness of the CHEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts

Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual CHEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes.

Material And Methods: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients' baseline characteristics were retrieved to calculate the CHEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home/sudden-deterioration/rehabilitation) and adverse in-hospital clinical events.

Results: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk CHEST stratum. The CHEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group-levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that CHEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury.

Conclusions: We demonstrated the usefulness and performance of the CHEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects.

Citing Articles

The Usefulness of the CHEST Score in Predicting the Clinical Outcomes of COVID-19 in COPD and Non-COPD Cohorts.

Gawrys J, Doroszko A, Drozdz O, Trocha M, Gajecki D, Gawrys K Microorganisms. 2024; 12(6).

PMID: 38930620 PMC: 11205505. DOI: 10.3390/microorganisms12061238.

The Usefulness of the CHEST Risk Score in Predicting Clinical Outcomes among Hospitalized Subjects with COVID-19 and Coronary Artery Disease.

Rola P, Doroszko A, Trocha M, Gajecki D, Gawrys J, Matys T Viruses. 2022; 14(8).

PMID: 36016394 PMC: 9415686. DOI: 10.3390/v14081771.

Usefulness of CHEST Score in Predicting Clinical Outcomes of COVID-19 in Heart Failure and Non-Heart-Failure Cohorts.

Rola P, Doroszko A, Trocha M, Giniewicz K, Kujawa K, Gawrys J J Clin Med. 2022; 11(12).

PMID: 35743564 PMC: 9225357. DOI: 10.3390/jcm11123495.

References

Whyte M, Vas P, Heiss C, Feher M . The contribution of diabetic micro-angiopathy to adverse outcomes in COVID-19. Diabetes Res Clin Pract. 2020; 164:108217. PMC: 7217793. DOI: 10.1016/j.diabres.2020.108217. View

Abdi A, Jalilian M, Sarbarzeh P, Vlaisavljevic Z . Diabetes and COVID-19: A systematic review on the current evidences. Diabetes Res Clin Pract. 2020; 166:108347. PMC: 7375314. DOI: 10.1016/j.diabres.2020.108347. View

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J . Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. PMC: 7042881. DOI: 10.1001/jama.2020.1585. View

Daryabor G, Atashzar M, Kabelitz D, Meri S, Kalantar K . The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System. Front Immunol. 2020; 11:1582. PMC: 7387426. DOI: 10.3389/fimmu.2020.01582. View

Hill M, Mantzoros C, Sowers J . Commentary: COVID-19 in patients with diabetes. Metabolism. 2020; 107:154217. PMC: 7102643. DOI: 10.1016/j.metabol.2020.154217. View

Huang I, Lim M, Pranata R . Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020; 14(4):395-403. PMC: 7162793. DOI: 10.1016/j.dsx.2020.04.018. View

Janus A, Szahidewicz-Krupska E, Mazur G, Doroszko A . Insulin Resistance and Endothelial Dysfunction Constitute a Common Therapeutic Target in Cardiometabolic Disorders. Mediators Inflamm. 2016; 2016:3634948. PMC: 4931075. DOI: 10.1155/2016/3634948. View

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. PMC: 7159299. DOI: 10.1016/S0140-6736(20)30183-5. View

Guo J, Lin W, Zucker J, Nandakumar R, Uhlemann A, Wang S . Inflammation and Mortality in COVID-19 Hospitalized Patients With and Without Type 2 Diabetes. J Clin Endocrinol Metab. 2022; 107(5):e1961-e1968. PMC: 8755390. DOI: 10.1210/clinem/dgac003. View

10.

Volpe C, Villar-Delfino P, Dos Anjos P, Nogueira-Machado J . Cellular death, reactive oxygen species (ROS) and diabetic complications. Cell Death Dis. 2018; 9(2):119. PMC: 5833737. DOI: 10.1038/s41419-017-0135-z. View

11.

Hu R, Xia C, Butfiloski E, Clare-Salzler M . Effect of high glucose on cytokine production by human peripheral blood immune cells and type I interferon signaling in monocytes: Implications for the role of hyperglycemia in the diabetes inflammatory process and host defense against infection. Clin Immunol. 2018; 195:139-148. PMC: 6119493. DOI: 10.1016/j.clim.2018.06.003. View

12.

Katsiki N, Gomez-Huelgas R, Mikhailidis D, Perez-Martinez P . Narrative review on clinical considerations for patients with diabetes and COVID-19: More questions than answers. Int J Clin Pract. 2021; 75(11):e14833. PMC: 8646329. DOI: 10.1111/ijcp.14833. View

13.

Liang W, Liang H, Ou L, Chen B, Chen A, Li C . Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020; 180(8):1081-1089. PMC: 7218676. DOI: 10.1001/jamainternmed.2020.2033. View

14.

Tang X, Du R, Wang R, Cao T, Guan L, Yang C . Comparison of Hospitalized Patients With ARDS Caused by COVID-19 and H1N1. Chest. 2020; 158(1):195-205. PMC: 7151343. DOI: 10.1016/j.chest.2020.03.032. View

15.

Marcolino M, Pires M, Ramos L, Silva R, Oliveira L, Carvalho R . ABC-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores. Int J Infect Dis. 2021; 110:281-308. PMC: 8302820. DOI: 10.1016/j.ijid.2021.07.049. View

16.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. PMC: 7270627. DOI: 10.1016/S0140-6736(20)30566-3. View

17.

Seiglie J, Platt J, Cromer S, Bunda B, Foulkes A, Bassett I . Diabetes as a Risk Factor for Poor Early Outcomes in Patients Hospitalized With COVID-19. Diabetes Care. 2020; 43(12):2938-2944. PMC: 7770271. DOI: 10.2337/dc20-1506. View

18.

Kumar N, Sridhar R, Nair D, Banurekha V, Nutman T, Babu S . Type 2 diabetes mellitus is associated with altered CD8(+) T and natural killer cell function in pulmonary tuberculosis. Immunology. 2014; 144(4):677-86. PMC: 4368174. DOI: 10.1111/imm.12421. View

19.

Hussain A, Bhowmik B, Cristina do Vale Moreira N . COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020; 162:108142. PMC: 7144611. DOI: 10.1016/j.diabres.2020.108142. View

20.

Alraddadi B, Watson J, Almarashi A, Abedi G, Turkistani A, Sadran M . Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Illness in Humans, Saudi Arabia, 2014. Emerg Infect Dis. 2015; 22(1):49-55. PMC: 4696714. DOI: 10.3201/eid2201.151340. View