Higher admission activated partial thromboplastin time, neutrophil-lymphocyte ratio, serum sodium, and anticoagulant use predict in-hospital covid-19 mortality in people with diabetes: Findings from two university hospitals in the UK

Objectives: To create and compare survival models from admission laboratory indices in people hospitalized with coronavirus disease 2019 (covid-19) with and without diabetes. Methods: We conducted a retrospective observational study of patients with confirmed covid-19 with or without diabetes admitted to Sheffield Teaching Hospitals from 29/2/20 to 1/5/20. The primary end-point was in-hospital mortality from covid-19. Predictive variables for mortality were explored in the diabetes and non-diabetes groups using Cox proportional hazard models. Results: Out of 505 patients, 156 (30.8%) had diabetes (DM) of which 143 (91.7%) had type 2 diabetes. There were significantly higher in-hospital covid-19 deaths in those with DM [DM covid-19 deaths 54 (34.6%) vs. non- DM covid-19 deaths 88 (25.2%): p 24 seconds without anticoagulants (Hazard ratio (HR) 3.71, 95% CI: 1.00-13.74: p = 0.04), APTT >24 seconds with anticoagulants (HR 8.78, 95% CI: 2.30-33.57: p = 0.001), neutrophil-lymphocyte ratio >8 (HR 4.30, 95% CI: 1.88-9.82: p = 0.001), and sodium > 136 mmol/L (HR 2.46, 95% CI: 1.10-5.49: p = 0.02) were associated with in-hospital covid-19 mortality. Conclusions: We report new findings that at admission elevated APTT with or without anticoagulants, neutrophil-lymphocyte ratio and serum sodium predict in-hospital covid-19 mortality in patients with diabetes compared to those without. These routinely measured indices can serve as important candidate biomarkers for future studies into risk stratification and prognostication in patients with diabetes hospitalized with covid-19.