Critically ill patients with diabetes and Middle East respiratory syndrome: a multi-center observational study

Jesna Jose, Hasan M. Al-Dorzi, Awad Al-Omari, Yasser Mandourah, Fahad Al-Hameed, Musharaf Sadat, Eman Al Qasim, Basem Alraddadi, Abdulrahman Al Harthy, Ghaleb A. Al Mekhlafi, Abdullah Almotairi, Kasim Al Khatib, Ahmed Abdulmomen, Ismael Qushmaq, Anees A. Sindi, Ahmed Mady, Othman Solaiman, Rajaa Al-Raddadi, Khalid Maghrabi, Ahmed RagabAyman Kharaba, Sarah Shalhoub, Abdulsalam M. Al-Aithan, Gajendra K. Vishwakarma, Atanu Bhattacharjee, Yaseen M. Arabi (Lead / Corresponding author),

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Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).

This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and
signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if
diabetes was an independent predictor of 90-day mortality.

Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to
present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p <0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality
(odds ratio, 2.09; 95% confidence interval, 1.18–3.72).

Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.
Original languageEnglish
Article number84
Number of pages9
JournalBMC Infectious Diseases
Publication statusPublished - 19 Jan 2021


  • Acute respiratory distress syndrome
  • Coronavirus
  • Diabetes
  • Middle East respiratory syndrome


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