SARS-CoV-2感染对青年T1D患者疾病轨迹的影响:来自RECOVER项目的基于ehr的队列研究

IF 3.9 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pediatric Diabetes Pub Date : 2023-08-09 DOI:10.1155/2023/8798997

P. Prahalad, V. Lorman, Qiong Wu, H. Razzaghi, Yong Chen, N. Pajor, A. Case, S. Bose-Brill, J. Block, Payal B. Patel, Suchitra Rao, A. Mejias, Christopher B. Forrest, L. C. Bailey, R. Jhaveri, D. Thacker, D. Christakis, Grace M. Lee, on behalf of the Simons Vip consortium

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引用次数: 0

摘要

背景。严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)感染急性后后遗症(PASC)与糖尿病恶化相关目前尚不清楚1型糖尿病儿童(T1D)的PASC是否表现为糖尿病病程恶化。目标。探讨SARS-CoV-2感染(COVID-19)与t1d相关医疗保健利用(糖尿病酮症酸中毒(DKA)或严重低血糖(SH))或血红蛋白(Hb) A1c轨迹的关系。方法:我们纳入了在进入队列之前患有T1D且HbA1c≥1的<21岁儿童，定义为COVID-19(阳性诊断试验或COVID-19诊断代码，儿童多系统炎症综合征或PASC)或在整个研究期间阴性的随机选择阴性试验(广泛队列)。纳入队列后28 - 275天HbA1c值≥1的亚组(窄队列)纳入轨迹分析。采用基于倾向评分的匹配队列设计，然后采用加权Cox回归来评估进入队列后≥28天COVID-19与医疗保健利用的关系。使用广义估计方程(GEE)模型来测量窄队列中HbA1c的变化。结果。从2020年3月1日到2022年6月22日，分别有2404名和1221名青年符合宽组和窄组的入学标准。利用的风险比为(HR 1.45 (95% CI: 0.97, 2.16))。在窄队列中，COVID-19患者的HbA1c变化率(斜率)在进入队列后91-180天增加(0.138 vs. - 0.002, p = 0.172)。180天后，阳性队列的HbA1c下降幅度更大(每月- 0.104 vs. 0.008, p = 0.024)。结论。虽然观察到T1D患者感染COVID-19后的预后有恶化的趋势，但这些发现没有统计学意义。有必要继续对COVID-19后青年T1D患者进行临床监测。

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Impact of SARS-CoV-2 Infection on Disease Trajectory in Youth with T1D: An EHR-Based Cohort Study from the RECOVER Program

Background. Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is associated with worsening diabetes trajectory. It is unknown whether PASC in children with type 1 diabetes (T1D) manifests as worsening diabetes trajectory. Objective. To explore the association between SARS-CoV-2 infection (COVID-19) and T1D-related healthcare utilization (for diabetic ketoacidosis (DKA) or severe hypoglycemia (SH)) or hemoglobin (Hb) A1c trajectory. Methods: We included children <21 years with T1D and ≥1 HbA1c prior to cohort entry, which was defined as COVID-19 (positive diagnostic test or diagnosis code for COVID-19, multisystem inflammatory syndrome in children, or PASC) or a randomly selected negative test for those who were negative throughout the study period (Broad Cohort). A subset with ≥1 HbA1c value from 28 to 275 days after cohort entry (Narrow Cohort) was included in the trajectory analysis. Propensity score-based matched cohort design followed by weighted Cox regression was used to evaluate the association of COVID-19 with healthcare utilization ≥28 days after cohort entry. Generalized estimating equation (GEE) models were used to measure change in HbA1c in the Narrow Cohort. Results. From March 01, 2020 to June 22, 2022, 2,404 and 1,221 youth met entry criteria for the Broad and Narrow Cohorts, respectively. The hazard ratio for utilization was (HR 1.45 (95% CI: 0.97, 2.16)). In the Narrow Cohort, the rate of change (slope) of HbA1c increased 91–180 days after cohort entry for those with COVID-19 (0.138 vs. −0.002, p = 0.172 ). Beyond 180 days, greater declines in HbA1c were observed in the positive cohort (−0.104 vs. 0.008 per month, p = 0.024 ). Conclusion. While a trend toward worse outcomes following COVID-19 in T1D patients was observed, these findings were not statistically significant. Continued clinical monitoring of youth with T1D following COVID-19 is warranted.

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来源期刊

Pediatric Diabetes 医学-内分泌学与代谢

CiteScore

6.60

自引率

14.70%

发文量

141

审稿时长

4-8 weeks

期刊介绍： Pediatric Diabetes is a bi-monthly journal devoted to disseminating new knowledge relating to the epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes in childhood and adolescence. The aim of the journal is to become the leading vehicle for international dissemination of research and practice relating to diabetes in youth. Papers are considered for publication based on the rigor of scientific approach, novelty, and importance for understanding mechanisms involved in the epidemiology and etiology of this disease, especially its molecular, biochemical and physiological aspects. Work relating to the clinical presentation, course, management and outcome of diabetes, including its physical and emotional sequelae, is considered. In vitro studies using animal or human tissues, whole animal and clinical studies in humans are also considered. The journal reviews full-length papers, preliminary communications with important new information, clinical reports, and reviews of major topics. Invited editorials, commentaries, and perspectives are a regular feature. The editors, based in the USA, Europe, and Australasia, maintain regular communications to assure rapid turnaround time of submitted manuscripts.