Middle East Respiratory Syndrome in Critically Ill Patients with Diabetes: A  Multicenter Observational Study of Clinical Presentation, Management and Outcomes

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 who developed Middle East Respiratory Syndrome (MERS).Methods: 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 between critically ill MERS patients who had diabetes and those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.Results: Of the 350 MERS patients, 171 (48.9%) had diabetes, were more likely to be older and have comorbid conditions. Patients with diabetes 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).Conclusions: Critically ill patients with diabetes constitute half of critically ill patients with MERS, presenting with more severe disease requiring mechanical ventilation compared to those who do not have diabetes. Diabetes is an independent predictor of mortality.