Characteristics of diabetes patients with COVID-19 infection
A total of 3059 patients (Ages ranged from 11 to 100 years old, mean age was 58 years old) with COVID-19 infection admitted in Wuhan Huoshenshan Hospital from February 4 to April 12, 2020. Except for 163 COVID-19 patients received CPT therapy, a total of 328 diabetes patients (Ages ranged from 33 to 90 years old, mean age was 64 years old) people out of 2893 illness received traditional treatment had comorbidity of diabetes as well, including 12 of died cases, the mortality rate was 3.66%. A total of 21 COVID-19 patients with diabetes were treated in ICU (intensive care unit) and noticed of critical illness. According to the clinical classification criterion in Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia released by the National Health Commission (7th trial version), except 7 patients without severity degree, the other 321 diabetes patients of COVID-19 infection received traditional treatment were divided into three classification, including 135 (42.06%) of mild patients, 164 (51.09%) of severe patients, and 22 (6.85%) of critical patients. The hospitalization time of 328 COVID-19 patients with comorbidity of diabetes ranged from 4 to 47 days, and average time was 16 days (Fig. 1).
Characteristics Of Covid-19 Patients Receiving Cpt Therapy
A total of 163 COVID-19 patients received CPT therapy in Wuhan Huoshenshan Hospital, in which 124 (Male: 68, Female: 56) COVID-19 patients had no comorbidity of diabetes, including 5 of died cases, the mortality rate was 4.04%. The age of 124 COVID-19 patients ranged from 21 to 93 years old, average age was 63 years old. The type of comorbidities was range between 0 to 11, average number of comorbidities was 1 type. In addition, a total of 15 patients were treated in ICU (intensive care unit) and noticed of critical illness. The 124 COVID-19 patients receiving CPT therapy were divided into three classification, including 13 (10.48%) of mild patients, 90 (72.58%) of severe patients, and 21 (16.94%) of critical patients. The time of hospitalization ranged from 5 to 57 days, and average time was 27 days. In addition, the time of discharge from hospital of COVID-19 patients after receiving CPT ranged from 1 to 35 days, and average time was 11 days (Fig. 2).
Correspondingly, a total of 39 (Male: 23, Female: 16) out 163 COVID-19 patients receiving CPT therapy had comorbidity of diabetes, including 3 of died cases, the mortality rate was 7.69%. The age of 39 diabetes patients ranged between 21 to 93 years old, average age was 63 years old. A total of 8 diabetes patients were treated in ICU (intensive care unit) and noticed of critical illness. Similarly, the 39 diabetes patients were divided into three classification, including 2 (5.13%) of normal patients, 27 (69.23%) of severe patients, and 10 (25.64%) of critical patients. The time of hospitalization ranged from 7 to 62 days, and average time was 26 days. While the time of discharge from hospital after receiving CPT ranged from 2 to 37 days, and average time was 13 days (Fig. 2).
Compared the baseline information of COVID-19 patients with diabetes comorbidity
The baseline information of 39 diabetes patients infected with COVID-19 receiving the CPT therapy was compared with that of 328 diabetes patients receiving traditional treatment. It was found that 8.2% mild COVID-19 patients receiving traditional treatment was below 50 years old, 29.6%, 40%, and 20% of patients with ages ranged between 50–60, 60–70, and 70–80 years old respectively. 2.2% of mild COVID-19 patients were over 80 years old. However, both ages between 50–60 and 60–70 years old of mild COVID-19 diabetes patients receiving CPT therapy accounted for 50%. Out of severe COVID-19 patients with traditional treatment, 51.9% of patients were over 60 years old, corresponding the patients receiving CPT therapy accounted for 81.5%. In addition, compared with 50% of critical COVID-19 patients receiving traditional treatment were over 70 years old, this percentage was 70% of critical patients receiving CPT therapy (Fig. 3A).
In 328 cases of COVID-19 diabetes patients receiving traditional treatment, 54.6% of patients were male, and 46.1% were female (Fig. 3B), including 42.1% of mild patients, 51.1% of severe patients, and 6.8% of critical patients respectively (Fig. 3C). Correspondingly, in 39 COVID-19 patients with comorbidity of diabetes receiving CPT therapy, 59% of male patients and 61% of female patients (Fig. 3B), including 5.1% of mild patients, 69.2% of severe patients, and 25.6% of critical patients respectively (Fig. 3C). Compared to 328 COVID-19 patients receiving traditional treatment with average 2 types of comorbidities, 39 diabetes patients receiving CPT therapy had average 3 types of comorbidities (Fig. 3D).
Analysis Of Blood And Biochemical Indicator Of Diabetes Patients
To examine the clinical outcome of CPT therapy for COVID-19 patients with comorbidity of diabetes, the blood and biochemical routine examination (Table 1, 2) reflecting kidney, liver and heart function of 39 COVID-19 patients receiving CPT therapy were compared to that of 328 diabetes patients receiving traditional treatment. The results indicated that in biochemical routine examination reflecting kidney function, the values of Urea and CysC of CPT therapy group were obviously higher than that of control group (p < 0.05) (Fig. 4A). In blood routine examination reflecting kidney function, although the values of LY%, MO% and EO% were within reference range, there were no obvious difference between CPT and non-CPT therapy group (Fig. 4B).
Table 1
Information of biochemical routine examination in this study
Test | Abbreviation | Reference range | Units |
Alanine aminotransferase | ALT | 9–60 | U/L |
Aspartate aminotransferase | AST | 10–40 | U/L |
Total protein | TP | 60–80 | g/L |
Albumin | ALB | 35–50 | g/L |
Globulin | GLB | 20–30 | g/L |
Total bilirubin | TBIL | 1.7–20.4 | µmol/L |
Direct bilirubin | DBIL | 0-6.8 | µmol/L |
Indirect bilirubin | IBIL | 1.7–10.2 | µmol/L |
Total bile acid | TBA | 0.1–10 | µmol/L |
Blood glucose | GLU | 3.9–6.1 | mmol/L |
Urea nitrogen | Urea | 7–20 | mg/dL |
Creatinine | Cre | 44–106 | µmol/L |
Uric acid | UA | 150–430 | µmol/L |
Alkaline phosphatase | ALP | 40–160 | U/L |
γ-glutamyl transpeptidase | GGT | 0–51 | U/L |
Cystatin C | CysC | 0.51–1.09 | mg/L |
Creatine kinase | CK | 24–170 | U/L |
Lactate dehydrogenase | LDH | 100–300 | U/L |
alpha-hydroxybutyrate dehydrogenase | HBDH | 90–182 | U/L |
Creatine kinase isoenzyme | CK-MB | 0–16 | U/L |
Table 2
Information of blood routine examination in this study
Test | Abbreviation | Reference range | Units |
White blood cell | WBC | 4–10 | 10^9/L |
Red blood cell | RBC | 3.5–5.5 | 10^12/L |
Hemoglobin | HB | 110–160 | g/L |
Packed cell volume | PCV | 0.37–0.54 | vol% |
Mean corpuscular | MCV | 80–97 | fL |
Mean corpuscular hemoglobin | MCH | 26.5–33.5 | pg |
Mean corpuscular hemoglobin concentration | MCHC | 300–360 | g/L |
Red blood cell volume distribution width | RDWB | 10–16 | % |
Blood platelet | PLT | 100–300 | 10^9/L |
Procalcitonin | PCT | < 0.5 | ng/mL |
Lymphocyte percentage | LY | 17–48 | % |
Monocyte percentage | MO | 4–10 | % |
Eosinophil percentage | EO | 0.5-5 | % |
C-reactive protein | CRP | < 8 | mg/L |
Hypersensitive C-reactive protein | hs-CRP | 0.06-10 | mg/L |
Correspondingly, in biochemical routine examination reflecting liver function, except the GLB values of patients receiving CPT therapy were obviously lower than that of non-CPT therapy patients (Fig. 4C), all other biochemical test results had not significant difference between CPT and non-CPT therapy patients. However, in blood routine examination reflecting liver function, the RBC values of diabetes patients receiving CPT therapy were significantly lower than that of diabetes patients receiving traditional treatment (p < 0.01), and the HB, PCV, and MCHV values of CPT therapy patients were obviously lower than traditional treatment patients (p < 0.05) (Fig. 4D). In addition, the RDWB values of CPT therapy patients were significantly higher than that of patients receiving traditional treatment (p < 0.001) (Fig. 4D).
Similarly, in biochemical and blood routine examination reflecting heart function, CK values of patients receiving CPT therapy were significantly lower than that of patients receiving traditional treatment (p < 0.01), and LDH values of CPT group were obviously higher than non-CPT group (p < 0.05) (Fig. 4E). It was worthy to note that the HBDH values of patients receiving CPT therapy were higher than that of patients receiving traditional treatment (p < 0.05), and these values were beyond the reference range (Table 2). Additionally, the Glu values of diabetes patients (average value was 8.0) after CPT therapy were similar with that of patients receiving traditional treatment (average value was 7.9) (Fig. 4F).
Cpt Therapy Was Effective For Covid-19 Patients With Diabetes
To evaluate the effectiveness of CPT therapy for COVID-19 patients with comorbidity of diabetes, the clinical outcome based on six categories of 39 patients receiving CPT therapy were compared to that of 328 patients receiving traditional treatment. Taking into consideration one point reduction as a criterion of clinical symptoms improving, the duration times of diabetes patients receiving traditional treatment varied from 1 day to 45 days, and the average duration time was 17 days (Fig. 5A). A total of 24.4% (80/328) of diabetes patients out of 328 COVID-19 cases matched this criterion, while 75.6% (248/328) of diabetes patients did not meet this criterion without clinical symptoms improving (Fig. 5B). Compared to these, the duration times of diabetes patients receiving CPT therapy varied from 1 day to 28 days, and the average duration time was only 10 days (Fig. 5A). It was worthy to note that high up to 69.2% (27/39) of COVID-19 patients matched this criterion with significantly clinical symptoms improving after CPT therapy (Fig. 5B).
Correspondingly, taking into consideration two points reduction as a criterion of clinical symptoms improving, in 328 COVID-19 patients with comorbidity of diabetes receiving traditional treatment, the duration times varied from 2 days to 39 days, and the average duration time was 27 days (Fig. 5C). Only 2.7% (9/328) of COVID-19 patients matched this criterion with clinical symptoms improving after traditional treatment such as anti-virus, steroids, and oxygen therapy (Fig. 5D). However, the duration times of diabetes patients receiving CPT therapy varied from 1 day to 28 days, and the average duration time was only 14 days (Fig. 5A). A total of 28.2% (11/39) of diabetes patients matched this criterion with clinical symptoms improving after CPT therapy (Fig. 5B). In conclusion, according to the six categories, the CPT therapy significantly improved the clinical outcome and reduced the duration time of COVID-19 patients with comorbidity of diabetes.