Modificação de efeito por sexo na associação entre Diabetes Mellitus e mortalidade por COVID-19 em unidades de terapia intensiva no Brasil: um estudo de coorte retrospectivo

Abstract

A growing body of evidence suggests that individuals with diabetes mellitus (DM) may be more susceptible to serious complications from Covid-19. However, it remains unclear whether the association between DM and mortality from Covid-19 differs between the sexes. This study investigated the effect modification by sex in the association between Diabetes Mellitus (DM) and Covid-19 mortality in patients in intensive care units (ICUs) in Brazil, in a retrospective cohort. Data were taken from hospital records, totaling 9564 ICU patients who tested positive for the SarsCov-2 virus, between March 2020 and May 2021. Means and standard deviations were calculated for continuous variables and absolute and relative frequencies for categorical variables. To compare the characteristics of the participants between those with and without diabetes, in each sex, Student's t-test was used for the continuous variables and Pearson's chi-square test for the categorical variables. Cox proportional hazard models were used to estimate the risk ratios and 95% confidence intervals (95% CI) of the association between DM and mortality from Covid-19 for each sex. The Hazard Ratio analysis showed a relevant effect modification between sex and DM in the association with mortality from Covid-19, for females with DM (HR= 1.16, 1.2 to 1.32; p-value=0.02) who showed an increase in risk in the adjusted model. The study concludes that the association between DM and mortality from Covid-19 was modified by gender, and was more pronounced in women with DM. These results are relevant to understanding the risk factors associated with Covid-19 in critically ill patients and highlight the importance of considering not only the presence of DM, but also factors such as gender when assessing the prognosis of these patients. This information can be valuable for guiding management strategies and identifying groups at greater risk, contributing to a more personalized approach to patient care in ICUs.