Mortality of COVID-19 Patients at ICU with Diabetes Mellitus in Bangladesh: Role of Multimorbidity and Diagnostic Biomarkers

Background: Diabetes Mellitus (DM) is one of the major reasons for mortality of hospitalized COVID-19 patients. This study aimed to determine the role of multimorbidity anddiagnostic biomarkers in the mortality of diabetic COVID-19 patients in the intensive care unit (ICU). Methods: We conducted a cross-sectional study among ICU admitted COVID-19 patients with DM at two tertiarylevel hospitals in Dhaka from May 2020 to April 2021. The role of multiple co-morbidities such as lung disease, cardiovascular diseases, hypertension, malignancy, hyperthyroidism, etc., including diagnostic biomarkers of COVID-19 severity were also assessed. Results: Overall, 40% of ICU admitted COVID-19 patients with DM died during the study period. With the increase in the number of co-morbidities, the proportion of death increases. The death rate was as high as 86% if COVID-19 patients had five or more selected chronic diseases. Moreover, smoking habit (AOR= 2.7, 95% CI: 1.6, 4.5), acute kidney infection (AOR=5.2,95% CI: 3.0, 8.9), anemia (AOR=1.7, 95%CI: 1.1, 2.8), lymphopenia (AOR=1.9, 95%CI: 1.2, 3.1), leukocytosis (AOR=1.9, 95%CI: 1.3, 2.9), abnormal D-Dimer (AOR=2.7, 95% CI: 1.7, 4.5), abnormal ALT level (AOR=1.5, 95%CI: 1.1, 2.9), and abnormal BUN (AOR=2.1, 95%CI: 1.2, 3.6) was identified as significant predictor of mortality. Conclusion: A highproportion of mortality was seen among patients with several comorbidities. Sincere attention should be given to COVID-19 patients with DM and early consideration of multimorbidity would decrease patients' death risk. Keywords: COVID-19; Diabetes Mellitus; Mortality; Multimorbidity; ICU; Biomarkers.