VCU-led study reveals elevated risks for patients with diabetes and liver disease during COVID-19 waves
A study led by Virginia Commonwealth University researchers found that while the omicron variant of COVID-19 caused fewer severe cases overall, patients with chronic conditions such as diabetes, respiratory and liver diseases remained at significantly higher risk for serious outcomes.
The retrospective study, which examined patient data across the pandemic’s waves of the alpha, delta, and omicron variants, provides critical insights into how these underlying health conditions influenced the need for mechanical ventilation and 30-day mortality rates.
The new study, posted online by the Journal of Clinical and Translational Sciences, reviewed data for 232,364 hospitalized COVID-19 patients, ages 18–90, in the National COVID Cohort Collaborative, from April 2020 to June 2022. It provides critical insights into how these underlying health conditions influenced the patients’ need for mechanical ventilation and 30-day mortality rates.
“This study underscores the need to stay vigilant in addressing the challenges posed by chronic conditions like diabetes and liver disease,” said the study’s corresponding author, Richard Sterling, M.D., M.Sc., the institute’s chief clinical officer, professor and the lead for clinical and translational science pilot programs at VCU’s C. Kenneth and Dianne Wright Center for Clinical and Translational Research. “Even as newer variants like omicron become less severe overall, we must prioritize care for those most at risk.”
Diabetes emerged as one of the most consistent predictors of severe outcomes during all three initial COVID-19 waves: the alpha, delta and omicron variants.
Patients with diabetes were more likely to require mechanical ventilation and had higher 30-day mortality rates than those without the condition. The year-long delta wave proved particularly challenging, with the highest rates of ventilation and death among diabetic patients. Although the omicron wave that began in late 2021 wasn’t as severe overall, diabetic patients still faced elevated risks, underscoring the importance of providing medical interventions for this patient population.
Similarly, liver disease played a significant role in increasing the likelihood of severe outcomes. Across the three waves, patients with liver disease consistently demonstrated higher odds of needing mechanical ventilation.
However, during the later omicron period, this risk decreased to levels that were no longer statistically significant. Researchers attribute this improvement to advancements in treatment, broader vaccination coverage, and immunity gained through previous infections. Despite this, there was a rise in the number of liver disease cases among hospitalized COVID-19 patients in more recent waves, highlighting the growing vulnerability of this group.
In addition to examining the clinical severity of COVID-19, the study highlighted persistent disparities in the disease’s impact on different racial and ethnic groups. While most patients studied were non-Hispanic white, nearly 20% were non-Hispanic Black or African American, and as many as 14% were Hispanic or Latino. Hispanic patients were particularly affected during the early COVID-19 waves, making up 20% of hospitalized cases during some periods. These disparities reflect broader inequities in healthcare access and the prevalence of chronic conditions in these communities.
The researchers emphasized the importance of using these findings to guide public health strategies. They called for continued efforts to protect high-risk populations through vaccination, improved access to healthcare, and targeted outreach to communities disproportionately affected by COVID-19.
In addition to Sterling, the VCU co-authors were Priyanka Parajuli, M.D.; Roy Sabo, Ph.D.; Rasha Alsaadawi; Amanda Robinson; and Evan French; on behalf of the National COVID Cohort Collaborative consortium. Lara A.C. Phipps, of the University of North Carolina at Chapel Hill, was also a co-author.
This project was supported in part by the Biostatistics, Epidemiology and Research Design core of the C. Kenneth and Dianne Wright Center for Clinical and Translational Research (award No. UL1TR002649 from the National Center for Advancing Translational Sciences).