Evaluation of the difference in severity of lung involvement in chest CT scan of diabetic and non-diabetic patients with Covid-19

Introduction: The new coronavirus, known as severe coronavirus syndrome (SARS-CoV2), is a viral pneumonia caused by an emerging virus that causes Coronavirus Disease 2019 (COVID-19) (1). The etiology and pathology of the disease are not known exactly, but it has been reported to enter host cells by the angiotensin-converting enzyme (ACE2). (2) The range of clinical symptoms of the disease varies from asymptomatic to respiratory failure, which requires mechanical ventilation. These symptoms have been more severe in patients with diabetes and hypertension (1). Detection of COVID-19 is based on RT-PCR (real-time reverse transcription polymerase chain reaction) test of the pharyngeal sample. It has been found that chest CT scans can be useful in diagnosing interstitial pneumonia in patients with suspected COVID-19 (7, 8). Bilateral peripheral GGO involvement is the most common finding on chest CT scan in COVID-19 patients. The appearance of GGO alone or with consolidative opacities was also a common finding in chest CT. Chest CT scan and pathological changes are more severe in patients with diabetes. Diabetes is one of the most common diseases in Iran and the world. This disease is considered as a risk factor in patients with 19-COVID. The risk of severe symptoms and death in diabetic patients with COVID-19 is higher than others. This study aimed to evaluate the differences in the severity of lung involvement in chest CT scan of diabetic and non-diabetic patients with Covid-19. Materials and Methods: The present study is a retrospective cross-sectional study that was performed on 148 patients with Covid-19 including 74 diabetic patients and 74 non-diabetic patients admitted to Kosar Hospital in Semnan and Firoozabadi Hospital in Tehran in 2016. Inclusion criteria were confirmation of coronary heart disease, confirmation of diagnosis of diabetes from 5 years ago and use of diabetic drugs in the case group. Demographic information, signs and symptoms, chest CT scan findings and RT-PCR were extracted from patients' medical records. Statistical analysis was performed using SPSS software and the significance level of P was less than 0.05. Results: There was a statistically significant difference between the age of patients with COVID-19 in the two groups of diabetic and non-diabetic patients (p_value = 0.002). Chest CT scan in diabetic and non-diabetic patients with COVID-19 was 21.44 and 20.04, respectively. There was no statistically significant difference between the chest CT scores of patients with diabetic and non-diabetic groups by sex and age. Conclusion: In the present study, the rate of lung involvement by chest CT scan in 74 diabetic patients with Covid-19 was compared with 74 non-diabetic patients. There was a statistically significant difference between the ages of patients with COVID-19 in both diabetic and non-diabetic patients, so that the mean age of diabetic patients was higher than non-diabetic patients. There was no statistically significant difference between the sex and chest CT scan score of patients with COVID-19 in the two groups of diabetic and non-diabetic patients. The results of the present study showed that the mean age of diabetic patients was higher than non-diabetic patients. The rate of pulmonary involvement in diabetic and non-diabetic patients with COVID-19 was not different and the score of lung CT scan was similar in both groups; In addition, age and gender had no effect on CT scan score. This finding is the most important result of the present study. Pulmonary infiltration may be due to the body's immune response to the virus, and overproduction of inflammatory cytokines, known as cytokine storms, can cause lung damage (15). People with diabetes are affected by low-grade chronic inflammation that may facilitate the cytokine storm, which in turn appears to be the cause of severe cases of COVID-19 (19). IL-6 is the most common marker of inflammation in diabetes mellitus with COVID-19. (20). From these cases, it can be concluded that in diabetic patients, due to the higher level of inflammatory cytokines, lung damage is also expected to increase. Another cause of severe COVID-19 9 and more lung involvement in diabetic patients can be a disorder in the innate immune system of these patients, which increases the risk of infection. Another mechanism in the disorder of the immune system in diabetic patients is the increased adhesion of microorganisms to the cells of diabetic patients; In addition, some microorganisms in a higher glucose environment are more pathogenic. Finally, although the pulmonary involvement of diabetic patients with COVID-19 is higher than non-diabetic patients, this difference is not statistically significant.