Investigation of the Relationship between Diabetes Mellitus or Hypertension and the Chest Computed Tomography Scan and Short-Term Clinical Outcome in Coronavirus Disease 2019 Pneumonia

Document Type : Original Article


1 Department of Radiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

2 Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

3 Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran

4 Department of Radiology, Yasrebi Hospital, Kashan, Iran



This study aims to investigate the relationship between diabetes mellitus (DM) or hypertension and the distribution and severity of pulmonary involvement and short-term clinical outcome in patients with coronavirus disease 2019 (COVID-19pneumonia.
Materials and Methods: 
In this case–control study, a group of patients with DM and COVID-19 pneumonia are compared to a group without DM. Demographic information, history of diabetes, hypertension, renal disease, tobacco use, laboratory data, current blood pressure, and chest computed tomography (CT) scan of all patients were extracted. The patients' laboratory tests were performed on the same day that the chest CT scan was performed. The data were analyzed using appropriate statistical tests.
The results show that gender, age, smoking, and history of kidney disease were not significantly associated with the history of diabetes and hypertension (P > 0.05). Furthermore, the history of diabetes and hypertension had no significant relationship with the distribution and severity of pulmonary involvement and short-term clinical outcome (P > 0.05). However, among the laboratory findings, hemoglobin, hematocrit, and erythrocyte sedimentation rate were significantly associated with a history of diabetes and blood urea nitrogen values were associated with a history of hypertension (P < 0.05).
Based on the findings of this study, it can be concluded that the history of diabetes and hypertension has no significant relationship with the distribution and severity of pulmonary involvement and short-term clinical outcome.


1. World Health Organization. Novel Coronavirus (COVID‑19) Situation. Available from: [Last accessed on 2020 May 02].
2. Yang Y, Yang M, Shen C, Wang F, Yuan J, Li J, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019‑nCoV infections. MedRxiv2020.
3. Ng MY, Lee EY, Yang J, Yang F, Li X, Wang H, et al. Imaging profile of the COVID‑19 infection: Radiologic findings and literature review. Radiol Cardiothorac Imaging 2020;2:e200034.
4. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel coronavirus
disease (COVID‑19): Analysis of nine patients treated in Korea. Korean J Radiol 2020;21:494‑500.
5. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT‑PCR testing for coronavirus disease 2019 (COVID‑19) in China: A report of 1014 cases. Radiology 2020;296:E32‑40.
6. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID‑19: Comparison to RT‑PCR. Radiology 2020;296:E115‑7.
7. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical coronavirus disease 2019 (COVID‑19) pneumonia: Relationship to negative RT‑PCR testing. Radiology 2020;296:E41‑5.
8. BernheimA, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease‑19 (COVID‑19): Relationship to duration of infection. Radiology 2020;295:200463.
9. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID‑19). Radiology 2020;295:715‑21.
10. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019‑nCoV). Radiology 2020;295:202‑7.
11. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus disease 2019 (COVID‑19): A perspective from China. Radiology 2020;296:E15‑25.
12. ChenN, ZhouM, DongX, Qu J, GongF, HanY, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507‑13.
13. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‑19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239‑42.
14. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS‑CoV‑2 pneumonia in Wuhan, China: A single‑centered, retrospective, observational study. Lancet Respir Med 2020;8:475‑81.
15. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934‑43.
16. Tikellis C, Thomas MC. Angiotensin‑converting Enzyme 2 (ACE2) is a key modulator of the renin angiotensin system in health and disease. Int J Pept 2012;2012:256294.
17. Knapp S. Diabetes and infection: Is there a link? – A mini‑review. Gerontology 2013;59:99‑104.
18. Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 2003;26:510‑3.
19. Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005;41:281‑8.
20. Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med 1999;341:1906‑12.
21. Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology 2015;144:171‑85.
22. Yang JK, Feng Y, Yuan MY, Yuan SY, Fu HJ, Wu BY, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med 2006;23:623‑8.
23. Loscalzo J, Fauci AS, Kasper DL, Hauser S, Longo D, Jameson JL. Harrison’s Principles of Internal Medicine. Vol. 1, 2. McGraw Hill Professional; 2022.
24. Khalili S, Moradi O, Kharazmi AB, Raoufi M, Sistanizad M, Shariat M. Comparison of mortality rate and severity of pulmonary involvement in coronavirus disease‑2019 adult patients with and without type 2 diabetes: A cohort study. Can J Diabetes 2021;45:524‑30.
25. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID‑19 in China. Clin Res Cardiol 2020;109:531‑8.
26. Wang X, Fang X, Cai Z, Wu X, Gao X, Min J, et al. Comorbid chronic diseases and acute organ injuries are strongly correlated with disease severity and mortality among COVID‑19 patients: A systemic review and meta‑analysis. Research (Wash D C) 2020;2020:2402961.
27. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID‑19: Evidence from meta‑analysis. Aging (Albany NY) 2020;12:6049‑57.
28. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS‑CoV‑2: A systematic review and meta‑analysis. Int J Infect Dis 2020;94:91‑5.
29. Pinto LC, Bertoluci MC. Type 2 diabetes as a major risk factor for COVID‑19 severity: A meta‑analysis. Arch Endocrinol Metab 2020;64:199‑200.
30. de Almeida‑PitittoB, Dualib PM, Zajdenverg L, DantasJR, de Souza FD, Rodacki M, et al. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: A meta‑analysis. Diabetol Metab Syndr 2020;12:75.
31. Chan JW, Ng CK, Chan YH, Mok TY, Lee S, Chu SY, et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax 2003;58:686‑9.
32. Morra ME, Van Thanh L, Kamel MG, Ghazy AA, Altibi AM, Dat LM, et al. Clinical outcomes of current medical approaches for Middle East respiratory syndrome: A systematic review and meta‑analysis. Rev Med Virol 2018;28:e1977.
33. Lippi G, Wong J, Henry BM. Hypertension in patients with coronavirus disease 2019 (COVID‑19): A pooled analysis. Pol Arch Intern Med 2020;130:304‑9.
34. Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID‑19 pneumonia: A systematic review, meta‑analysis and meta‑regression. J Renin Angiotensin Aldosterone Syst 2020;21(2).
35. Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M, et al. Age and multimorbidity predict death among COVID‑19 patients: Results of the SARS‑RAS study of the Italian Society of Hypertension. Hypertension 2020;76:366‑72