The influence of diabetes on in-hospital complications and mortality in a Cardiovascular Intensive Care Unit in sub Saharan Africa

Introduction : patients living with type 2 diabetes are at increased risk of cardiovascular related death but there is little data on the influence of diabetes on early outcomes of cardiovascular emergencies (CVEs). This study aimed at describing the influence of diabetes on early outcome of patients admitted for CVEs. Methods : database of Cardiovascular Intensive Care Unit (CICU) of the Douala General Hospital was queried for patients admitted for CVEs between November 2012 and November 2015. We compared patients with and without known diabetes for sociodemographic profile and risk factors for CVEs using 2-sided tests (Chi-squared & one-way ANOVA). While Cox regression and Kaplan Meier survival models were used to compare in-hospital complications and mortality. Results : of the 333 patients admitted during the study period, 99 (29.7%) had a diagnosis of diabetes. Patients with diabetes were older (65.8 ± 13.8 vs 60.4 ± years, p<0.001) with a similar sex distribution to patients without diabetes. Hypertension (90.9% vs 68.4%, p < 0.001), dyslipidemia (44.4% vs 6.4%, p<0.001), sedentary lifestyle (68.7% vs 44.8%, p = 0.001) and gout (15.2% vs 6.8%, p = 0.02) were more frequent in patients with diabetes. Stroke (54.3% vs 37.2%), acute heart failure (26.3% vs 24.8%), acute coronary syndrome (6.1% vs 2.1%) and complications [(p<0.001): infectious (41.4% vs 23.5%), cardiovascular (16.2% vs 12.8%) and multi-systemic failure (9.1% vs 1.7%)] were also more frequent in patients with diabetes. Complications occurred much earlier (p<0.001), estimated survival time was shorter (p < 0.001) and mortality was higher in patients with diabetes [46.5% vs 25.6%, adjusted Hazard Ratio (aHR) for age & sex was 1.77 (95% CI: 1.18 – 2.64), adj-p = 0.005].