{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T03:19:58Z","timestamp":1764645598448,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C2HEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes. Material and Methods: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients\u2019 baseline characteristics were retrieved to calculate the C2HEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home\/sudden-deterioration\/rehabilitation) and adverse in-hospital clinical events. Results: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk C2HEST stratum. The C2HEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group\u2014levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that C2HEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury. Conclusions: We demonstrated the usefulness and performance of the C2HEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects.<\/jats:p>","DOI":"10.3390\/jcm11030873","type":"journal-article","created":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T20:36:42Z","timestamp":1644266202000},"page":"873","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8628-7262","authenticated-orcid":false,"given":"Damian","family":"Gajecki","sequence":"first","affiliation":[{"name":"Clinical Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5472-028X","authenticated-orcid":false,"given":"Adrian","family":"Doroszko","sequence":"additional","affiliation":[{"name":"Clinical Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3951-205X","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"Trocha","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine, Wroclaw Medical University, Mikulicz-Radecki Street 2, 50-345 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Giniewicz","sequence":"additional","affiliation":[{"name":"Statistical Analysis Centre, Wroclaw Medical University, K. Marcinkowski Street 2-6, 50-368 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2812-4702","authenticated-orcid":false,"given":"Krzysztof","family":"Kujawa","sequence":"additional","affiliation":[{"name":"Statistical Analysis Centre, Wroclaw Medical University, K. Marcinkowski Street 2-6, 50-368 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1569-9216","authenticated-orcid":false,"given":"Marek","family":"Skarupski","sequence":"additional","affiliation":[{"name":"Faculty of Pure and Applied Mathematics, Wroclaw University of Science and Technology, Wybrze\u017ce Wyspia\u0144skiego Street 27, 50-370 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakub","family":"Gawry\u015b","sequence":"additional","affiliation":[{"name":"Clinical Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomasz","family":"Matys","sequence":"additional","affiliation":[{"name":"Clinical Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewa","family":"Szahidewicz-Krupska","sequence":"additional","affiliation":[{"name":"Clinical Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0963-2712","authenticated-orcid":false,"given":"Piotr","family":"Rola","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Provincial Specialized Hospital, Iwaszkiewicza 5 Street, 59-220 Legnica, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Stachowska","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Isotope Therapy, Faculty of Medicine, Wroclaw Medical University, Ludwik Pasteur 4, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6901-377X","authenticated-orcid":false,"given":"Jowita","family":"Halupczok-\u017by\u0142a","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Isotope Therapy, Faculty of Medicine, Wroclaw Medical University, Ludwik Pasteur 4, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Adamik","sequence":"additional","affiliation":[{"name":"Clinical Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3291-5294","authenticated-orcid":false,"given":"Krzysztof","family":"Kaliszewski","sequence":"additional","affiliation":[{"name":"Department of General, Minimally Invasive and Endocrine Surgery, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Kilis-Pstrusinska","sequence":"additional","affiliation":[{"name":"Clinical Department of Paediatric Nephrology, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2747-8851","authenticated-orcid":false,"given":"Krzysztof","family":"Letachowicz","sequence":"additional","affiliation":[{"name":"Clinical Department of Nephrology and Transplantation Medicine, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnieszka","family":"Matera-Witkiewicz","sequence":"additional","affiliation":[{"name":"Laboratory of Biological Activity Tests and Collection of Biological Material, Wroclaw Medical University, Borowska Street 211A, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micha\u0142","family":"Pomorski","sequence":"additional","affiliation":[{"name":"Clinical Department of Gynecology and Obstetrics, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcin","family":"Protasiewicz","sequence":"additional","affiliation":[{"name":"Clinical Department and Clinic of Cardiology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcin","family":"Madziarski","sequence":"additional","affiliation":[{"name":"Clinical Department of Rheumatology and Internal Medicine, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0111-7617","authenticated-orcid":false,"given":"Klaudia","family":"Konikowska","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Wroclaw Medical University, Parkowa Street 34, 51-616 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agata","family":"Remiorz","sequence":"additional","affiliation":[{"name":"Clinical Department of Nephrology and Transplantation Medicine, Wroclaw University Hospital, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maja","family":"Or\u0142owska","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Wroclaw University Hospital, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krzysztof","family":"Proc","sequence":"additional","affiliation":[{"name":"Clinical Department of Rheumatology and Internal Medicine, Wroclaw University Hospital, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ma\u0142gorzata","family":"Szymala-Pedzik","sequence":"additional","affiliation":[{"name":"Clinical Department of Geriatrics, Wroclaw Medical University, Pasteur 4 Street, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Zorawska","sequence":"additional","affiliation":[{"name":"Clinical Department of Geriatrics, Wroclaw Medical University, Pasteur 4 Street, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1732-1188","authenticated-orcid":false,"given":"Karolina","family":"Lindner","sequence":"additional","affiliation":[{"name":"Clinical Department of Geriatrics, Wroclaw Medical University, Pasteur 4 Street, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janusz","family":"Soko\u0142owski","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewa A.","family":"Jankowska","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"},{"name":"Institute of Heart Diseases, University Hospital in Wroclaw, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3624-3691","authenticated-orcid":false,"given":"Katarzyna","family":"Madziarska","sequence":"additional","affiliation":[{"name":"Clinical Department of Nephrology and Transplantation Medicine, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, 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Disorders","volume":"2016","author":"Janus","year":"2016","journal-title":"Mediat. Inflamm."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"108142","DOI":"10.1016\/j.diabres.2020.108142","article-title":"COVID-19 and diabetes: Knowledge in progress","volume":"162","author":"Hussain","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"108217","DOI":"10.1016\/j.diabres.2020.108217","article-title":"The contribution of diabetic micro-angiopathy to adverse outcomes in COVID-19","volume":"164","author":"Whyte","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e14833","DOI":"10.1111\/ijcp.14833","article-title":"Narrative review on clinical considerations for patients with diabetes and COVID-19: More questions than answers","volume":"75","author":"Katsiki","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1001\/jamainternmed.2020.2033","article-title":"Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19","volume":"180","author":"Liang","year":"2020","journal-title":"JAMA Intern. Med."},{"doi-asserted-by":"crossref","unstructured":"Robin, X., Turck, N., Hainard, A., Tiberti, N., Lisacek, F., Sanchez, J.C., and M\u00fcller, M. (2011). pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform., 12.","key":"ref_8","DOI":"10.1186\/1471-2105-12-77"},{"unstructured":"Therneau, T. (2021, October 31). A Package for Survival Analysis in R; R Package Version 3.2-7. Mayo Foundation for Medical Education and Research, Available online: https:\/\/CRAN.R-project.org\/package=survival.","key":"ref_9"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1198\/000313006X118430","article-title":"A lego system for conditional inference","volume":"60","author":"Hothorn","year":"2006","journal-title":"Am. Stat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"409","DOI":"10.32614\/RJ-2017-067","article-title":"QGIS: Integrating R with QGIS for statistical geocomputing","volume":"9","author":"Muenchow","year":"2017","journal-title":"R J. (Scopus)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2938","DOI":"10.2337\/dc20-1506","article-title":"Diabetes as a Risk Factor for Poor Early Outcomes in Patients Hospitalized With COVID-19","volume":"43","author":"Seiglie","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"108347","DOI":"10.1016\/j.diabres.2020.108347","article-title":"Diabetes and COVID-19: A systematic review on the current evidences","volume":"166","author":"Abdi","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.dsx.2020.04.018","article-title":"Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia\u2014a systematic review, meta-analysis, and meta-regression: Diabetes and COVID-19","volume":"14","author":"Huang","year":"2020","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1038\/s41419-017-0135-z","article-title":"Cellular death, reactive oxygen species (ROS) and diabetic complications","volume":"9","author":"Volpe","year":"2018","journal-title":"Cell Death Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.clim.2018.06.003","article-title":"Effect of high glucose on cytokine production by human peripheral blood immune cells and type I interferon signaling in monocytes: Implications for the role of hyperglycemia in the diabetes inflammatory process and host defense against infection","volume":"195","author":"Hu","year":"2018","journal-title":"Clin. Immunol."},{"doi-asserted-by":"crossref","unstructured":"Guo, J., Lin, W.W., Zucker, J.E., Nandakumar, R., Uhlemann, A.C., Wang, S., and Shivakoti, R. (2022). Inflammation and mortality in COVID-19 hospitalized patients with and without type 2 diabetes. J. Clin. Endocrinol. Metab., dgac003. online, ahead of print.","key":"ref_19","DOI":"10.1210\/clinem\/dgac003"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"108936","DOI":"10.1016\/j.diabres.2021.108936","article-title":"Is diabetes mellitus a wrongdoer to COVID-19 severity?","volume":"178","author":"Sarkar","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"doi-asserted-by":"crossref","unstructured":"Harbuwono, D.S., Handayani, D.O.T.L., Wahyuningsih, E.S., Supraptowati, N., Kurniawan, F., Wafa, S., Kristanti, M., Pantoro, N.I., and Sinto, R. (2021). Impact of diabetes mellitus on COVID-19 clinical symptoms and mortality: Jakarta\u2019s COVID-19 epidemiological registry. Prim. Care Diabetes, in press.","key":"ref_21","DOI":"10.1016\/j.pcd.2021.11.002"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.dsx.2020.04.044","article-title":"Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis","volume":"14","author":"Kumar","year":"2020","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e131774","DOI":"10.1172\/jci.insight.131774","article-title":"Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection","volume":"4","author":"Kulcsar","year":"2019","journal-title":"JCI Insight"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3201\/eid2201.151340","article-title":"Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Illness in Humans, Saudi Arabia, 2014","volume":"22","author":"Alraddadi","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.3389\/fimmu.2020.01582","article-title":"The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System","volume":"11","author":"Daryabor","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/imm.12421","article-title":"Type 2 diabetes mellitus is associated with altered CD8+ T and natural killer cell function in pulmonary tuberculosis","volume":"144","author":"Kumar","year":"2015","journal-title":"Immunology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"154217","DOI":"10.1016\/j.metabol.2020.154217","article-title":"Commentary: COVID-19 in patients with diabetes","volume":"107","author":"Hill","year":"2020","journal-title":"Metabolism"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ijid.2021.07.049","article-title":"ABC2-SPH risk score for in-hospital mortality in COVID-19 patients: Development, external validation and comparison with other available scores","volume":"110","author":"Marcolino","year":"2021","journal-title":"Int. J. Infect. Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/873\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:15:37Z","timestamp":1760134537000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/873"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,7]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11030873"],"URL":"https:\/\/doi.org\/10.3390\/jcm11030873","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,2,7]]}}}