{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:03:15Z","timestamp":1784178195678,"version":"3.55.0"},"reference-count":50,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"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\/Objectives: Several risk factors have been identified as being involved in the progression of COVID-19 over time. Among these, age, comorbidities, and various laboratory parameters have been reported. Diabetes mellitus is one of the most common comorbidities found among patients diagnosed with SARS-CoV-2 infection. Glucose metabolism dysfunction can exacerbate pre-existing diabetes or even induce diabetes mellitus. The purpose of this study is to assess the accuracy of the CURB-65, PSI, MuLBSTA severity scores and laboratory parameters in patients with diabetes mellitus diagnosed with COVID-19. Methods: We conducted a retrospective study involving patients with diabetes mellitus diagnosed with SARS-CoV-2 infection, performed between June 2023 and December 2024. Results: We analyzed 73 patients with pre-existing diabetes who were diagnosed with COVID-19. There were 56.16% men, living mostly in urban areas, with a median hospital stay of 9.38 days. Elevated levels of LDH (367.50, p = 0.002), CRP (133.90, p = 0.012), ferritin (724.25, p = 0.012), ESR (55.00, p = 0.014), D-dimers (2455.04, p = 0.004), white blood cells (12.76, p = 0.007) and the neutrophil-to-lymphocyte ratio (15.86, p = 0.021) were recorded in the group of deceased patients. Significantly elevated values were recorded for all three severity scores, the AUC for CURB-65 was 0.69, PSI 0.81 and MuLBSTA 0.86. Conclusions: Severity scores showed robust prognostic value in predicting mortality among patients with diabetes mellitus and COVID-19, emphasizing their relevance as clinically applicable tools for risk stratification and outcome assessment.<\/jats:p>","DOI":"10.3390\/jcm15145424","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:16:28Z","timestamp":1783689388000},"page":"5424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive Value of the CURB-65, MuLBSTA, Pneumonia Severity Index Scores and Laboratory Parameters for In-Hospital Mortality in Patients with Diabetes Mellitus and COVID-19 Infection"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0672-3652","authenticated-orcid":false,"given":"Andreea Magdalena","family":"Ghibu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"},{"name":"Infectious Diseases Department, Academic Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9284-597X","authenticated-orcid":false,"given":"Ionela","family":"Maniu","sequence":"additional","affiliation":[{"name":"Faculty of Sciences, Department of Mathematics and Informatics, Research Center in Informatics and Information Technology, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"},{"name":"Research Team, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7391-3394","authenticated-orcid":false,"given":"Victoria","family":"Birlutiu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"},{"name":"Infectious Diseases Department, Academic Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"244","DOI":"10.36519\/idcm.2022.169","article-title":"Comparison of CURB-65 Pneumonia Severity Score, Quick COVID-19 Severity Index, and Brescia-COVID Respiratory Severity Scale in Emergently Hospitalized COVID-19 Patients with Pneumonia","volume":"4","author":"Toker","year":"2022","journal-title":"Infect. Dis. Clin. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Abu-Ashour, W., Twells, L.K., Valcour, J.E., and Gamble, J.-M. (2018). Diabetes and the occurrence of infection in primary care: A matched cohort study. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-2975-2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0168-8227(98)00023-0","article-title":"Infections in patients with type 2 diabetes in general practice","volume":"40","author":"Bartelink","year":"1998","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.cmet.2020.04.021","article-title":"Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes","volume":"31","author":"Zhu","year":"2020","journal-title":"Cell Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/S2213-8587(20)30272-2","article-title":"Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: A whole-population study","volume":"8","author":"Barron","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.2147\/DMSO.S243263","article-title":"Long-term Risk of Malignant Neoplastic Disorders in Type 2 Diabetes Mellitus Patients with Metabolic Syndrome","volume":"13","author":"Albai","year":"2020","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4274\/hamidiyemedj.galenos.2021.10820","article-title":"Confronting a pandemic in early stages: A ret rospective analysis from a pandemic hospital","volume":"1","author":"Eren","year":"2020","journal-title":"Hamidiye Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ijid.2020.06.038","article-title":"Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19","volume":"98","author":"Satici","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"15511","DOI":"10.1128\/JVI.79.24.15511-15524.2005","article-title":"Severe acute respiratory syndrome coronavirus infection of human ciliated airway epithelia: Role of ciliated cells in viral spread in the conducting airways of the lungs","volume":"79","author":"Sims","year":"2005","journal-title":"J. Virol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1373\/clinchem.2005.054460","article-title":"Early enhanced expression of interferon-inducible protein-10 (CXCL-10) and other chemokines predicts adverse outcome in severe acute respiratory syndrome","volume":"51","author":"Tang","year":"2005","journal-title":"Clin. Chem."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"bnaa011","DOI":"10.1210\/endrev\/bnaa011","article-title":"Coronavirus Infections and Type 2 Diabetes\u2014Shared Pathways with Therapeutic Implications","volume":"41","author":"Drucker","year":"2020","journal-title":"Endocr. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.cell.2020.02.058","article-title":"Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein","volume":"181","author":"Walls","year":"2020","journal-title":"Cell"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1111\/cen.14288","article-title":"COVID-19 and diabetes: Insulin requirements parallel illness severity in critically unwell patients","volume":"93","author":"Wu","year":"2020","journal-title":"Clin. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Albai, O., Frandes, M., Sima, A., Timar, B., Vlad, A., and Timar, R. (2022). Practical Applicability of the ISARIC-4C Score on Severity and Mortality due to SARS-CoV-2 Infection in Patients with Type 2 Diabetes. Medicina, 58.","DOI":"10.3390\/medicina58070848"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"408","DOI":"10.53854\/liim-2903-12","article-title":"CURB-65 plus hypoalbuminemia: A new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia","volume":"29","author":"Oliva","year":"2021","journal-title":"Infez. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ghibu, A.M., Maniu, I., and Birlutiu, V. (2026). Severity Scores in SARS-CoV-2 Infection-A Comprehensive Bibliometric Review and Visualization Analysis. Epidemiologia, 7.","DOI":"10.3390\/epidemiologia7010008"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"George, R., Mehta, A.A., Paul, T., Sathyapalan, D.T., Haridas, N., Kunoor, A., and Ravindran, G.C. (2022). Validation of MuLBSTA score to derive modified MuLB score as mortality risk prediction in COVID-19 infection. PLoS Glob. Public Health, 2.","DOI":"10.1371\/journal.pgph.0000511"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.ijid.2021.08.027","article-title":"External Validation and Recalibration of the CURB-65 and PSI for Predicting 30-Day Mortality and Critical Care Intervention in Multiethnic Patients with COVID-19","volume":"111","author":"Elmoheen","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"403e6","DOI":"10.1016\/j.dsx.2021.01.018","article-title":"Heterogeneity in presentation of hyperglycaemia during COVID-19 pandemic: A proposed classification","volume":"15","author":"Misra","year":"2021","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Atwah, B., Iqbal, M.S., Kabrah, S., Kabrah, A., Alghamdi, S., Tabassum, A., Baghdadi, M.A., and Alzahrani, H. (2023). Susceptibility of Diabetic Patients to COVID-19 Infections: Clinico-Hematological and Complications Analysis. Vaccines, 11.","DOI":"10.3390\/vaccines11030561"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"102235","DOI":"10.1016\/j.dsx.2021.102235","article-title":"Post COVID-19 Syndrome (\u201cLong COVID\u201d) and Diabetes: Challenges in Diagnosis and Management","volume":"15","author":"Raveendran","year":"2021","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"108955","DOI":"10.1016\/j.diabres.2021.108955","article-title":"Higher admission activated partial thromboplastin time, neutrophil-lymphocyte ratio, serum sodium, and anticoagulant use predict in-hospital COVID-19 mortality in people with Diabetes: Findings from Two University Hospitals in the U.K","volume":"178","author":"Iqbal","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1007\/s11739-022-03016-7","article-title":"Stratification of patients admitted for SARS-CoV2 infection: Prognostic scores in the first and second wave of the pandemic","volume":"17","author":"Innocenti","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ocho, K., Hagiya, H., Hasegawa, K., Fujita, K., and Otsuka, F. (2022). Clinical Utility of 4C Mortality Scores among Japanese COVID-19 Patients: A Multicenter Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030821"},{"key":"ref_25","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_26","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1007\/s00125-020-05180-x","article-title":"Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: The CORONADO study","volume":"63","author":"Cariou","year":"2020","journal-title":"Diabetologia"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Rodina, L., Monescu, V., Caplan, L.G., Cocuz, M.E., and B\u00eerlu\u021biu, V. (2025). Admission Hyperglycemia as an Early Predictor of Severity and Poor Prognosis in COVID-19: A Retrospective Cohort Study of Hospitalized Adults. J. Clin. Med., 14.","DOI":"10.20944\/preprints202509.0581.v1"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"108374","DOI":"10.1016\/j.diabres.2020.108374","article-title":"Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration","volume":"168","author":"Fadini","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e3159","DOI":"10.1002\/dmrr.3159","article-title":"Diabetic lung, an underrated complication from restrictive functional pattern to pulmonary hypertension","volume":"35","author":"Fuso","year":"2019","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e3346","DOI":"10.1002\/dmrr.3346","article-title":"The diabetic lung: An easy target for SARS-CoV-2?","volume":"36","author":"Caruso","year":"2020","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.diabet.2008.08.001","article-title":"The metabolic syndrome, diabetes and lung dysfunction","volume":"34","author":"Tiengo","year":"2008","journal-title":"Diabetes Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1016\/S2213-2600(20)30216-2","article-title":"COVID-19 cytokine storm: The interplay between inflammation and coagulation","volume":"8","author":"Jose","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"108118","DOI":"10.1016\/j.diabres.2020.108118","article-title":"Timely blood glucose management for the outbreak of 2019 novel coronavirus disease (COVID-19) is urgently needed","volume":"162","author":"Wang","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ghibu, A.M., Maniu, I., and Birlutiu, V. (2026). Predictability of Severity Scores in Patients over 70 Years Old with COVID-19 Infection: Results from a Single-Center Retrospective Observational Study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15062104"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1111\/dom.14098","article-title":"Why is hyperglycaemia worsening COVID-19 and its prognosis?","volume":"22","author":"Ceriello","year":"2020","journal-title":"Diabetes Obes. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1089\/jir.2019.0085","article-title":"Constitutive inflammatory cytokine storm: A major threat to human health","volume":"40","author":"Gupta","year":"2020","journal-title":"J. Interferon Cytokine Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"BSR20203584","DOI":"10.1042\/BSR20203584","article-title":"Hyperglycemia at admission is a strong predictor of mortality and severe\/critical complications in COVID-19 patients: A meta-analysis","volume":"41","author":"Yang","year":"2021","journal-title":"Biosci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Liontos, A., Biros, D., Kavakli, A., Matzaras, R., Tsiakas, I., Athanasiou, L., Samanidou, V., Konstantopoulou, R., Vagias, I., and Panteli, A. (2023). Glycemic Dysregulation, Inflammation and Disease Outcomes in Patients Hospitalized with COVID-19: Beyond Diabetes and Obesity. Viruses, 15.","DOI":"10.3390\/v15071468"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.2337\/dc20-0643","article-title":"Exploring Diseases\/Traits and Blood Proteins Causally Related to Expression of ACE2, the Putative Receptor of SARS-CoV-2: A Mendelian Randomization Analysis Highlights Tentative Relevance of Diabetes-Related Traits","volume":"43","author":"Rao","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/S2213-2600(20)30076-X","article-title":"Pathological findings of COVID-19 associated with acute respiratory distress syndrome","volume":"8","author":"Xu","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.2337\/dc20-1380","article-title":"Pisa COVID-19 Study Group; Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study","volume":"43","author":"Coppelli","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.15419\/bmrat.v4i11.382","article-title":"The relationship between some biochemical and hematological changes in type 2 diabetes mellitus","volume":"4","author":"Shehri","year":"2017","journal-title":"Biomed. Res. Ther."},{"key":"ref_44","first-page":"e53524","article-title":"Type 2 Diabetes Status, Diabetes Complication Severity Index Scores, and Their Relationship With COVID-19 Severity: A Retrospective Cohort Study of Hospitalized Patients in a Southwest Virginia Health System","volume":"16","author":"Bendetson","year":"2024","journal-title":"Cureus"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ion, R., Kimidi, J.S.S.K., Kalapala, C., Fnu, O., Chandrababu, V.R., Desireddygari, O.R., Grigras, M.L., Rosca, O., Bratosin, F., and Cioca, F. (2024). Evaluating the Utility of Clinical Scores APACHE, CURB, SOFA, and NEWS2 at Admission and 5-Days after Symptom Onset in Predicting Severe COVID-19 in Patients with Diabetes. J. Pers. Med., 14.","DOI":"10.3390\/jpm14080868"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1007\/s11606-021-06626-7","article-title":"Severity Scores in COVID-19 Pneumonia: A Multicenter, Retrospective, Cohort Study","volume":"36","author":"Artero","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_47","first-page":"1037.e1","article-title":"Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: A validation and clinical applicability study","volume":"27","author":"Marino","year":"2021","journal-title":"Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2002113","DOI":"10.1183\/13993003.02113-2020","article-title":"Comparison of severity scores for COVID-19 patients with pneumonia: A retrospective study","volume":"56","author":"Fan","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"223","DOI":"10.4103\/jfmpc.jfmpc_1766_20","article-title":"MuLBSTA score in COVID-19 pneumonia and prediction of 14-day mortality risk: A study in an Indian cohort","volume":"10","author":"Preetam","year":"2021","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Boesing, M., L\u00fcthi-Corridori, G., B\u00fcttiker, D., Hunziker, M., Jaun, F., Vaskyte, U., Br\u00e4ndle, M., and Leuppi, J.D. (2024). The Predictive Performance of Risk Scores for the Outcome of COVID-19 in a 2-Year Swiss Cohort. Biomedicines, 12.","DOI":"10.3390\/biomedicines12081702"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5424\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:12:56Z","timestamp":1784175176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5424"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":50,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145424"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145424","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}