Prognostic Value of Mean Absolute Lymphocyte Count for Survival in Hospitalized Patients With Type 2 Diabetes and COVID-19

Background: Lymphopenia is associated with increased mortality risk in patients with Coronavirus disease 2019 (COVID-19), especially those with comorbidities such as T2DM. This study aimed to evaluate the impact of mean absolute lymphocyte count (ALC) on the survival of T2DM patients hospitalized with COVID-19. Methods: Two hundred sixteen diabetic patients with PCR-positive for COVID-19 were included in the study. Clinical, laboratory, imaging, treatment, and outcome data were collected, with patients stratified by survival. Comparisons of mean ALC at admission between survivor and non-survivor groups were performed. Subgroup analyses assessed associations between clinicodemographic factors, imaging severity, comorbidities, treatment options, and ALC levels in both groups. In addition, logistic regression analysis was conducted to estimate odds ratios for survival according to various COVID-19 treatment regimens, adjusting for potential confounders. Results: Mean ALC did not differ significantly between survivors and non-survivors. However, subgroup analyses revealed significantly lower ALC in deceased patients aged 60 to 69 years ( P =0.04), those with oxygen saturation >90% at admission ( P =0.03), and rural residents ( P =0.04). Use of antiviral agents (Kaletra, interferon, remdesivir), convalescent plasma therapy, and corticosteroids was independently associated with improved survival ( P <0.05). Remdesivir conferred the highest survival benefit (OR=17.06; 95% CI: 2.5-116.7, P =0.03). Conclusions: The prognostic value of mean ALC for survival in diabetic COVID-19 patients seems limited overall but is significant in specific subgroups, such as those aged 60 to 69 years, oxygen saturation <90%, and rural residents. Antivirals (mostly remdesivir), convalescent plasma therapy, and corticosteroids were independently associated with improved survival, highlighting their importance in optimizing care for this high-risk population.