Hyperglycemic 2X more likely to have severe COVID-19 - Nov 2020

Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry

Annals of Medicine, Volume 53, 2021 - Issue 1. DOI: 10.1080/07853890.2020.1836566
Francisco Javier Carrasco-Sánchez ORCID Icon,Mª Dolores López-Carmona,Francisco Javier Martínez-Marcos,Luis M. Pérez-Belmonte,Alicia Hidalgo-Jiménez,Verónica Buonaiuto

 Download the PDF from Vitamin D Life

Outcomes vs level

All-cause COVID-19 mortality

Table 4. Association with composite outcome (death, mechanical ventilation and/or ICU admission).

OR: odds ratio; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; LDH: lactate dehydrogenase. Adjusted multivariate logistic regression model. The model included all variables of medical history and laboratory findings

Background
Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19.

Methods
This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140–180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality.

Results
Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140–180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31–1.73) (BG 140–180 mg/dL; HR 1.48; 95%CI: 1.29–1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality.

Conclusions
Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes.

KEY MESSAGE

• Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19.
• Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19.
• Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.

References

1. Ministerio de Sanidad. Situacion de COVID-19 en Espana. Centro de Coordinacion de Alertas y Emergencias Sanitarias. Enfermedad por el corona- virus (COVID-19); 2020; [cited 2020 Aug 9]. Available from: https://cnecovid.isciii.es/
2. Carrasco-Soanchez FJ, Carretero-Goomez J, Goomez- Huelgas R, et al. Stress-induced hyperglycemia on complications in non-critically elderly hospitalized patients. Rev Clin Esp. 2018;218:223-231.
3. Zhu L, She Z, Cheng X, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31: 1-10.
4. Sardu C, D'Onofrio N, Balestrieri ML, et al. Outcomes in patients with hyperglycemia affected by Covid-19: can we do more on glycemic control? Diabetes Care. 2020;43:1408-1415.
5. Bode B, Garrett V, Messler J, et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J Diabetes Sci Technol. 2020;14:813-821.
6. Zhang Y, Li H, Zhang J, et al. The clinical characteristics and outcomes of diabetes mellitus and secondary hyperglycaemia patients with coronavirus disease 2019: a single-center, retrospective, observational study in Wuhan. Diabetes Obes Metab. 2020;22: 1443-1454.
7. Wu J, Huang J, Zhu G, et al. Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study. BMJ Open Diabetes Res Care. 2020;8:e001466.
8. Iacobellis G, Penaherrera CA, Bermudez LE, et al. Admission hyperglycemia and radiological findings of SARS-COv2 in patients with and without diabetes. Diabetes Res Clin Pract. 2020;164:108185.
9. Singh AK, Singh R. Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19? Diabetes Metab Syndr Clin Res Rev. 2020;14:725-727.
10. Wang S, Zhang S, Song S, et al. Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study. Diabetologia. 2020;63:2102-2111.
11. Ceriello A. Hyperglycemia and the worse prognosis of COVID-19. Why a fast blood glucose control should be mandatory. Diabetes Res Clin Pract. 2020;163: 108186.
12. Maddaloni E, Buzzetti R. Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev. 2020.
13. Ceriello A, De Nigris V, Prattichizzo F. Why is hyperglycemia worsening COVID-19 and its prognosis? Diabetes Obes Metab. 2020;22:1951-1952.
14. Kumar A, Arora A, Sharma P, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr Clin Res Rev. 2020;14:535-545.
15. Wu J, Zhang J, Sun X, et al. Influence of diabetes mellitus on the severity and fatality of SARS-CoV-2 infection. Diabetes Obes Metab. 2020.
16. Sardu C, Gargiulo G, Esposito G, et al. Impact of diabetes mellitus on clinical outcomes in patients affected by Covid-19. Cardiovasc Diabetol. 2020;19:76.
17. Casas-Rojo J, AntOn-Santos J, MillOn-Nunez-Cortes J, et al. Caracteristicas clinicas de los pacientes hospitali- zados con COVID-19 en Espana: resultados del Registro SEMI-COVID-19. Rev Clin Espanola. 2020.
18. Li H, Tian S, Chen T, et al. Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID- 19. Diabetes Obes Metab. 2020;22:1897-1906.
19. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020.
20. Li Z, Liu G, Wang L, et al. From the insight of glucose metabolism disorder: oxygen therapy and blood glucose monitoring are crucial for quarantined COVID-19 patients. Ecotoxicol Environ Saf. 2020;197:110614.
21. Goyal A, Gupta S, Gupta Y, et al. Proposed guidelines for screening of hyperglycemia in patients hospitalized with COVID-19 in low resource settings. Diabetes Metab Syndr Clin Res Rev. 2020;14:753-756.
22. Pasquel FJ, Umpierrez GE. Individualizing inpatient diabetes management during the coronavirus disease 2019 pandemic. J Diabetes Sci Technol. 2020;14: 705-707.
23. Attri B, Goyal A, Gupta Y, et al. Basal-bolus insulin regimen for hospitalised patients with COVID-19 and diabetes mellitus: a practical approach. Diabetes Ther. 2020;11:2177-2194.
24. Sardu C, D'Onofrio N, Balestrieri ML, et al. Hyperglycaemia on admission to hospital and COVID- 19. Diabetologia. 2020;63:2486-2487.