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

Abstract

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.

Hyperglycemia is Associated With Increased Mortality in Critically Ill Patients With COVID-19

“…The combination of the elevated biomarkers of systemic inflammation and lactate suggest a systemic inflammatory response leading to stress hyperglycemia in the group without pre-existing DM. Several studies in hospitalized individuals with COVID-19 have reported that hyperglycemia is associated with more severe infection, and adverse outcomes such as respiratory failure requiring mechanical ventilation, multi-organ failure, and death ( 8 , 16 ). Our findings are consistent with another retrospective study from North-East Italy, which showed that new-onset diabetes or admission hyperglycemia were predictors of more severe COVID-19, an association which was stronger among patients without pre-existing diabetes than those with a history of diabetes ( 17 ).…”

“…A number of other studies have also associated hyperglycemia with worse outcomes in hospitalized patients with COVID-19 ( 5 , 6 , 7 ). However, these studies have analyzed these questions in hospitalized populations predominantly outside of the intensive-care unit (ICU), and the impact of hyperglycemia on mortality in critically ill patients with and without pre-existing DM in the setting of COVID-19 remains unclear ( 8 ).…”

Glycemia, Beta-Cell Function and Sensitivity to Insulin in Mildly to Critically Ill Covid-19 Patients

“…Infection with coronaviridae may have repercussions in insulin secretion and glycemia [ 1 ]. Critically ill and non-critically ill patients with SARS-CoV-2 infection (Covid-19) may present with higher-than-expected glycemia, even in the absence of diabetes [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Critically ill patients may show stress hyperglycemia [ 8 ].…”

Could diet and exercise reduce risk of COVID-19 syndemic?

“…Furthermore, elevated Hemoglobin A1c levels has been associated with worse COVID-19 prognosis [4] . Hyperglycemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality [5] . After adjusting for age, diabetes, hypertension and other confounding factors, hyperglycemia was reported to be an independent risk factor of mortality: when >180 mg/dL (hazard ratio 1.50 [95% CI: 1.31–1.73]), when 140–180 mg/dL (hazard ratio 1.48 [95%CI: 1.29–1.70]) [5] .…”

“…Hyperglycemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality [5] . After adjusting for age, diabetes, hypertension and other confounding factors, hyperglycemia was reported to be an independent risk factor of mortality: when >180 mg/dL (hazard ratio 1.50 [95% CI: 1.31–1.73]), when 140–180 mg/dL (hazard ratio 1.48 [95%CI: 1.29–1.70]) [5] . Patients with higher blood glucose levels have more severe symptoms associated with SARS-CoV-2 infection (weighted mean difference 2.21 [95% CI: 1.30–3.13, P < 0.001]) [6] .…”