Association Between Prehospital Blood Glucose Levels and Outcomes in Patients With COVID-19 Infection: A Retrospective Cohort Study

Abstract

Background: Hyperglycaemia is associated with worse outcomes in many settings. However, the association between dysglycaemia and adverse outcomes remains debated in COVID-19 patients. The objective of this study was to determine the association between prehospital blood glucose levels and acute medical unit (intensive care unit or high dependency unit) admission and mortality among COVID-19 infected patients. Methods: This was a monocentric retrospective cohort study, based on patients taken care by the prehospital medical mobile unit from a Swiss university hospital between March 2020 and April 2021 All adult patients in whom a COVID-19 infection was confirmed or suspected during the study period a were included. Data were obtained from the prehospital medical files. The main exposure was prehospital blood glucose level. A 7.8mmol/l cut-off was used to define high blood glucose level. Restricted cubic splines were also used to analyse the exposure as a continuous variable. The primary endpoint was acute medical unit admission, and secondary endpoints were and 7-day and 30-day mortality. Multivariable logistic regressions were performed to compute odds ratios. Results: A total of 276 patients were included. The mean prehospital blood glucose level was 8.8mmol/l, and 123 patients presented high blood glucose levels. The overall acute medical unit admission rate was 31.2%, with no statistically significant difference according to prehospital blood glucose levels. The mortality rate was 13.8% at seven days and 25% at 30 days. The mortality rate at 30 days was higher in patients with high prehospital blood glucose levels, with an adjusted odds-ratio of 2.5 (1.3 – 4.8). Conclusions: In patients with acute COVID-19 infection, prehospital blood glucose levels do not seem to be associated with acute medical unit admission. An increased risk of 30-day mortality was however found in COVID-19 patients who presented high prehospital blood glucose levels.

Association of preclinical blood glucose with hospitalization rate and in‐hospital mortality: A single‐center retrospective cohort study

“…The median PBG in the analyzed cohort was comparable to previously reported studies. 8,21,30 A significantly higher hospitalization rate was detected in patients with PBG ≥140 mg/dL compared to patients with lower PBG. Mortality was higher in the hyperglycemic group but this effect was confounded by age, sex, and prediagnosed diabetes.…”

“…with PBG were not performed, as many of these data are missing. Last, it has to be mentioned that the observation period included the first waves of the COVID‐19 pandemic 3,8 . This challenging global health crisis caused many changes in society and might have led to a delay in patients seek for medical help, with a possible negative impact on clinical outcomes 27 …”

“…It correlates with higher in‐hospital morbidity, length of stay, and mortality 4 . Poorer outcomes associated with SH have been reported for myocardial infarction and stroke but also in viral infections like COVID‐19 5–9 . Therefore, it has been proposed that blood glucose should be regarded as a vital sign and should be measured on a regular basis in emergency medicine 10 .…”

“… 4 Poorer outcomes associated with SH have been reported for myocardial infarction and stroke but also in viral infections like COVID‐19. 5 , 6 , 7 , 8 , 9 Therefore, it has been proposed that blood glucose should be regarded as a vital sign and should be measured on a regular basis in emergency medicine. 10 The exact mechanisms for developing SH are not fully elucidated.…”

Mean Blood Glucose Level During ICU Hospitalization is a Strong Predictor of the Mortality of COVID-19

“… 6 Recently, a cohort study illustrated that enhanced prehospital glucose levels increased the risk of 30-day mortality of COVID-19 patients. 7 …”