Association of hyperglycaemia with hospital mortality in nondiabetic COVID-19 patients: A cohort study

Mamtani, Manju; Athavale, Ambarish M.; Abraham, Miriam; Vernik, Jane; Amarah, Amatur; Ruiz, Juan Pablo Pizarro; Joshi, Anirudh; Itteera, M.; Zhukovski, Sara D; Madaiah, Ravi Prakash; White, Blaine C.; Hart, Peter D.; Kulkarni, Hemant

doi:10.1016/j.diabet.2021.101254

Cited by 17 publications

(22 citation statements)

References 37 publications

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“…Despite its being a defensive mechanism, stress hyperglycemia can lead to adverse effects due to the stimulation of oxidative stress and endothelial dysfunction [ 36 ]. The hypothesis that background hyperglycemia protects against the harmful effects of stress hyperglycemia due to down-regulation of glucose transporters may explain why COVID-19 patients with new hyperglycemia have poorer outcomes than patients with known diabetes [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

Aon

Alsaeedi

Alzafiri

et al. 2022

Infectious Disease Reports

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Evidence is conflicting about the diabetes characteristics associated with worse outcome among hospitalized COVID-19 patients. We aimed to assess the role of stress hyperglycemia ratio (SHR) as a prognostic marker among them. In our retrospective cohort study, patients were stratified according to SHR, admission glucose, and glycated hemoglobin tertiles. The primary outcome was a composite endpoint of invasive mechanical ventilation, intensive care unit admission, and in-hospital mortality. The study included 395 patients with a mean age of 59 years, and 50.1% were males. Patients in the third tertile of SHR developed more primary events, and the difference was significant compared to the first tertile (p = 0.038) and close to significance compared to the second tertile (p = 0.054). There was no significant difference in the outcomes across admission glucose and glycated hemoglobin tertiles. A higher SHR tertile was an independent risk factor for the primary outcome (OR, 1.364; 95% CI: 1.014–1.836; p = 0.040) after adjustment for other covariables. In hospitalized COVID-19 diabetic patients, SHR third tertile was significantly associated with worse outcome and death. SHR can be a better prognostic marker compared to admission glucose and glycated hemoglobin. A higher SHR was an independent risk factor for worse outcome and in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

Aon

Alsaeedi

Alzafiri

et al. 2022

Infectious Disease Reports

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“…Many published international experiences have found an association between hyperglycaemia and inpatient mortality; however, these reported on patients admitted before June 2020. 11 , 26 , 27 Importantly, in the DINGO COVID‐19 cohort, most patients were admitted after July 2020, which followed the RECOVERY trial's preprint release, establishing the glucocorticoid dexamethasone as standard of care in hypoxic or intubated patients hospitalised with COVID‐19. 17 Of the 104 patients without known diabetes who experienced hyperglycaemia in our cohort, 90 (88%) required oxygen and 88 (85%) received glucocorticoid therapy, a therapy well established to increase in‐hospital hyperglycaemia risk.…”

Section: Discussionmentioning

confidence: 99%

Diabetes IN hospital – Glucose and Outcomes in the COVID‐19 pandemic (DINGO COVID‐19): the 2020 Melbourne hospital experience prior to novel variants and vaccinations

Barmanray

Gong

Kyi

et al. 2022

Internal Medicine Journal

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Background and Aims A relationship between diabetes, glucose and COVID‐19 outcomes has been reported in international cohorts. This study aimed to assess the relationship between diabetes, hyperglycaemia and patient outcomes in those hospitalised with COVID‐19 during the first year of the Victorian pandemic prior to novel variants and vaccinations. Design, setting Retrospective cohort study from March to November 2020 across five public health services in Melbourne, Australia. Participants All consecutive adult patients admitted to acute wards of participating institutions during the study period with a diagnosis of COVID‐19, comprising a large proportion of patients from residential care facilities and following dexamethasone becoming standard‐of‐care. Admissions in patients without known diabetes and without inpatient glucose testing were excluded. Results The DINGO COVID‐19 cohort comprised 840 admissions. In 438 admissions (52%), there was no known diabetes or in‐hospital hyperglycaemia, in 298 (35%) patients had known diabetes, and in 104 (12%) patients had hyperglycaemia without known diabetes. ICU admission was more common in those with diabetes (20%) and hyperglycaemia without diabetes (49%) than those with neither (11%, P < 0.001 for all comparisons). Mortality was higher in those with diabetes (24%) than those without diabetes or hyperglycaemia (16%, P = 0.02) but no difference between those with in‐hospital hyperglycaemia and either of the other groups. On multivariable analysis, hyperglycaemia was associated with increased ICU admission (adjusted odds ratio (aOR) 6.7, 95% confidence interval (95% CI) 4.0–12, P < 0.001) and longer length of stay (aOR 173, 95% CI 11–2793, P < 0.001), while diabetes was associated with reduced ICU admission (aOR 0.55, 95% CI 0.33–0.94, P = 0.03). Neither diabetes nor hyperglycaemia was independently associated with in‐hospital mortality. Conclusions During the first year of the COVID‐19 pandemic, in‐hospital hyperglycaemia and known diabetes were not associated with in‐hospital mortality, contrasting with published international experiences. This likely mainly relates to hyperglycaemia indicating receipt of mortality‐reducing dexamethasone therapy. These differences in published experiences underscore the importance of understanding population and clinical treatment factors affecting glycaemia and COVID‐19 morbidity within both local and global contexts.

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“…A large multicenter prospective randomized controlled trial showed that hyperglycemia is predictive of post-stroke infections in patients with AIS ( Zonneveld et al, 2017 ). Moreover, admission hyperglycemia is associated with mortality in a multitude of infectious diseases, such as Coronavirus Disease 2019 (COVID-19), pneumonia, and central venous catheter-related bloodstream infection ( Schuetz et al, 2014 ; Xie et al, 2020 ; Mamtani et al, 2021 ). Hyperglycemia aggravates inflammation and the oxidative stress response by damaging the brain-blood barrier, exacerbating brain edema, increasing apoptosis, disordering the coagulation function, and increasing plasma concentrations of free fatty acids, which may affect stroke outcomes after infection ( Song et al, 2003 ; Yamato et al, 2007 ; Kruyt et al, 2010 ; Chiu et al, 2013 ; Fiorentino et al, 2013 ; Chen et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Stroke-associated infection in patients with co-morbid diabetes mellitus is associated with in-hospital mortality

Wei

Huang

et al. 2022

Front. Aging Neurosci.

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Background and objectiveThe association between infection and acute ischemic stroke (AIS) with diabetes mellitus (DM) remains unknown. Therefore, this study aimed to explore the effect of infection on AIS with DM.Materials and methodsThe data of patients with AIS and DM were extracted from the Chinese Stroke Center Alliance (CSCA) database from August 2015 to July 2019. The association between infections [pneumonia or urinary tract infection (UTI)] and in-hospital mortality was analyzed. Logistic regression models were used to identify the risk factors for in-hospital mortality of patients with infection.ResultsIn total, 1,77,923 AIS patients with DM were included in the study. The infection rate during hospitalization was 10.5%, and the mortality rate of infected patients was 3.4%. Stroke-associated infection was an independent risk factor for an early poor functional outcome [odds ratio (OR) = 2.26, 95% confidence interval (CI): 1.97–2.34, P < 0.0001] and in-hospital mortality in AIS patients with DM. The in-hospital mortality after infection was associated with age (OR = 1.02, 95% CI: 1.01–1.03, P < 0.0001), male (OR = 1.39, 95% CI: 1.13–1.71, P = 0.0018), reperfusion therapy (OR = 2.00, 95% CI: 1.56–2.56, P < 0.0001), and fasting plasma glucose at admission (OR = 1.05, 95% CI: 1.03–1.08, P < 0.0001). In contrast, antiplatelet drug therapy (OR = 0.63, 95% CI: 0.50–0.78, P < 0.0001) and hospital stay (OR = 0.96, 95% CI: 0.94–0.97, P < 0.0001) were independent protecting factors against in-hospital mortality of patients with infection.ConclusionInfection is an independent risk factor of in-hospital mortality for patients with AIS and DM, and those patients require strengthening nursing management to prevent infection.

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Association of hyperglycaemia with hospital mortality in nondiabetic COVID-19 patients: A cohort study

Cited by 17 publications

References 37 publications

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

Diabetes IN hospital – Glucose and Outcomes in the COVID‐19 pandemic (DINGO COVID‐19): the 2020 Melbourne hospital experience prior to novel variants and vaccinations

Stroke-associated infection in patients with co-morbid diabetes mellitus is associated with in-hospital mortality

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