Association of Hyperglycemia With Hospital Mortality in Covid-19 Patients Without Diabetes: A Cohort Study

Abstract

Objective: Diabetes is a known risk factor for mortality in Coronavirus disease 2019 (COVID-19) patients. Our objective was to identify prevalence of hyperglycemia in COVID-19 patients with and without diabetes and quantify its association with COVID-19 disease course. Research Design and Methods: In this observational cohort study, all consecutive COVID-19 patients admitted to John H Stroger Jr. Hospital, Chicago, IL from March 15, 2020 to May 15, 2020 were included. The primary outcome was hospital mortality and the main predictor was hyperglycemia (any blood glucose ≥7.78 mmol/L during hospitalization). Results: Of 403 COVID-19 patients studied, 228 (57%) developed hyperglycemia. Of these, 83 (21%) had hyperglycemia without diabetes. A total of 51 (12.7%) patients died. Compared to the reference group no-diabetes/no-hyperglycemia patients the no-diabetes/hyperglycemia patients showed higher mortality (1.8% versus 20.5%, adjusted odds ratio 21.94 (95% confidence interval 4.04-119.0), p < 0.001); improved prediction of death (p=0.0162) and faster progression to death (p=0.0051). Hyperglycemia within the first 24 and 48 hours was also significantly associated with mortality (odds ratio 2.15 and 3.31, respectively). Further, compared to the same reference group, no-diabetes/hyperglycemia patients had higher risk of ICU admission (p<0.001), mechanical ventilation (p<0.001) and acute respiratory distress syndrome (p<0.001) and a longer hospital stay in survivors (p<0.001). Conclusions: Hyperglycemia in the absence of diabetes was common (21% of hospitalized COVID-19 patients) and was associated with an increased risk of and faster progression to death. Development of hyperglycemia in COVID-19 patients who do not have diabetes is an early indicator of poor prognosis.

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…Hyperglycemia on hospital admission in severely ill people with COVID-19 is very well recognized and is predictive of a poor outcome, even in subjects without pre-existing diabetes ( Cai et al., 2020 ; Fadini et al., 2020 ; Huang et al., 2020b ; Mamtani et al., 2020a ). For example, dysregulated glucose control was associated with poor outcomes in 1,122 hospitalized people with COVID-19 analyzed in the Glytec database from March 1 to April 6, 2020 ( Bode et al., 2020 ).…”

Hyperglycemia Induced by COVID-19 with and without Present Diabetes: A Systematic Review

“…IL-6) will induce or worsen insulin resistance and disrupt the insulin secretion. Zhou et al 6 and Mamtani et al 5 in their studies showed that elevation of proinflammatory cytokines in circulation, such as CRP, IL-6, Interferon Gamma, and Tumor Necrosis Factor Alpha occured in hyperglycemic patients either with diabetes or without diabetes. Sachdeva et al 8 found that IL-6 level decreased after the hyperglycemia was treated.…”

“…Secondly, an indirect mechanism was found via the impact of pro-inflammatory cytokines, acute stress factors, or a history of glucocorticoid therapy usage. 5 SARS-CoV-2 could damage pancreatic β cells by binding to ACE-2 receptor, hence insulin secretion is impaired. As a consequence, blood sugar level will increase and worsen the diabetes condition or induce hyperglycemia in patients without prior diabetes.…”

“…6,8,10,15,16 SARS-CoV-2 may affect the innate immune system by downregulating and shedding virusinduced ACE-2, thus stimulate abundant proinflammatory cytokines release in hosts cell resulting in cytokine storm. 5,8 Structural and functional damage in endothelial cell occurs in this condition leading to impairment in insulin secretion and pancreatic beta cell causing hyperglycemia. Metaanalyses studies by Lee et al 9 and Sachdeva et al 8 showed that host immune response dysregulation which cause cytokine production impairment (e.g.…”

“…4 However, a recent report suggests the occurrence of hyperglycemia without any present diabetes in COVID-19 patients. [5][6][7][8] Some studies suggest hyperglycemic condition could be a predictor of mortality in COVID-19 patients. 4,[9][10][11][12][13][14] The systematic review was conducted to analyze the occurrence of hyperglycemia in COVID-19 patients with diabetes and without present diabetes.…”