Chronic dysglycemia and risk of SARS‐CoV‐2 associated respiratory failure in hospitalized patients

Abstract

Background Diabetes is common among patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐induced respiratory failure. We aimed to investigate the relationship between different stages of chronic dysglycemia and development of respiratory failure in hospitalized SARS‐CoV‐2 positive patients. Methods In this retrospective observational study, we included 385 hospitalized SARS‐CoV‐2 positive patients at Karolinska University Hospital, Sweden with an HbA1c test obtained within 3 months before admission. Based on HbA1c level and previous diabetes history, we classified patients into the following dysglycemia categories: prediabetes, unknown diabetes, controlled diabetes, or uncontrolled diabetes. We used multivariable logistic regression analysis adjusted for age, sex, and body mass index, to assess the association between dysglycemia categories and development of SARS‐CoV‐2‐induced respiratory failure. Results Of the 385 study patients, 88 (22.9%) had prediabetes, 68 (17.7%) had unknown diabetes, 36 (9.4%) had controlled diabetes, and 83 (21.6%) had uncontrolled diabetes. Overall, 299 (77.7%) patients were admitted with or developed SARS‐CoV‐2‐induced respiratory failure during hospitalization. In multivariable logistic regression analysis compared with no chronic dysglycemia, prediabetes (OR 14.41, 95% CI 5.27–39.43), unknown diabetes (OR 15.86, 95% CI 4.55–55.36), and uncontrolled diabetes (OR 17.61, 95% CI 5.77–53.74) was independently associated with increased risk of SARS‐CoV‐2‐induced respiratory failure. Conclusion In our cohort of hospitalized SARS‐CoV‐2 positive patients with available HbA1c data, prediabetes, undiagnosed diabetes, and poorly controlled diabetes were associated with a markedly increased risk of SARS‐CoV‐2‐associated respiratory failure.

Prevalence and impact of chronic dysglycaemia among patients with COVID-19 in Swedish intensive care units: a multicentre, retrospective cohort study

“…In addition to the above speculations about SARS-CoV-2 as a cause of dysglycaemia, there is also evidence suggesting that patients with pre-existing dysglycaemia are prone to a more severe course of COVID-19. For example, some studies have shown that hospitalised SARS-CoV-2 positive with pre-diabetes, unknown diabetes and known poorly controlled diabetes are at increased risk of SARS-CoV-2-associated respiratory failure requiring intensive care 17. A higher burden of comorbidities, hyperglycaemia per se and chronic low-grade inflammation in diabetes may explain this observation 18…”

“…For example, some studies have shown that hospitalised SARS-CoV-2 positive with pre-diabetes, unknown diabetes and known poorly controlled diabetes are at increased risk of SARS-CoV-2-associated respiratory failure requiring intensive care. 17 A higher burden of comorbidities, hyperglycaemia per se and chronic low-grade inflammation in diabetes may explain this observation. 18 Open access et al identifiy fasting glucose as an independent predictor for 28-day mortality in hospitalised individuals with COVID-19 and previously unknown diabetes.…”