Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study

Abstract

To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS Hospitalized COVID-19 patients (N 5 271) were subdivided based on at-admission glycemic status: 1) glucose levels <7.78 mmol/L (NG) (N 5 149 [55.0%]; median glucose 5.99 mmol/L [range 5.38-6.72]), 2) known diabetes mellitus (DM) (N 5 56 [20.7%]; 9.18 mmol/L [7.67-12.71]), and 3) no diabetes and glucose levels ‡7.78 mmol/L (HG) (N 5 66 [24.3%]; 8.57 mmol/L [8.18-10.47]). RESULTS Neutrophils were higher and lymphocytes and PaO 2 /FiO 2 lower in HG than in DM and NG patients. DM and HG patients had higher D-dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs. 16.8%; unadjusted hazard ratio [HR] 2.20, 95% CI 1.27-3.81, P 5 0.005) than in NG (16.8%) and marginally so in DM (28.6%; 1.73, 0.92-3.25, P 5 0.086) patients. Upon multiple adjustments, only HG remained an independent predictor (HR 1.80, 95% CI 1.03-3.15, P 5 0.04). After stratification by quintile of glucose levels, mortality was higher in quintile 4 (Q4) (3.57, 1.46-8.76, P 5 0.005) and marginally in Q5 (29.6%) (2.32, 0.91-5.96, P 5 0.079) vs. Q1. CONCLUSIONS Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19. Diabetes is common among persons hospitalized for coronavirus disease 2019 (COVID-19), and it is associated with increased risk of mortality (1). Stress-induced hyperglycemia occurring at hospital admission for acute medical or surgical illness in individuals with no history of diabetes (2) is a worse predictor than diabetes for poor clinical outcomes and mortality (3). In subjects with severe acute respiratory syndrome, at-admission hyperglycemia was an independent predictor for mortality (4). Therefore, we have evaluated the impact of at-admission plasma glucose levels in hospitalized COVID-19 patients. RESEARCH DESIGN AND METHODS We retrospectively analyzed 271 adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection consecutively admitted to the University

Hyperglycemia without diabetes and new-onset diabetes are both associated with poorer outcomes in COVID-19

“…While Li et al [13] demonstrated an increase trend in all-cause mortality (HR 3.29; 95% CI, 0.65-16.6) in patients with hyperglycemia without diabetes (FPG 5.6-6.9 mmol/L and/or HbA1c 5.7-6.4%), compared to normoglycemic patients (FPG < 5.6 mmol/L and HbA1c < 5.7%) with COVID-19, at a mean follow-up of 30 days. The most recent study by Coppelli and colleagues reported that mortality was significantly higher in hyperglycemia without diabetes (defined as no diabetes and glucose 7.78 mmol/L at admission) compared with normoglycemic patients (at-admission blood glucose < 7.78 mmol/L) with COVID-19 (39.4% vs. 16.8% respectively; unadjusted HR 2.20; 95% CI, 1.27-3.81; p = 0.005) at a mean observation of 17 days period [14].…”

High admission blood glucose is an independent risk factor of poor prognosis in COVID-19: A systematic review and dose-response meta-analysis

“…However, Cariou et al reported that the observed effect diminished following adjustments for clinical and biological features (odds ratio 1.30 [95% CI: 0.94-1.82]), 25 while Coppelli et al stated otherwise, 31 Moreover, exposure-response trend were also observed in two studies, 31,42 Appendix Table S10). 31 However, we were unable to perform a formal dose-response analysis due to insufficient information. In addition, two studies also reported that the risk of mortality was more accentuated in patients without history of diabetes 30,31 31 Subgroup and sensitivity analyses, as well as publication bias assessment and DRMA was not conducted due to insufficient number of studies.…”

“…From 35 included studies, more than half were conducted in China (23 studies), while the others were five each in America 18,21,[27][28][29] and Europe 20,25,[30][31][32] , and one each in Hong Kong 33 and South Korea 34 . FBG was utilized in 23 studies, while RBG in 13 studies.…”

“…25,31 . However, Cariou et al reported that the observed effect diminished following adjustments for clinical and biological features (odds ratio 1.30 [95% CI: 0.94-1.82]), 25 while Coppelli et al stated otherwise, 31 Moreover, exposure-response trend were also observed in two studies, 31,42 Appendix Table S10). 31 However, we were unable to perform a formal dose-response analysis due to insufficient information.…”

“…31 However, we were unable to perform a formal dose-response analysis due to insufficient information. In addition, two studies also reported that the risk of mortality was more accentuated in patients without history of diabetes 30,31 31 Subgroup and sensitivity analyses, as well as publication bias assessment and DRMA was not conducted due to insufficient number of studies.…”