Hyperglycemia is Associated With Increased Mortality in Critically Ill Patients With COVID-19

Mazori, Alon; Bass, Ilana; Chan, Lili; Mathews, Kusum S.; Altman, Deena R.; Saha, Aparna; Soh, Howard; Wen, Huei Hsun; Bose, Sonali; Leven, Emily; Wang, Jing Gennie; Mosoyan, Gohar; Pattharanitima, Pattharawin; Greco, Giampaolo; Gallagher, Emily J.

doi:10.1016/j.eprac.2020.12.015

Cited by 29 publications

(30 citation statements)

References 31 publications

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“…Hyperglycemia is not a physiological or benign condition; clinically, hyperglycemia has been linked to increased incidences of sepsis, longer hospital stays and higher mortality [ 39 , 40 , 41 ]. A continuous glucose monitoring may be useful to detect glycemic fluctuation and to prevent metabolic imbalance.…”

Section: Discussionmentioning

confidence: 99%

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

et al. 2021

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An interaction between metabolic glucose impairment and coronavirus disease 2019 is reported. The development of a severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection has been described. We evaluated the impact of MIS-C on glycemic patterns in pediatric patients. A group of 30 children and adolescents affected by MIS-C were considered; all patients were normal weight. Clinical and biochemical assessments, including surrogate markers of insulin resistance (IR) such as homeostasis model analysis-IR (HOMA-IR) and triglyceride–glucose (TyG) indexes, were recorded. Patients were also invited to undergo an intermittently scanned continuous glucose monitoring (isCGM). HOMA-IR index was calculated in 18 patients (60%), of which 17 (94%) revealed a pathological value. TyG index was computed for all patients and pathological values were detected in all cases. In 15 patients, isCGM data were recorded on average for 9 days (±3 days). Overall, average glucose was 105 mg/dL (±16 mg/dL) and average time spent in the 70–180 mg/dL range (TIR) was 93.76%, with nearly 10% of glucose readings in the 141–180 mg/dL range; glycemic fluctuations over the hyperglycemic threshold were detected in four patients. Regular glucose monitoring may be useful to prevent metabolic imbalance and obtain a better outcome.

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Section: Discussionmentioning

confidence: 99%

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

et al. 2021

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“…A growing number of observational studies have shown that hyperglycemia is a strong predictor of morbidity and mortality in hospitalized and critically ill COVID-19 patients, independent of pre-existing diabetes status [ 11 , 12 , 13 ]. However, it is still unclear how the combination of underlying T2D and the presence of hyperglycemia at the time of hospital admission is associated with the inflammatory burden and outcomes of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Association between Hyperglycemia at Hospital Presentation and Hospital Outcomes in COVID-19 Patients with and without Type 2 Diabetes: A Retrospective Cohort Study of Hospitalized Inner-City COVID-19 Patients

et al. 2021

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This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted from the hospital database. HG was defined as BG > 200 mg/dL. Patients with type 1 diabetes or BG < 70 mg/dL were excluded. A total of 458 patients with T2D and 976 patients without T2D were included in the study. The mean ± SD age was 56 ± 17 years and 642 (45%) were female. HG occurred in 193 (42%) and 42 (4%) of patients with and without T2D, respectively. Overall, the in-hospital mortality rate was 9%. Among patients without T2D, HG was statistically significantly associated with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders (p < 0.05). However, only ICU admission and acute kidney injury were associated with HG among patients with T2D (p < 0.05). Among the 235 patients with HG, the presence of T2D was associated with decreased odds of mortality, ICU admission, intubation, and severe sepsis/septic shock, after adjusting for potential confounders, including BG (p < 0.05). In conclusion, HG in the subset of patients without T2D could be a strong indicator of high inflammatory burden, leading to a higher risk of severe COVID-19.

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“…Non-survivors were older, had a longer duration of hospital stay and significantly increased levels of IL6, hsCRP, LDH and D-dimer. In the study on 133 COVID-19 patients by Mazori et al , those with new-onset hyperglycemia having blood glucose > 180 mg/dL during the first 2 days after ICU admission had higher levels of median C-reactive protein (306.3 mg/L, P = 0.036), procalcitonin (1.26 ng/mL, P = 0.028), and lactate (2.2 mmol/L, P = 0.023) ( 21 ). Procalcitonin and lactate levels were not measured in our study.…”

Section: Discussionmentioning

confidence: 99%

“…There are reports of association of plasma glucose at admission with morbidity and mortality with COVID-19 ( 17 , 18 , 19 , 20 , 21 , 22 ). A guidance review suggests aggressive screening for hyperglycemia in patients with COVID-19 receiving systemic glucocorticoids ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of plasma glucose at admission on COVID-19 mortality: experience from a tertiary hospital

Kumar

Mittal

Gopalakrishnan

et al. 2021

Endocrine Connections

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Objective: Plasma glucose has been correlated with in-hospital mortality among many diseases including infections. We aimed to study plasma glucose at admission of hospitalized patients with COVID-19 at a tertiary care referral hospital at Jodhpur, India and its relation with mortality. Design: A hospital-based clinical study of plasma glucose of COVID-19 patients conducted from May 15th to June 30th, 2020 after ethical approval. Measurements: Random blood samples at admission were collected for plasma glucose, interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP) after written informed consent. Plasma glucose was analyzed by automated analyzer, IL-6 by chemiluminescent immunoassay and hsCRP by immune-turbidimetric assay. Results: A total of 386 patients studied (female 39.6%); 11.1% had severe disease and 4.1% expired. There were 67 (17.4%) patients with known diabetes mellitus (DM). Patients with history of DM had three times higher mortality (6/66, 9%) than those without DM (10/319, 3.1%). Patients with moderate and severe disease according to ICMR and WHO grading had higher plasma glucose than those with asymptomatic or mild disease (p<0.0001). Plasma glucose levels at admission were significantly higher in non-survivors when compared to those who survived (297±117 vs. 131±73; p<0.0001). COVID-19 patients showed increasing mortality with incremental plasma glucose levels. Hazard ratio for mortality was 1.128 (95%CI 0.86-14.860),1.883 (95%CI 0.209-16.970), and 4.005 (95%CI 0.503-32.677) in random plasma glucose group of >100-200, >200-300 and >300mg/dl respectively compared to those with random plasma glucose of <100mg/dl at admission. Plasma glucose was strongly correlated with hsCRP (p<0.001) and IL-6 (p<0.0001). Conclusions: Plasma glucose at admission in hospitalized COVID-19 patients is a strong predictor of mortality.

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Hyperglycemia is Associated With Increased Mortality in Critically Ill Patients With COVID-19

Cited by 29 publications

References 31 publications

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

Association between Hyperglycemia at Hospital Presentation and Hospital Outcomes in COVID-19 Patients with and without Type 2 Diabetes: A Retrospective Cohort Study of Hospitalized Inner-City COVID-19 Patients

Effect of plasma glucose at admission on COVID-19 mortality: experience from a tertiary hospital

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