The prognostic role of hyperglycemia and glucose variability in covid-related acute respiratory distress Syndrome

Lazzeri, Chiara; Bonizzoli, Manuela; Batacchi, S; Valvasone, S Di; Chiostri, Marco; Peris, Adriano

doi:10.1016/j.diabres.2021.108789

Cited by 18 publications

(20 citation statements)

References 39 publications

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“…Additionally, recently a few studies have been published that analysed individual metrics of glycaemic variability. For example, high inter-subject coefficient of variation and standard deviation have been associated with disease progression 35 and in-ICU mortality 36 in COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

Hartmann

Verket

Balfanz

et al. 2022

Sci Rep

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There is high mortality among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19). Important factors for COVID-19 mortality are diabetes status and elevated fasting plasma glucose (FPG). However, the effect of glycaemic variability on survival has not been explored in patients with COVID-19 and ARDS. This single-centre cohort study compared several metrics of glycaemic variability for goodness-of-fit in patients requiring mechanical ventilation due to COVID-19 ARDS in the ICU at University Hospital Aachen, Germany. 106 patients had moderate to severe ARDS (P/F ratio median [IQR]: 112 [87–148] mmHg). Continuous HRs showed a proportional increase in mortality risk with daily glycaemic variability (DGV). Multivariable unadjusted and adjusted Cox-models showed a statistically significant difference in mortality for DGV (HR: 1.02, (P) < 0.001, LR(P) < 0.001; HR: 1.016, (P) = 0.001, LR(P) < 0.001, respectively). Kaplan–Meier estimators yielded a shorter median survival (25 vs. 87 days) and a higher likelihood of death (75% vs. 31%) in patients with DGV ≥ 25.5 mg/dl (P < 0.0001). High glycaemic variability during ICU admission is associated with significant increase in all-cause mortality for patients admitted with COVID-19 ARDS to the ICU. This effect persisted even after adjustment for clinically predetermined confounders, including diabetes, median procalcitonin and FPG.

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Section: Discussionmentioning

confidence: 99%

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

Hartmann

Verket

Balfanz

et al. 2022

Sci Rep

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“…This local inflammatory milieu is an important etiological factor of the development of insulin resistance, dysfunction of insulin secretion and hyperglycemia [ 11 ]. The observation that hyperglycemia is more commonly observed in non survivors after ICU admission emphasizes the importance of abdominal fat as a relevant determinant of poor COVID-19 prognosis [ 12 – 14 ]. In agreement with the literature, we confirmed in our cohort that blood glucose levels at admission were significantly higher in non survivors and in patients reaching the composite endpoint including ICU-R.…”

Section: Discussionmentioning

confidence: 99%

Cardiac adipose tissue volume and IL-6 level at admission are complementary predictors of severity and short-term mortality in COVID-19 diabetic patients

Phan

Boussouar

Lucidarme

et al. 2021

Cardiovasc Diabetol

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Background COVID-19 diabetic adults are at increased risk of severe forms irrespective of obesity. In patients with type-II diabetes, fat distribution is characterized by visceral and ectopic adipose tissues expansion, resulting in systemic inflammation, which may play a role in driving the COVID-19 cytokine storm. Our aim was to determine if cardiac adipose tissue, combined to interleukin-6 levels, could predict adverse short-term outcomes, death and ICU requirement, in COVID-19 diabetic patients during the 21 days after admission. Methods Eighty one consecutive patients with type-II diabetes admitted for COVID-19 were included. Interleukin-6 measurement and chest computed tomography with total cardiac adipose tissue index (CATi) measurement were performed at admission. The primary outcome was death during the 21 days following admission while intensive care requirement with or without early death (ICU-R) defined the secondary endpoint. Associations of CATi and IL-6 and threshold values to predict the primary and secondary endpoints were determined. Results Of the enrolled patients (median age 66 years [IQR: 59–74]), 73% male, median body mass index (BMI) 27 kg/m2 [IQR: 24–31]) 20 patients had died from COVID-19, 20 required intensive care and 41 were in conventional care at day 21 after admission. Increased CATi and IL-6 levels were both significantly related to increased early mortality (respectively OR = 6.15, p = 0.002; OR = 18.2, p < 0.0001) and ICU-R (respectively OR = 3.27, p = 0.01; OR = 4.86, p = 0.002). These associations remained significant independently of age, sex, BMI as well as troponin-T level and pulmonary lesion extension in CT. We combined CATi and IL-6 levels as a multiplicative interaction score (CATi*IL-6). The cut-point for this score was ≥ 6386 with a sensitivity of 0.90 and a specificity of 0.87 (AUC = 0.88) and an OR of 59.6 for early mortality (p < 0.0001). Conclusions Cardiac adipose tissue index and IL-6 determination at admission could help physicians to better identify diabetic patients with a potentially severe and lethal short term course irrespective of obesity. Diabetic patients with high CATi at admission, a fortiori associated with high IL-6 levels could be a relevant target population to promptly initiate anti-inflammatory therapies.

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“…On the other hand, glucose levels have been shown to be associated with prognosis in patients with ARDS. 19 However, there are no biomarkers that combine glucose and lymphocyte counts to predict prognosis in critically ill patients with ARDS. In this study, we analyzed the association between glucose‐to‐lymphocyte ratio (GLR) and in‐hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of glucose‐to‐lymphocyte ratio in critically ill patients with acute respiratory distress syndrome: A retrospective cohort study

Zhang

2022

Clinical Laboratory Analysis

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Background: There is need to identify biomarkers for prognosis of acute respiratory distress syndrome (ADRS). This may allow early and accurate identification of patients with high-risk ARDS to guide adjustment of clinical treatment and nursing intervention, which would ultimately improve prognosis of patients with ARDS. Biomarkers based on a combination of fasting glucose and lymphocyte counts to predict prognosis in critically ill patients with ARDS remain undefined. In this study, we investigated the association between glucose-to-lymphocyte ratio (GLR) and in-hospital mortality. Methods:The study obtained data from Medical Information Mart for Intensive Care-IV (MIMIC-IV Version 1.0) database. We defined the GLR as fasting glucose/ lymphocyte count and the patient in-hospital mortality was considered as the outcome. In addition, we employed linear and logistic regression models for analysis. Results:In total, 1,085 patients with ARDS were included in this study. The eligible participants included 498 female and 587 males, with a mean age of 64.2 ± 17.5 years.Logistic regression analysis demonstrated that higher GLR was an independent risk factor for all-cause mortality (OR =1.67, 95% CI: 1.26-2.22) after adjusting for age, sex, anion gap, white blood cell count, congestive heart failure, sequential organ failure assessment (SOFA), SBP, DBP, and respiratory rate in both the dichotomized group and subgroups. We also analyzed the in-hospital mortality to ROC curves by comparing the value between SOFA + GLR and SOFA. The area under the curve (AUC) was 0.6991 for the SOFA + GLR (95% CI: 0.6634-0.7348), and 0.6613 for the SOFA (95%

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The prognostic role of hyperglycemia and glucose variability in covid-related acute respiratory distress Syndrome

Cited by 18 publications

References 39 publications

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

Cardiac adipose tissue volume and IL-6 level at admission are complementary predictors of severity and short-term mortality in COVID-19 diabetic patients

Prognostic value of glucose‐to‐lymphocyte ratio in critically ill patients with acute respiratory distress syndrome: A retrospective cohort study

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