Thromboembolism risk among patients with diabetes/stress hyperglycemia and COVID-19

Stefania, Calvisi Laura; Ramirez, Giuseppe A.; Scavini, Marina; Prat, Valentina Da; Lucca, Giuseppe Di; Laurenzi, Andrea; Gallina, Gabriele; Cavallo, Ludovica; Borio, Giorgia; Farolfi, Federica; Pascali, Maria Paola; Castellani, Jacopo; Lampasona, Vito; D’Angelo, Armando; Landoni, Giovanni; Ciceri, Fabio; Querini, Patrizia Rovere; Tresoldi, Moreno; Piemonti, Lorenzo

doi:10.1016/j.metabol.2021.154845

Cited by 26 publications

(23 citation statements)

References 37 publications

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Section: Discussionmentioning

confidence: 99%

“…Stress hyperglycemia involves increases in blood glucose due to sympathetic system activation during critical illnesses such as trauma, sepsis, MI, stroke [ 11 – 13 ]. Calvisi et al further suggested that, even among patients with COVID-19 pneumonia, DM/stress hyperglycemia is associated higher thromboembolic risk and worse clinical outcomes [ 11 ]. Stress-induced increases in the release of glucagon, cortisol and catecholamines promote the rate of glycogenolysis and gluconeogenesis, eventually leading to hyperglycemia [ 6 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Yang

Zhu

et al. 2022

Cardiovasc Diabetol

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Background Stress hyperglycemia is a strong predictor of adverse outcomes in patients with acute myocardial infarction (AMI). Recently, the stress hyperglycemia ratio (SHR) has been designed as an index to identify acute hyperglycemia with true risk; however, data regarding the impact of SHR on the prognosis of ST-segment elevation myocardial infarction (STEMI) remains limited. This study aimed to evaluate the predictive value of the SHR in patients with acute STEMI and to assess whether it can improve the predictive efficiency of the Thrombolysis in Myocardial Infarction (TIMI) risk score. Methods This study included 7476 consecutive patients diagnosed with acute STEMI across 274 emergency centers. After excluding 2052 patients due to incomplete data, 5417 patients were included in the final analysis. Patients were divided into three groups according to SHR tertiles (SHR1, SHR2, and SHR3) and were further categorized based on diabetes status. All patients were followed up for major cardiovascular adverse events (MACEs) and all-cause mortality. Results After 30 days of follow-up, 1547 MACEs (28.6%) and 789 all-cause deaths (14.6%) occurred. The incidence of MACEs was highest among patients in the SHR3 group with diabetes mellitus (DM) (42.6%). Kaplan–Meier curves demonstrated that patients with SHR3 and DM also had the highest risk for MACEs when compared with other groups (p < 0.001). Moreover, C-statistics improved significantly when SHR3 was added into the original model: the ΔC-statistics (95% confidence interval) were 0.008 (0.000–0.013) in the total population, 0.010 (0.003–0.017) in the DM group, and 0.007 (0.002–0.013) in the non-DM group (all p < 0.05). In the receiver operating characteristic analysis, the area under the curve (AUC) for the original TIMI risk score for all-cause death was 0.760. When an SHR3 value of 1 point was used to replace the history of DM, hypertension, or angina in the original TIMI risk score, the Delong test revealed significant improvements in the AUC value (∆AUC of 0.009, p < 0.05), especially in the DM group (∆AUC of 0.010, p < 0.05). Conclusion The current results suggest that SHR is independently related to the risks of MACEs and mortality in patients with STEMI. Furthermore, SHR may aid in improving the predictive efficiency of the TIMI risk score in patients with STEMI, especially those with DM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Yang

Zhu

et al. 2022

Cardiovasc Diabetol

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“…Diabetes has also been shown to independently increase the risk of thrombosis in hospitalised patients with COVID-19. 22 To our knowledge, this is the first study to specifically address the significantly elevated risk of thrombosis and its associated excess mortality in males with COVID-19 relative to females. Although mortality as a function of sex was not specifically addressed in the meta-analysis of the 42 studies noted in the introduction, 5 that study also documented that thrombosis contributes to excess mortality in COVID-19.…”

Section: Discussionmentioning

confidence: 96%

“…Diabetes has also been shown to independently increase the risk of thrombosis in hospitalised patients with COVID-19. 22 …”

Section: Discussionmentioning

confidence: 99%

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Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study

et al. 2022

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BackgroundThe mortality rate of COVID-19 is elevated in males compared with females.ObjectiveDetermine the extent that the elevated thrombotic risk in males relative to females contributes to excess COVID-19 mortality in males.DesignObservational study.SettingData sourced from electronic medical records from over 200 US hospital systems.Participants60 877 patients aged 18 years and older hospitalised with COVID-19.ExposureExposure variable: biological sex; key variable of interest: thrombosis.Primary outcome measuresPrimary outcome was COVID-19 mortality. We measured: (1) mortality rate of males relative to females, (2) rate of thrombotic diagnoses occurring during hospitalisation for COVID-19 in both sexes and (3) mortality rate when evidence of thrombosis was present.ResultsThe COVID-19 mortality rate of males was 29.9% higher than that of females. Males had a 35.8% higher rate of receiving a thrombotic diagnosis compared with females. The mortality rate of all patients with a thrombotic diagnosis was 40.0%—over twice that of patients with COVID-19 without a thrombotic diagnosis (adjusted OR 2.50 (2.37 to 2.64), p<0.001). When defining thrombosis as either a documented thrombotic diagnosis or a D-dimer level ≥3.0 µg/mL, 16.4% of the excess mortality in male patients could be explained by increased thrombotic risk.ConclusionsOur findings suggest the higher COVID-19 mortality rate in males may be significantly accounted for by the elevated risk of thrombosis among males. Understanding the mechanisms that underlie increased male thrombotic risk may allow for the advancement of effective anticoagulation strategies that reduce COVID-19 mortality in males.

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Pathophysiology of Lung Dysfunction in Diabetes

Habibullah

Wang

2023

Contemporary Endocrinology

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Thromboembolism risk among patients with diabetes/stress hyperglycemia and COVID-19

Cited by 26 publications

References 37 publications

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study

Pathophysiology of Lung Dysfunction in Diabetes

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