A prospective study of the impact of glycaemic status on clinical outcomes and anti-SARS-CoV-2 antibody responses among patients with predominantly non-severe COVID-19

Abstract

Aims We carried out this prospective study of predominantly non-severe COVID-19 patients, to evaluate the influence of glycaemic status on clinical outcomes and neutralising antibody (Nab) responses, potentially relevant to the COVID-19 vaccination programme. Methods We included consecutive adults admitted to Queen Mary Hospital for COVID-19 from July 2020–May 2021. Glycaemic status was defined by admission HbA1c. Clinical deterioration was defined by radiological progression/new oxygen requirement/intensive care requirement/death. COVID-19 survivors had Nab measurements at 1-month, 2-month, 3-month and 6-month post-discharge. Results Among 605 patients (96.9% non-severe COVID-19; 325 normoglycaemia, 185 prediabetes, 95 diabetes), 74(12.2%) had clinical deterioration, more likely with worse glycaemic status and higher HbA1c (p<0.001). Older age (p<0.001), higher viral loads (p<0.001), higher C-reactive protein (CRP) (p<0.001) and symptomatic presentation (p=0.008), but not glycaemic status/HbA1c, independently predicted clinical deterioration. Older age (p=0.001), higher CRP (p=0.038), elevated lactate dehydrogenase (p=0.046) and interferon treatment (p=0.001), but not glycaemic status/HbA1c, independently predicted Nab titres. Rate of Nab titre decline was comparable across glycaemic status. Conclusions COVID-19 patients with worse glycaemic status were more likely to deteriorate clinically, mediated through the association of worse glycaemic status with older age, more severe inflammation and higher viral loads. Importantly, Nab responses did not differ across glycaemic status.

ISTH guidelines for antithrombotic treatment in COVID‐19

“…Patients with COVID‐19, who survive until discharge from the hospital, may still be at increased risk of adverse outcomes. Some patients demonstrate biomarkers for residual hypercoagulability (high D‐dimer), 55 and elevated inflammatory response (high C‐reactive protein), 57 which might increase post‐discharge risk of thromboembolic events and death in the convalescence. One RCT showed that prophylactic dose of a DOAC (rivaroxaban) compared to no anticoagulation reduced risk of non‐fatal or fatal VTE without a significant increase in bleeding risk 56 .…”

Contribution of low population immunity to the severe Omicron BA.2 outbreak in Hong Kong

“…First, some COVID-19 patients or vaccine recipients do not develop su cient protective antibody responses. Lower neutralizing antibody (NAb) titers are found in patients with asymptomatic or mild COVID-19, immunocompromised patients and older adults 10,11,12,13,14,15,16 . Second, the NAb titers elicited by inactivated whole virion or adenovirus-vectored vaccines are lower than those elicited by mRNA vaccines 17,18,19 .…”

A Prospective 1-Year Follow-up of Glycemic Status and C-Peptide Levels of COVID-19 Survivors with Dysglycemia in Acute COVID-19 Infection

“…Critical disease was defined by respiratory failure requiring mechanical ventilation, shock, and intensive care unit admission. C-reactive protein (CRP) levels during hospitalization for COVID-19 were retrieved with CRP >0.76 mg/dL considered elevated [15].…”

“…HbA1c was measured in whole blood using cation-exchange high-performance liquid chromatography. The assay was certified by National Glycohemoglobin Standardization Programme and standardized to Diabetes Control and Complications Trial reference assay [15]. Insulin levels were measured using Human Insulin Quantikine enzyme-linked immunosorbent assay (ELI-SA) kit (R&D Systems Inc., Minneapolis, MN, USA) with intraassay coefficient of variability (CV) of 3.7%-4.0% and inter-assay CV of 6.9%-7.5%.…”