Abnormal Glucose Metabolism Leads To Severe COVID-19 Due To Hyperinflammation: A Cross-Sectional Study

Abstract

Background: We aimed to describe the clinical features of novel coronavirus disease 2019 (COVID-19) patients with or without diabetes, focusing on the effect of abnormal HbA1c levels on inflammatory reactions and disease severity.Methods: A total of 190 patients with COVID-19 were included in this cross-sectional study. Clinical and laboratory characteristics were collected and compared among moderate, severe, and critical cases, as well as among diabetes, prediabetes and nondiabetes cases. Receiver operating characteristic (ROC) curves were constructed to determine the diagnostic ability of HbA1c for disease severity. Logistic regression was used to explore the relationship between HbA1c levels and worse prognosis of COVID-19.Results: HbA1c levels at admission were significantly different in patients with moderate, severe, and critical diseases (P<0.001). The area under the curve (AUC) of HbA1c levels to distinguish between moderate and severe-critical diseases was 0.938 (95% CI 0.906–0.970). After adjustment for confounders, the results showed that the increasing odds of in-hospital deaths were associated with HbA1c levels >6.0% (42 mmol/mol) (aOR 2.971 [95% CI 1.002, 8.804], P=0.049), and the increasing odds of severe or critical COVID-19 were associated with HbA1c levels ≥5.7% (39 mmol/mol) (aOR 29.588 [95% CI 8.285, 105.457], P<0.001). In addition, HbA1c levels strongly correlated with inflammatory markers and cytokines.Conclusions: Abnormal glucose metabolism can cause a hyperinflammatory state of COVID-19, which manifests as severe disease.