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

Abstract

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.

Elevated Levels of Pleiotropic Interleukin-6 (IL-6) and Interleukin-10 (IL-10) are Critically Involved With the Severity and Mortality of COVID-19: An Updated Longitudinal Meta-Analysis and Systematic Review on 147 Studies

“…We conducted this meta-analysis on overall 31 909 COVID-19 patients from 147 studies. 2 , 4 - 7 , 9 - 18 , 24 …”

Diabetic ketoacidosis (DKA) in type 1 diabetes mellitus (T1DM) temporally related to COVID-19 vaccination

“…The compromised innate immunity, an underlying chronic low-grade inflammation and an exaggerated pro-inflammatory response, characterized by increased cytokines like IL-1, IL-6, TNF-α, C-reactive protein, ferritin, and a hypercoagulable state contribute to the increasing severity in diabetics [ [9] , [10] , [11] ]. Acute hyperglycemia can upregulate angiotensin-converting enzyme 2 (ACE-2) expression facilitating viral entry, while chronic hyperglycemia can lead to low ACE-2 expression, leading to decreased degradation of angiotensin II to the vasodilatory, anti-proliferative and anti-inflammatory peptide angiotensin [ [1] , [2] , [3] , [4] , [5] , [6] , [7] ]. This response may be exaggerated after the immune response after natural infection or vaccination [ 12 ].…”

“…It has been demonstrated in multiple studies that diabetes has been associated with increased risk of severe disease, acute respiratory distress syndrome (ARDS), disease progression and increased mortality rates [ 3 , 4 ]. In fact, there exists a bidirectional relationship between SARS-CoV2 infection and diabetes, with infection being associated with worsening of hyperglycemia in preexisting diabetes and new-onset hyperglycemia [ 5 ].…”

RSSDI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2022

“…976 This was confirmed in a study by Kumar et al, where higher plasma glucose at admission strongly correlated with inflammatory markers, was predictive of moderate-tosevere disease, and patients with plasma glucose of 180 mg/dL or less had better survival. 977 In another recent meta-analysis, admission fasting blood glucose was found to be an independent predictor of disease severity, with every one mmol/L increase in fasting blood glucose translating into a 33% increased risk of disease severity. 978 • Clinical guidance protocols have been previously published by Gupta et al and the Ministry of Health and Family Welfare (MOHFW) for the management of diabetes in Covid19 infected patients.…”