Elevated glycohemoglobin is linked to critical illness in COVID-19: a retrospective analysis

Abstract

Background: Several studies have explored hospitalization risk factors with the novel coronavirus disease 2019 (COVID-19) infection. Our goal was to identify clinical characteristics outside of laboratory or radiologic data associated with intubation or death within 7 days of admission. Methods: The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed COVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median height for patients’ sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction. Results: Participants had a mean [standard deviation (SD)] age 55 (17), BMI 30.9 (8.2), 55% were male and 80% were ethnic/racial minorities. Increasing age [aOR: 1.24 (1.07, 1.45) per 10 years], higher BMI (aOR 1.03 (1.00, 1.06), and poorly controlled diabetes [hemoglobin A1C (HbA1c) ⩾ 8] (aOR 2.26 (1.24, 4.12) were significantly ( p < 0.05) associated with greater odds of intubation or death. Female sex [aOR: 0.63, 95% CI (0.40, 0.98); p value = 0.043] was associated with lesser odds of intubation or death. The odds of death and/or intubation increased 19% for every 1 unit increase in HbA1c value [OR: 1.19 (1.01, 1.43); p = 0.04]. Our final MCP model included indicators of A1C ⩾ 8, age > 65, sex, and minority status, but predicted intubation/death only slightly better than random chance [area under the receiver operating characteristic curve (AUC) = 0.61 (0.56, 0.67)]. Conclusion: In a hospitalized patient cohort with COVID-19, worsening control of diabetes as evidenced by higher HbA1c was associated with increased risk of intubation or death within 7 days of admission. These results complement and help clarify previous associations found between diabetes and acute disease in COVID-19. Importantly, our analysis is missing some known predictors of severity in COVID-19. Our predictive model had limited success, suggesting unmeasured factors contribute to disease severity differences.

Factors associated with disease severity of COVID‑19 in patients with type 2 diabetes mellitus

“…By contrast, research by Zhang et al (42), revealed no significant correlation between concomitant hypertension and severity of COVID-19. Conversely, hypertension was the comorbidity most commonly associated with an increased risk of severity in individuals with COVID-19 (27,28,(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55). Immune system disruption in patients with T2DM and hypertension increases the risk of infection with COVID-19 (46).…”

“…The present study may be useful in providing insights into the severity of COVID-19 and comorbities, particularly T2DM. Several studies found a correlation between severity of COVID-19 and increased inflammatory responses (34,42,45,48,49), while other studies determined that glycemic control was associated with patient outcome (24,(51)(52)(53), and certain others found that there is a correlation between hypertension, diabetes and COVID-19 infection (22,27,28,(43)(44)(45). The aforementioned are independent studies, and while they support each other and the findings of the present study, to the best of our knowledge, research comparing a combination of several factors has yet to be performed.…”

“…As aforementioned, in the present study, an HbA1c value of ≥8% was associated with the severity of COVID-19 in patients with T2DM admitted to hospital. A recent study revealed that an HbA1c of 8% was a risk factor for severe COVID-19 with intubation or death after 7 days of therapy (OR 2.26; P<0.05) ( 51 ). In patients with T2DM, an HbA1c >9% was revealed to be an independent predictor of multiple organ damage (OR 2.98; P=0.043) ( 17 ).…”