Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study

Abstract

IntroductionWith intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19.Research design and methodsWe collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes.ResultsElevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes.ConclusionsElevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic.

Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry

“…A small number of observational studies have analyzed the relationship betweenglycemic control and clinical outcomes in patients hospitalized due to COVID-19 with and without diabetes. All of them provide clinical evidence of a correlation between uncontrolled hyperglycemia with poor prognosis and a particularly high mortality rate [3][4][5][6][7].…”

“…Wu et al [7]collected data on 2,041 patients admitted to two medical centers. They compared non-critical patients at admission (n=1,690) to critical patients at the time of admission or at the time of transition from the non-critical group (n=697).…”

“…Acutehyperglycemiahas been associated with in-hospital complications in noncritically ill patients with and without diabetes mellitus (DM) [2]. In regard to COVID-19, elevated blood glucose(BG) levelsis also associated with in-hospital complications, including mechanicalventilation requirement, intensive care unit (ICU) admission, and death [3][4][5][6][7].Thus, hyperglycemia, particularly upon admission, could be a marker of poor prognosisregardless of diabetes status. This suggests that elevated BG may play a decisiverole in the severityof the disease at an early stage [8][9][10].…”

The associations between fasting plasma glucose levels and mortality of COVID-19 in patients without diabetes

“…Previous studies analyzed clinical characteristics of the patients with diabetes which revealed that the poorly controlled FPG levels could worsen the outcome of the new coronavirus disease [13]. In a retrospective study of 2041 patients with COVID-19, the results revealed that elevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19 [14]. Another study indicated that tight glycemic control could improve clinical outcomes in patients with diabetes [15].…”

Hyperglycemia and COVID-19: What was known and what is really new?

“…However, it is worth to mention that glucose variability during the hospitalization, in both diabetes and non-diabetes, also emerged as independent risk factor for a worse prognosis in COVID-19 [4,5].…”