Glycated hemoglobin level on admission associated with progression to severe disease in hospitalized patients with non‐severe coronavirus disease 2019

Abstract

Aims/Introduction Poor glycemic control is known to be associated with severe infection development. This retrospective observational study examined whether glycemic control before coronavirus disease 2019 (COVID‐19) onset contributes to progression from non‐severe to severe COVID‐19. Materials and Methods Glycated hemoglobin (HbA1c) was measured on hospital admission in 415 patients with non‐severe COVID‐19. The outcome was determined from time of hospital admission to severe progression, based on clinical practice guidelines for COVID‐19 in Japan. Results The median value for HbA1c on admission was 6.1%, with diabetes present in 138 patients (33.3%). Among the total cohort, 93 (22.4%) progressed to severe COVID‐19 with a median (interquartile range) time of 4 days (3–7 days), whereas 322 (77.6%) were discharged after 13 days (10–17 days). A multivariable Cox proportional hazards regression model showed that HbA1c level on admission was independently associated with progression to severe COVID‐19 (hazard ratio for 1% increase 1.237, 95% confidence interval 1.037–1.475; P = 0.018), with findings consistent among several sensitivity analyses. In subgroup analyses, such an association was significant in patients with diabetes, as well as older age, current smoking habit, lower estimated glomerular filtration rate, higher C‐reactive protein level, moderate II COVID‐19, dyslipidemia and chronic respiratory disease, with no remarkable inconsistency among the subgroups. Finally, higher HbA1c level (≥7%) was more strongly associated with severe COVID‐19 progression than diabetes. Conclusions The results suggest that poor glycemic control before COVID‐19 onset contributes to progression from non‐severe to severe COVID‐19, even in patients with severe COVID‐19 risk factors regardless of the presence of diabetes.

Inflammation Related to Association of Low Uric Acid and Progression to Severe Disease in Patients Hospitalized for Non-Severe Coronavirus Disease 2019

“…Blood parameters including uric acid, CRP, KL-6, and D-dimer levels were routinely measured using a sample obtained at the time of admission, with or without fasting [ 20 , 21 ]. Serum uric acid was measured by use of a uricase-N-(3-sulfopropyl)-3-methoxy-5-methylaniline assay (L-Type UA M; FUJIFILM Wako Pure Chemical Corporation, Osaka, Japan), serum CRP by use of a latex-enhanced immunoturbidimetric assay (IATRO CRP-EX; LSI Medience Corporation, Tokyo, Japan), and serum KL-6 by use of a latex immunoturbidimetric assay (Nanopia KL-6; Sekisui Medical Co. Ltd., Tokyo, Japan), with analyses of those performed with an automated biochemical analyzer (LABOSPECT 008; Hitachi High-Technologies, Tokyo, Japan).…”

“…The outcome for the present cases was based on period (days) between hospital admission and severe COVID-19 status progression. Any patient who did not progress to severe and met the discharge criteria was noted as not demonstrating progression to severe status following discharge, as previously described [ 21 , 24 ].…”

Reduced Risk of Progression from Non-Severe to Severe COVID-19 in Hospitalized Dialysis Patients by Full COVID-19 Vaccination

“…A severe classification was noted upon admission to the intensive care unit (ICU) or when the use of a mechanical ventilator was required [ 21 , 22 , 23 ]. Thus, patients classified as mild, moderate I, or moderate II were defined as non-severe COVID-19 [ 24 ].…”

“…The examined outcome of the present study was the time (days) between hospital admission and progression to severe COVID-19. Patients who did not show a progression to severe status and met the criteria for discharge were assumed to not have progressed to severe status after discharge, as previously described [ 24 ].…”

“…Diabetes, hypertension, and dyslipidemia were diagnosed based on the previous history of treatment for the respective condition or guidelines provided by the Japanese Diabetes Society, Japanese Society of Hypertension, or Japan Atherosclerosis Society [ 25 , 26 , 27 ]. Abnormal findings indicating pneumonia were evaluated using a chest computed tomography examination [ 24 ].…”