Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

Abstract

Evidence is conflicting about the diabetes characteristics associated with worse outcome among hospitalized COVID-19 patients. We aimed to assess the role of stress hyperglycemia ratio (SHR) as a prognostic marker among them. In our retrospective cohort study, patients were stratified according to SHR, admission glucose, and glycated hemoglobin tertiles. The primary outcome was a composite endpoint of invasive mechanical ventilation, intensive care unit admission, and in-hospital mortality. The study included 395 patients with a mean age of 59 years, and 50.1% were males. Patients in the third tertile of SHR developed more primary events, and the difference was significant compared to the first tertile (p = 0.038) and close to significance compared to the second tertile (p = 0.054). There was no significant difference in the outcomes across admission glucose and glycated hemoglobin tertiles. A higher SHR tertile was an independent risk factor for the primary outcome (OR, 1.364; 95% CI: 1.014–1.836; p = 0.040) after adjustment for other covariables. In hospitalized COVID-19 diabetic patients, SHR third tertile was significantly associated with worse outcome and death. SHR can be a better prognostic marker compared to admission glucose and glycated hemoglobin. A higher SHR was an independent risk factor for worse outcome and in-hospital mortality.

Diabetes is associated with increased risk of death in COVID‐19 hospitalizations in Mexico 2020: A retrospective cohort study

“…22 Diabetes and high blood sugar alone has been found to result in poorer outcomes. 33 Many descriptive studies have found high rates of COVID-19 and diabetes concurrently. 34,35 The results of the present survival analysis is consistent with other survival studies find survival analysis studies.…”

“…Research has indicated that people with diabetes may be more likely to experience severe illness and complications from COVID‐19 22 . Diabetes and high blood sugar alone has been found to result in poorer outcomes 33 . Many descriptive studies have found high rates of COVID‐19 and diabetes concurrently 34,35 …”

Profiling of circulating serum exosomal microRNAs in elderly patients with infectious stress hyperglycaemia

“…3 Especially under infection background, such as patients with coronavirus disease 2019 (COVID-19) are reported to have a greater prevalence of hyperglycaemia. [4][5][6][7] Cytokine release as a consequence of severe infection may precipitate the onset of metabolic alterations by affecting glucose homeostasis, which leads to abnormalities in glycometabolic control, insulin resistance (IR) and β cell dysfunction in patients with infection even without any pre-existing history or diagnosis of diabetes. Stress hyperglycaemia seriously affects the stability of the body's internal environment, which cause a profound impact on metabolism and immune function, thereby affecting the patients' prognosis.…”

“…It is a series of immune‐neuro‐endocrine responses that appear after stress, including acute myocardial infarction, stroke, perioperative period, severe infection and so on, which mostly manifested as elevated blood glucose level and lead to related changes in body metabolism 3 . Especially under infection background, such as patients with coronavirus disease 2019 (COVID‐19) are reported to have a greater prevalence of hyperglycaemia 4–7 . Cytokine release as a consequence of severe infection may precipitate the onset of metabolic alterations by affecting glucose homeostasis, which leads to abnormalities in glycometabolic control, insulin resistance (IR) and β cell dysfunction in patients with infection even without any pre‐existing history or diagnosis of diabetes.…”