Stress hyperglycemia ratio, rather than admission blood glucose, predicts in-hospital mortality and adverse outcomes in moderate-to severe COVID-19 patients, irrespective of pre-existing glycemic status

Mondal, Shaikat; Dasgupta, Riddhi; Lodh, Moushumi; Garai, Ramprasad; Choudhury, Brojen; Hazra, Arindam Kumar; Mondal, Aniket; Ganguly, Arunangshu

doi:10.1016/j.diabres.2022.109974

Cited by 16 publications

(22 citation statements)

References 48 publications

(52 reference statements)

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“…Our study, based on existing evidence from observational studies regarding SHR as a meaningful measure for stress hyperglycemia in patients with AMI, ACS, stroke, trauma [ 28 ], or COVID-19 [ 29 ], for the first time assessed how SHR signifies in non-surgical patients hospitalized with type 2 diabetes and heart failure. This large study population comes from a multi-center database, increasing the generalizability of our findings to Chinese people with type 2 diabetes hospitalized with heart failure.…”

Section: Discussionmentioning

confidence: 99%

Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

Zhou

Liu²,

Huang

et al. 2022

Cardiovasc Diabetol

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Objective To evaluate the impact of stress hyperglycemia on the in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes. Research design and methods We identified non-surgical hospitalized patients with heart failure and type 2 diabetes from a large electronic medical record-based database of diabetes in China (WECODe) from 2011 to 2019. We estimated stress hyperglycemia using the stress hyperglycemia ratio (SHR) and its equation, say admission blood glucose/[(28.7 × HbA1c)− 46.7]. The primary outcomes included the composite cardiac events (combination of death during hospitalization, requiring cardiopulmonary resuscitation, cardiogenic shock, and the new episode of acute heart failure during hospitalization), major acute kidney injury (AKI stage 2 or 3), and major systemic infection. Results Of 2875 eligible Chinese adults, SHR showed U-shaped associations with composite cardiac events, major AKI, and major systemic infection. People with SHR in the third tertile (vs those with SHR in the second tertile) presented higher risks of composite cardiac events ([odds ratio, 95% confidence interval] 1.89, 1.26 to 2.87) and major AKI (1.86, 1.01 to 3.54). In patients with impaired kidney function at baseline, both SHR in the first and third tertiles anticipated higher risks of major AKI and major systemic infection. Conclusions Both high and low SHR indicates poor prognosis during hospitalization in non-surgical patients with heart failure and type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

Zhou

Liu²,

Huang

et al. 2022

Cardiovasc Diabetol

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“…To the best of our knowledge, this is the first study to investigate the value of the A/C glycemic ratio independently for patients with undiagnosed diabetes mellitus and pre‐existing diabetes mellitus. At the same time, previous reports have examined the usefulness of the parameters of acute hyperglycemia in patients with diabetes mellitus as a whole 5 , 6 , 9 .…”

Section: Discussionmentioning

confidence: 99%

“…In patients with diabetes mellitus who had cardiovascular disease or COVID‐19, factors including acute‐to‐chronic (A/C) glycemic ratio, stress hyperglycemia ratio or glycemic gap have been found to be strongly associated with the outcome rather than blood glucose or glycated hemoglobin (HbA1c) levels on admission 6 , 7 , 8 , 9 ; this suggests that the magnitude of acute blood glucose elevation from chronic levels could be harmful. However, these indicators have not been previously confirmed in patients with undiagnosed diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

Association of acute‐to‐chronic glycemic ratio and outcomes in patients with COVID‐19 and undiagnosed diabetes mellitus: A retrospective nationwide cohort study

Uchihara

Sugiyama

Bouchi

et al. 2023

J of Diabetes Invest

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Aims/Introduction To assess the association of undiagnosed diabetes mellitus and its acute‐to‐chronic glycemic ratio with clinical outcome in patients hospitalized with coronavirus disease 2019 (COVID‐19) using a large‐scale nationwide registry in Japan. Materials and Methods Overall, 4,747 patients were included between July 2021 and January 2022. We evaluated blood glucose and glycated hemoglobin levels at admission, and calculated the acute‐to‐chronic glycemic ratio for each non‐diabetes mellitus, undiagnosed diabetes mellitus and pre‐existing diabetes mellitus group. The primary composite outcome comprised in‐hospital mortality, invasive mechanical ventilation, extracorporeal membrane oxygenation support, intensive care unit admission and transfer to a more advanced medical facility. Results Compared with the non‐diabetes mellitus group, the undiagnosed diabetes mellitus group was significantly associated with a worse COVID‐19 outcome (odds ratio 2.18, 95% confidence interval 1.50–3.18). In patients with undiagnosed diabetes mellitus, the 3rd tertile of the acute‐to‐chronic glycemic ratio was linked with a worse COVID‐19 outcome compared with the 1st tertile (odds ratio 3.33, 95% confidence interval 1.43–7.77), whereas glycated hemoglobin levels were not; among patients with pre‐existing diabetes mellitus, glycated hemoglobin levels were linked with a worse outcome. Conclusions Among patients with undiagnosed diabetes mellitus with COVID‐19, the magnitude of elevation of blood glucose from chronic to acute levels is associated with worse outcomes.

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“…The SHR controls for background glycemia in patient evaluations and is also a superior marker of critical illness compared to absolute measurements. The SHR is associated with adverse outcomes for patients with moderate-to-severe COVID-19 ( 35 ), including elevated in-hospital morbidity and mortality ( 34 ).…”

Section: Edge 1: Covid-19 and Type 2 Diabetesmentioning

confidence: 99%

“…Regardless of underlying diabetes, stress-induced hyperglycemia is a well-documented occurrence during acute infections and has been observed even in mild cases of COVID-19 ( 35 ). The purported mechanisms causing hyperglycemia rely on the imbalance between insulin action and insulin secretion, and are primarily instigated by inflammation, cytokine action, neuroendocrine mechanisms, and counter-regulatory hormones ( 3 ).…”

Section: Edge 1: Covid-19 and Type 2 Diabetesmentioning

confidence: 99%

The syndromic triad of COVID-19, type 2 diabetes, and malnutrition

Mechanick

Christofides²,

Marchetti³

et al. 2023

Front. Nutr.

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The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype—the COVID-Related Cardiometabolic Syndrome—linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.

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Stress hyperglycemia ratio, rather than admission blood glucose, predicts in-hospital mortality and adverse outcomes in moderate-to severe COVID-19 patients, irrespective of pre-existing glycemic status

Cited by 16 publications

References 48 publications

Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

Association of acute‐to‐chronic glycemic ratio and outcomes in patients with COVID‐19 and undiagnosed diabetes mellitus: A retrospective nationwide cohort study

The syndromic triad of COVID-19, type 2 diabetes, and malnutrition

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