Thromboembolism risk among patients with diabetes/stress hyperglycemia and COVID-19

Stefania, Calvisi Laura; Ramirez, Giuseppe A.; Scavini, Marina; Prat, Valentina Da; Lucca, Giuseppe Di; Laurenzi, Andrea; Gallina, Gabriele; Cavallo, Ludovica; Borio, Giorgia; Farolfi, Federica; Pascali, Maria Paola; Castellani, Jacopo; Lampasona, Vito; D’Angelo, Armando; Landoni, Giovanni; Ciceri, Fabio; Querini, Patrizia Rovere; Tresoldi, Moreno; Piemonti, Lorenzo

doi:10.1101/2021.04.17.21255540

Cited by 5 publications

(5 citation statements)

References 40 publications

(49 reference statements)

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“…However, several studies have reported that stress hyperglycemia Fig. 2 Restricted cubic splines for the odds ratio of in-hospital mortality is strongly associated with adverse clinical outcomes among patients with critical illnesses, including myocardial infarction, stroke, sepsis, and COVID-19 [11,18,19]. Stress hyperglycemia has been identified as an independent risk factor for worsened prognoses in patients with ACS [4][5][6]20].…”

Section: Discussionmentioning

confidence: 99%

Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: insights from a large cohort study

Song

Wang

et al. 2022

Cardiovasc Diabetol

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Background Stress hyperglycemia is strongly associated with poor clinical outcomes in patients with acute coronary syndrome (ACS). Recently, the stress hyperglycemia ratio (SHR) has been proposed to represent relative hyperglycemia. Studies regarding the relationship between SHR and mortality in coronary artery disease (CAD) are limited. This study aimed to clarify the association between SHR and in-hospital mortality in patients with CAD. Methods A total of 19,929 patients with CAD who were hospitalized in Beijing Hospital were enrolled in this study. Patients with an estimated glomerular filtration rate < 30 ml/min, cancer, or missing blood glucose/HbA1c data were excluded; therefore, 8,196 patients were included in the final analysis. The patients were divided into three groups based on tertiles of SHR: T1 group (SHR < 0.725, n = 2,732), T2 group (0.725 ≤ SHR < 0.832, n = 2,730), and T3 group (SHR ≥ 0.832, n = 2,734). The primary endpoint was in-hospital mortality. Results The overall in-hospital mortality rate was 0.91% (n = 74). After adjusting for covariates, SHR was significantly associated with in-hospital mortality in patients with CAD [odds ratio (OR) = 17.038; 95% confidence interval (CI) = 9.668–30.027; P < 0.001], and the T3 group had a higher risk of in-hospital mortality (OR = 4.901; 95% CI = 2.583–9.297; P < 0.001) compared with T1 group. In the subgroup analysis, the T3 group had an increased risk of mortality among patients with pre-diabetes mellitus (pre-DM) (OR = 9.670; 95% CI = 1.886–49.571; P = 0.007) and diabetes mellitus (DM) (OR = 5.023; 95% CI = 2.371–10.640; P < 0.001) after adjustments for covariates. The relationship between SHR and in-hospital mortality among patients with ACS and chronic coronary syndrome was consistent with the main finding. SHR and in-hospital mortality exhibited a dose-response relationship, and the risk of in-hospital mortality increased when the SHR index was above 1.20. Moreover, the area under the curve of SHR for predicting in-hospital mortality in patients with CAD was 0.741. Conclusion SHR is significantly associated with in-hospital mortality in patients with CAD. SHR may be an effective predictor of in-hospital mortality in patients with CAD, especially for those with pre-DM and DM.

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Section: Discussionmentioning

confidence: 99%

Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: insights from a large cohort study

Song

Wang

et al. 2022

Cardiovasc Diabetol

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“…In our best knowledge, this is the first study specifically examining the impact of T2D on ROTEM®-tested coagulation in patients with mild COVID-19 pneumonia. On contrary, Calvisi et al previously in a prospective analysis of 180 hospitalized patients with COVID-19 pneumonia [17] reported that diabetes/stress hyperglycemia was associated with higher risk of thromboembolism (arterial and venous). In this study, patients with diabetes/stress hyperglycemia had increased inflammation, higher D-dimer levels, and lower antithrombin III activity.…”

Section: Discussionmentioning

confidence: 95%

“…[18] All these diabetes-related abnormalities might aggravate the risk of thrombosis and explain higher incidence of thrombotic events observed among COVID-19 patients with diabetes/stress hyperglycemia by Calvisi et al Another possible explanation is that stress hyperglycemia could act as a marker, rather than as a direct contributor of an increased risk of COVID-19-related thrombosis. Calvisi et al [17] reported an increased inflammation and tissue damage circulatory markers in those with diabetes/stress hyperglycemia. In our study, no significant differences were found in inflammatory markers between T2D and nondiabetic individuals.…”

Section: Discussionmentioning

confidence: 99%

Rotational thromboelastometry in patients with type 2 diabetes and mild COVID-19 pneumonia: A pilot prospective study

et al. 2022

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Background: It was repeatedly demonstrated that patients with severe COVID-19 pneumonia, as well as patients with type 2 diabetes (T2D) have higher risk of thromboembolic complications. Rotational thromboelastometry (ROTEM®) is a viscoelastic hemostatic assay which allows complex assessment of hemostasis in whole blood. The aim of this study was to compare changes in hemostasis measured by ROTEM® in diabetic and nondiabetic patients with mild COVID-19 pneumonia. Methods: We performed a pilot, prospective, observational study and enrolled 33 consecutive patients (14 with T2D and 19 nondiabetic ones) admitted to regular ward with mild COVID-19 pneumonia. The control group consisted from 11 healthy, nondiabetic blood donors. Blood samples were tested with ROTEM® using INTEM® and EXTEM® reagents. Results: We detected significant differences in EXTEM® clotting time (CT), clot formation time (CFT), and maximum clot firmness (MCF) comparing patients with mild COVID-19 pneumonia and healthy donors. However, there were no significant differences in EXTEM®, INTEM®, and HEPTEM® parameters (CT, CFT, and MCF) according to diabetes status. Conclusions: Our study demonstrated hypercoagulation in patients with mild COVID-19 pneumonia. T2D did not affected ROTEM® parameters in patients with mild COVID-19 pneumonia.

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“…39,40 A study of hyperglycaemia (not specifically with HHS) during COVID-19 admissions suggested that the risk of arterial and VTE was three times higher than those without hyperglycaemia. 41 Other work has estimated that people with diabetes and hyperosmolality have a risk of VTE similar, or only marginally above those with acute renal failure, acute sepsis or acute connective tissue disease. 42,43 The risk of venous thromboembolism is greater than in diabetic ketoacidosis.…”

Section: Anticoagulationmentioning

confidence: 99%

Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group

et al. 2022

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Hyperosmolar Hyperglycaemic State (HHS) is a medical emergency associated with high mortality. It occurs less frequently than diabetic ketoacidosis (DKA), affects those with pre-existing/new type 2 diabetes mellitus and increasingly affecting children/younger adults. Mixed DKA/HHS may occur. The JBDS HHS care pathway consists of 3 themes (clinical assessment and monitoring, interventions, assessments and prevention of harm) and 5 phases of therapy (0-60 min, 1-6, 6-12, 12-24 and 24-72 h). Clinical features of HHS include marked hypovolaemia, osmolality ≥320 mOsm/kg using [(2×Na + ) + glucose+urea], marked hyperglycaemia ≥30 mmol/L, without significant ketonaemia (≤3.0 mmol/L), without significant acidosis (pH >7.3) and bicarbonate ≥15 mmol/L. Aims of the therapy are to improve clinical status/replace fluid losses by 24 h, gradual decline in osmolality (3.0-8.0 mOsm/kg/h to minimise the risk of neurological complications), blood glucose 10-15 mmol/L in the first 24 h, prevent hypoglycaemia/hypokalaemia and prevent harm (VTE, osmotic demyelination, fluid overload, foot ulceration). Underlying precipitants must be identified and treated. Interventions include: (1) intravenous (IV) 0.9% sodium chloride to restore circulating volume (fluid losses 100-220 ml/kg, caution in elderly), (2) fixed rate intravenous insulin infusion (FRIII) should be commenced once osmolality stops falling with fluid replacement unless there is ketonaemia (FRIII should be commenced at the same time as IV fluids). (3) glucose infusion (5% or 10%) should be started once glucose <14 mmol/L and (4) potassium replacement according to potassium levels. HHS resolution criteria are: osmolality <300 mOsm/kg, hypovolaemia corrected (urine output ≥0.5 ml/kg/h), cognitive status returned to pre-morbid state and blood glucose <15 mmol/L.

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Thromboembolism risk among patients with diabetes/stress hyperglycemia and COVID-19

Cited by 5 publications

References 40 publications

Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: insights from a large cohort study

Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: insights from a large cohort study

Rotational thromboelastometry in patients with type 2 diabetes and mild COVID-19 pneumonia: A pilot prospective study

Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group

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