tetano
Editor, Senior Moderator
Diabetes Care
. 2020 Aug 11;dc201380.
doi: 10.2337/dc20-1380. Online ahead of print.
Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study
Alberto Coppelli[SUP] 1 [/SUP], Rosa Giannarelli[SUP] 1 [/SUP], Michele Aragona[SUP] 1 [/SUP], Giuseppe Penno[SUP] 1 2 [/SUP], Marco Falcone[SUP] 2 [/SUP], Giusy Tiseo[SUP] 2 [/SUP], Lorenzo Ghiadoni[SUP] 2 [/SUP], Greta Barbieri[SUP] 2 [/SUP], Fabio Monzani[SUP] 2 [/SUP], Agostino Virdis[SUP] 2 [/SUP], Francesco Menichetti[SUP] 2 [/SUP], Stefano Del Prato, Pisa COVID-19 Study Group
Collaborators, Affiliations
Abstract
Objective: To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for coronavirus disease 2019 (COVID-19).
Research design and methods: Hospitalized COVID-19 patients (N = 271) were subdivided based on at-admission glycemic status: 1) glucose levels <7.78 mmol/L (NG) (N = 149 [55.0%]; median glucose 5.99 mmol/L [range 5.38-6.72]), 2) known diabetes mellitus (DM) (N = 56 [20.7%]; 9.18 mmol/L [7.67-12.71]), and 3) no diabetes and glucose levels ≥7.78 mmol/L (HG) (N = 66 [24.3%]; 8.57 mmol/L [8.18-10.47]).
Results: Neutrophils were higher and lymphocytes and PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] lower in HG than in DM and NG patients. DM and HG patients had higher D-dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs. 16.8%; unadjusted hazard ratio
2.20, 95% CI 1.27-3.81, P = 0.005) than in NG (16.8%) and marginally so in DM (28.6%; 1.73, 0.92-3.25, P = 0.086) patients. Upon multiple adjustments, only HG remained an independent predictor (HR 1.80, 95% CI 1.03-3.15, P = 0.04). After stratification by quintile of glucose levels, mortality was higher in quintile 4 (Q4) (3.57, 1.46-8.76, P = 0.005) and marginally in Q5 (29.6%) (2.32, 0.91-5.96, P = 0.079) vs. Q1.
Conclusions: Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19.
. 2020 Aug 11;dc201380.
doi: 10.2337/dc20-1380. Online ahead of print.
Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study
Alberto Coppelli[SUP] 1 [/SUP], Rosa Giannarelli[SUP] 1 [/SUP], Michele Aragona[SUP] 1 [/SUP], Giuseppe Penno[SUP] 1 2 [/SUP], Marco Falcone[SUP] 2 [/SUP], Giusy Tiseo[SUP] 2 [/SUP], Lorenzo Ghiadoni[SUP] 2 [/SUP], Greta Barbieri[SUP] 2 [/SUP], Fabio Monzani[SUP] 2 [/SUP], Agostino Virdis[SUP] 2 [/SUP], Francesco Menichetti[SUP] 2 [/SUP], Stefano Del Prato, Pisa COVID-19 Study Group
Collaborators, Affiliations
- PMID: 32788285
- DOI: 10.2337/dc20-1380
Abstract
Objective: To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for coronavirus disease 2019 (COVID-19).
Research design and methods: Hospitalized COVID-19 patients (N = 271) were subdivided based on at-admission glycemic status: 1) glucose levels <7.78 mmol/L (NG) (N = 149 [55.0%]; median glucose 5.99 mmol/L [range 5.38-6.72]), 2) known diabetes mellitus (DM) (N = 56 [20.7%]; 9.18 mmol/L [7.67-12.71]), and 3) no diabetes and glucose levels ≥7.78 mmol/L (HG) (N = 66 [24.3%]; 8.57 mmol/L [8.18-10.47]).
Results: Neutrophils were higher and lymphocytes and PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] lower in HG than in DM and NG patients. DM and HG patients had higher D-dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs. 16.8%; unadjusted hazard ratio
2.20, 95% CI 1.27-3.81, P = 0.005) than in NG (16.8%) and marginally so in DM (28.6%; 1.73, 0.92-3.25, P = 0.086) patients. Upon multiple adjustments, only HG remained an independent predictor (HR 1.80, 95% CI 1.03-3.15, P = 0.04). After stratification by quintile of glucose levels, mortality was higher in quintile 4 (Q4) (3.57, 1.46-8.76, P = 0.005) and marginally in Q5 (29.6%) (2.32, 0.91-5.96, P = 0.079) vs. Q1.
Conclusions: Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19.