tetano
Editor, Senior Moderator
Sci Rep
. 2022 Jun 14;12(1):9862.
doi: 10.1038/s41598-022-13816-8.
Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study
Bojan Hartmann[SUP] 1 [/SUP], Marlo Verket[SUP] 1 [/SUP], Paul Balfanz[SUP] 1 [/SUP], Niels-Ulrik Hartmann[SUP] 1 [/SUP], Malte Jacobsen[SUP] 1 [/SUP], Julia Brandts[SUP] 1 [/SUP], Michael Dreher[SUP] 2 [/SUP], Nils Kossack[SUP] 3 [/SUP], Dennis Häckl[SUP] 4 [/SUP], Nikolaus Marx[SUP] 1 [/SUP], Dirk Müller-Wieland[SUP] 5 6 [/SUP]
Affiliations
Abstract
There is high mortality among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19). Important factors for COVID-19 mortality are diabetes status and elevated fasting plasma glucose (FPG). However, the effect of glycaemic variability on survival has not been explored in patients with COVID-19 and ARDS. This single-centre cohort study compared several metrics of glycaemic variability for goodness-of-fit in patients requiring mechanical ventilation due to COVID-19 ARDS in the ICU at University Hospital Aachen, Germany. 106 patients had moderate to severe ARDS (P/F ratio median [IQR]: 112 [87-148] mmHg). Continuous HRs showed a proportional increase in mortality risk with daily glycaemic variability (DGV). Multivariable unadjusted and adjusted Cox-models showed a statistically significant difference in mortality for DGV (HR: 1.02, (P) < 0.001, LR(P) < 0.001; HR: 1.016, (P) = 0.001, LR(P) < 0.001, respectively). Kaplan-Meier estimators yielded a shorter median survival (25 vs. 87 days) and a higher likelihood of death (75% vs. 31%) in patients with DGV ≥ 25.5 mg/dl (P < 0.0001). High glycaemic variability during ICU admission is associated with significant increase in all-cause mortality for patients admitted with COVID-19 ARDS to the ICU. This effect persisted even after adjustment for clinically predetermined confounders, including diabetes, median procalcitonin and FPG.
. 2022 Jun 14;12(1):9862.
doi: 10.1038/s41598-022-13816-8.
Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study
Bojan Hartmann[SUP] 1 [/SUP], Marlo Verket[SUP] 1 [/SUP], Paul Balfanz[SUP] 1 [/SUP], Niels-Ulrik Hartmann[SUP] 1 [/SUP], Malte Jacobsen[SUP] 1 [/SUP], Julia Brandts[SUP] 1 [/SUP], Michael Dreher[SUP] 2 [/SUP], Nils Kossack[SUP] 3 [/SUP], Dennis Häckl[SUP] 4 [/SUP], Nikolaus Marx[SUP] 1 [/SUP], Dirk Müller-Wieland[SUP] 5 6 [/SUP]
Affiliations
- PMID: 35701574
- DOI: 10.1038/s41598-022-13816-8
Abstract
There is high mortality among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19). Important factors for COVID-19 mortality are diabetes status and elevated fasting plasma glucose (FPG). However, the effect of glycaemic variability on survival has not been explored in patients with COVID-19 and ARDS. This single-centre cohort study compared several metrics of glycaemic variability for goodness-of-fit in patients requiring mechanical ventilation due to COVID-19 ARDS in the ICU at University Hospital Aachen, Germany. 106 patients had moderate to severe ARDS (P/F ratio median [IQR]: 112 [87-148] mmHg). Continuous HRs showed a proportional increase in mortality risk with daily glycaemic variability (DGV). Multivariable unadjusted and adjusted Cox-models showed a statistically significant difference in mortality for DGV (HR: 1.02, (P) < 0.001, LR(P) < 0.001; HR: 1.016, (P) = 0.001, LR(P) < 0.001, respectively). Kaplan-Meier estimators yielded a shorter median survival (25 vs. 87 days) and a higher likelihood of death (75% vs. 31%) in patients with DGV ≥ 25.5 mg/dl (P < 0.0001). High glycaemic variability during ICU admission is associated with significant increase in all-cause mortality for patients admitted with COVID-19 ARDS to the ICU. This effect persisted even after adjustment for clinically predetermined confounders, including diabetes, median procalcitonin and FPG.
