Keywords
COVID 19
Diabetes Mellitus
Mortality
Acute respiratory distress syndrome
Acute kidney injury
How to Cite
Abstract
Context: In patients with COVID-19, diabetes mellitus and hyperglycemia are prevalent conditions. The literature is scarce regarding the association of these two variables with unfavorable outcomes in patients hospitalized for COVID-19.
Objective: To evaluate the association between hyperglycemia and the occurrence of adverse outcomes in patients with COVID-19.
Methodology: Retrospective cohort study evaluating the association between hyperglycemia at presentation with the occurrence of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and in-hospital death in patients hospitalized with COVID-19.
Results: 408 patients were included (mean age 60.48, 58.8% men, 34.1% with diabetes, 40.4% with in-hospital hyperglycemia). Hyperglycemia was independently associated with increased risk of ARDS (OR: 1.84; 95% CI: 1.15-2.94; p=0.001), AKI (OR: 2.73; CI: 1.24-5.96; p=0.012) and in-hospital death (OR: 2.61; CI: 1.20-5.68; p=0.015) after controlling for confounding variables. History of diabetes was not independently associated with increased risk for any of the three adverse outcomes.
Conclusions: Hyperglycemia is independently associated with worse outcomes in patients hospitalized for COVID-19, unlike diabetes mellitus.
References
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. https://doi.org/10.1016/j.diabres.2019.107843
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3
Gómez AM, Henao DC, Muñoz OM, Aschner P, Yepes CA, Jojoa R, et al. Glycemic control metrics using flash glucose monitoring and hospital complications in patients with COVID-19. Diabetes Metab Syndr. 2021;15(2):499–503. https://doi.org/10.1016/j.dsx.2021.02.008
Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020;14(4):395–403. https://doi.org/10.1016/j.dsx.2020.04.018
Carrasco-Sánchez FJ, López-Carmona MD, Martínez-Marcos FJ, Pérez-Belmonte LM, et al. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Ann Med. 2021;53(1):103–116. https://doi.org/10.1080/07853890.2020.1836566
Carrasco-Sánchez FJ, Carretero-Gómez J, Gómez-Huelgas R, Garcia-Ordoñez MA, Pardo-Ortega M v., de Escalante-Yanguela B, et al. Hiperglucemia inducida por estrés en pacientes ancianos hospitalizados no críticos. Rev Clin Esp. 2018;218(5):223–231. https://doi.org/10.1016/j.rce.2018.02.017
Godinjak A, Iglica A, Burekovic A, Jusufovic S, Ajanovic A, Tancica I, Kukuljac A. Hyperglycemia in critically ill patients: management and prognosis. Med Arch. 2015;69(3):157–160. https://doi.org/10.5455/medarh.2015.69.157-160
Wu J, Huang J, Zhu G, Wang Q, Lv Q, Huang Y, et al. Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study. BMJ Open Diabetes Res Care. 2020;8:e001476. https://doi.org/10.1136/bmjdrc-2020-001476
Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573–1582. https://doi.org/10.1007/s00134-012-2682-1
Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney IntSuppl. 2012;2(1):1–138. https://experts.umn.edu/en/publications/kidney-disease-improving-global-outcomes-kdigo-acute-kidney-injur
Lazzeri C, Bonizzoli M, Batacchi S, Di Valvasone S, Chiostri M, Peris A. The prognostic role of hyperglycemia and glucose variability in covid-related acute respiratory distress syndrome. Diabetes Res Clin Pract. 2021;175:108789. https://doi.org/10.1016/j.diabres.2021.108789
Logette E, Lorin C, Favreau C, Oshurko E, Coggan JS, Casalegno F, et al. A machine-generated view of the role of blood glucose levels in the severity of COVID-19. Front Public Health. 2021;9:695139. https://doi.org/10.3389/fpubh.2021.695139
Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31(6):1068-1077.e3. https://doi.org/10.1016/j.cmet.2020.04.021
Oficina Regional para las Américas de la Organización Mundial de la Salud. Reporte de situación COVID-19 Colombia n. º 293 - 8 de marzo 2023. Colombia: Paho. https://www.paho.org/es/documentos/reporte-situacion-covid-19-colombia-no-293-8-marzo-2023
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2023 Revista Colombiana de Endocrinología, Diabetes & Metabolismo