Hyperglycemic 2X more likely to have severe COVID-19 - Nov 2020

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

Annals of Medicine, Volume 53, 2021 - Issue 1. DOI: 10.1080/07853890.2020.1836566
Francisco Javier Carrasco-Sánchez ORCID Icon,Mª Dolores López-Carmona,Francisco Javier Martínez-Marcos,Luis M. Pérez-Belmonte,Alicia Hidalgo-Jiménez,Verónica Buonaiuto

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Outcomes vs level

All-cause COVID-19 mortality

Table 4. Association with composite outcome (death, mechanical ventilation and/or ICU admission).

OR: odds ratio; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; LDH: lactate dehydrogenase. Adjusted multivariate logistic regression model. The model included all variables of medical history and laboratory findings

Background
Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19.

Methods
This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140–180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality.

Results
Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140–180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31–1.73) (BG 140–180 mg/dL; HR 1.48; 95%CI: 1.29–1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality.

Conclusions
Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes.

KEY MESSAGE

• Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19.
• Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19.
• Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.

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