Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study.

Abstract

INTRODUCTION:

With intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19.

RESEARCH DESIGN AND METHODS:

We collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes.

RESULTS:

Elevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes.

CONCLUSIONS:

Elevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic.

• Authors: Jianfeng Wu, Jianqiang Huang, Guochao Zhu, Qiongya Wang, Qingquan Lv, Ying Huang, Yang Yu, Xiang Si, Hui Yi, Cuiping Wang, Yihao Liu, Han Xiao, Qian Zhou, Xin Liu, Daya Yang, Xiangdong Guan, Yanbing Li, Sui Peng, Joseph Sung, Haipeng Xiao
• Journal: BMJ open diabetes research & care (BMJ Open Diabetes Res Care) Vol. 8 Issue 1 (06 2020) ISSN: 2052-4897 [Electronic] England
• PMID: 32503812 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Blood Glucose

Topics

• Aged
• Betacoronavirus
• Blood Glucose (analysis)
• COVID-19
• Coronavirus Infections (blood, mortality, virology)
• Critical Illness
• Disease Progression
• Female
• Follow-Up Studies
• Hospital Mortality
• Hospitalization
• Humans
• Hyperglycemia (diagnosis)
• Inpatients
• Length of Stay
• Male
• Middle Aged
• Pandemics
• Pneumonia, Viral (blood, mortality, virology)
• Prognosis
• Retrospective Studies
• Risk Factors
• SARS-CoV-2
• Treatment Outcome