American Diabetes Association
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Admission Blood Glucose Level and Its Association With Cardiovascular and Renal Complications in Patients Hospitalized With COVID-19

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Version 3 2022-03-18, 19:21
Version 2 2022-03-18, 19:20
Version 1 2022-03-14, 22:53
posted on 2022-03-18, 19:21 authored by Tom Norris, Cameron Razieh, Thomas Yates, Francesco Zaccardi, Clare L Gillies, Yogini V Chudasama, Alex Rowlands, Melanie J Davies, Gerry P McCann, Amitava Banerjee, Annemarie B Docherty, Peter JM Openshaw, J Kenneth Baillie, Malcolm G Semple, Claire A. Lawson, Kamlesh Khunti, ISARIC4C Investigators
Objective: Investigate the association between admission blood glucose levels and risk of in-hospital cardiovascular and renal complications.

Research Design and Methods: A multicentre, prospective study of 36269 adults hospitalised with COVID-19 between 06.02.2020–16.03.2011 (total n before exclusions:143266). Logistic regression models explored associations between admission glucose level (mmol/l and mg/dL) and odds of in-hospital complications including heart failure, arrhythmia, cardiac ischaemia, cardiac arrest, coagulation complications, stroke and renal injury. Non-linearity was investigated using restricted cubic splines. Interaction models explored whether associations between glucose levels and complications were modified by clinically relevant factors.

Results: Cardiovascular and renal complications occurred in 10421 (28.7%) patients; median admission glucose level was 6.7mmol/l (IQR:5.8,8.7; 120.6mg/dL(104.4,156.6)). Accounting for confounders, for all complications except cardiac ischaemia and stroke there was a non-linear association between glucose and cardiovascular and renal complications. For example, odds of heart failure, arrhythmia, coagulation complications and renal injury decreased to a nadir at 6.4(115mg/dL), 4.9(88.2mg/dL), 4.7(84.6mg/dL) and 5.8(104.4mg/dL) mmol/l, respectively and increased thereafter until 26.0(468mg/dL), 50.0(900mg/dL), 8.5(153mg/dL) and 32.4(583.2mg/dL) mmol/l. Compared to 5 mmol/l (90mg/dL), odds ratios at these glucose levels were 1.28 (95%CI: 0.96,1.69) for heart failure, 2.23 (95%CI: 1.03,4.81) for arrhythmia, 1.59 (95%CI: 1.36,1.86) for coagulation complications and 2.42 (95%CI: 2.01,2.92) for renal injury. For most complications, a modifying effect of age was observed, with higher odds of complications at higher glucose levels for patients younger than 69 years. Pre-existing diabetes status had a similar modifying effect on odds of complications, but evidence was strongest for renal injury, cardiac ischaemia and ‘any cardiovascular/renal complication’.

Conclusions: Increased odds of cardiovascular or renal complications were observed for admission glucose levels indicative of both hypo- and hyperglycaemia. Admission glucose could be used as a marker for risk stratification of high-risk patients. Further research should evaluate interventions to optimize admission glucose on improving COVID-19 outcomes.


This work was supported by the NIHR Leicester BRC, NIHR ARC-EM and a grant from the UKRI (MRC)-DHSC (NIHR) COVID-19 Rapid Response Rolling Call (MR/V020536/1), HDR-UK (HDRUK2020.138), the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool. Role of the funder/sponsor The funder/sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.


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