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