Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019
RESEARCH DESIGN AND METHODS— The study is a large case series and data were obtained regarding consecutive patients hospitalized with COVID-19 in the Central Hospital of Wuhan between January 2 and February 15, 2020. All patients with definite outcomes (death or discharge) were included. Demographic, clinical, treatment, and laboratory information were extracted from electronic medical records. We collected daily fasting glucose data from standard morning fasting blood biochemistry to determine glycemic status and fluctuation (calculated as the square root of the variance of daily fasting glucose levels) during the first week of hospitalization.
RESULTS— A total of 548 patients were included in the study (median age 57 years; =298 [54%] women; n=99 diabetes [18%]), 215 suffered acute respiratory distress syndrome (ARDS), 489 survived, and 59 died. Patients who had higher mean levels of glucose during their first week of hospitalization were older and more likely to have a comorbidity and abnormal laboratory markers, prolonged hospital stays, increased expenses, and greater risks of severe pneumonia, ARDS, and death. Compared with patients with the lowest quartile of glycemic fluctuation, those had the highest quartile of fluctuation magnitude had an increased risk of ARDS (risk ratio 1.97 [95% CI: 1.01, 4.04]) and mortality (hazard ratio 2.73 [95% CI: 1.06, 7.73]).CONCLUSIONS— These results may have implications for optimizing glycemic control strategies in COVID-19 patients during the early phase of hospitalization.