Hyperglycemia at hospital admission is associated with severity of the prognosis in patients hospitalized for COVID-19: The Pisa COVID-19 Study

Version 4 2020-09-18, 17:11

Version 3 2020-08-13, 19:03

Version 2 2020-08-13, 18:34

Version 1 2020-08-11, 22:05

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posted on 2020-09-18, 17:11 authored by Alberto Coppelli, Rosa Giannarelli, Michele Aragona, Giuseppe Penno, Marco Falcone, Giusy Tiseo, Lorenzo Ghiadoni, Greta Barbieri, Fabio Monzani, Agostino Virdis, Francesco Menichetti, Stefano Del Prato, Pisa-COVID-19 Study Group

OBJECTIVE

To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for Covid-19.

RESEARCH DESIGN AND METHODS

Hospitalized Covid-19 subjects (N=271) were subdivided based on at-admission glycemic status: 1. glucose levels <7.78 mmol/L (NG; N=149; 55.0%; median glucose 5.99 [5.38-6.72] mmol/L), 2. known diabetes (DM; N=56; 20.7%; 9.18 [7.67-12.71] mmol/L), and 3. no diabetes and glucose levels ≥7.78 mmol/L (HG; N=66, 24.3%; 8.57 [8.18-10.47] mmol/L).

RESULTS

Neutrophils were higher and lymphocytes and PaO₂/FiO₂ lower in HG than DM and NG. DM and HG had higher D-Dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs 16.8%; unadjusted HR 2.20, 95%CI 1.27-3.81, p=0.005) than in NG (16.8%), and marginally so in DM (28.6%; HR 1.73, 0.92-3.25, p=0.086). Upon multiple adjustments, only HG remained an independent predictor (1.80, 1.03-3.15, p=0.04). After stratification by quintile of glucose levels, mortality was higher in Q4 (HR 3.57, 1.46-8.76, p=0.005) and marginally in Q5 (29.6%; HR 2.32, 95% CI 0.91-5.96, p=0.079) vs Q1.

CONCLUSIONS

Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19.