Admission Hyperglycaemia As a Predictor of Mortality in Patients Hospitalized with COVID-19 Regardless of Diabetes Status: Data from the Spanish SEMI-COVID-19 Registry

Background: Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19.

Methods: This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality.

Results: Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), <.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, <.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality.

Conclusions: Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. KEY MESSAGE Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.

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References

Attri B, Goyal A, Gupta Y, Tandon N . Basal-Bolus Insulin Regimen for Hospitalised Patients with COVID-19 and Diabetes Mellitus: A Practical Approach. Diabetes Ther. 2020; 11(9):2177-2194. PMC: 7368619. DOI: 10.1007/s13300-020-00873-3. View

Singh A, Singh R . Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19?. Diabetes Metab Syndr. 2020; 14(5):725-727. PMC: 7251348. DOI: 10.1016/j.dsx.2020.05.037. View

Zhu L, She Z, Cheng X, Qin J, Zhang X, Cai J . Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab. 2020; 31(6):1068-1077.e3. PMC: 7252168. DOI: 10.1016/j.cmet.2020.04.021. View

Ceriello A, De Nigris V, Prattichizzo F . Why is hyperglycaemia worsening COVID-19 and its prognosis?. Diabetes Obes Metab. 2020; 22(10):1951-1952. PMC: 7283840. DOI: 10.1111/dom.14098. View

Ceriello A . Hyperglycemia and the worse prognosis of COVID-19. Why a fast blood glucose control should be mandatory. Diabetes Res Clin Pract. 2020; 163:108186. PMC: 7188620. DOI: 10.1016/j.diabres.2020.108186. View

Li H, Tian S, Chen T, Cui Z, Shi N, Zhong X . Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19. Diabetes Obes Metab. 2020; 22(10):1897-1906. PMC: 7283710. DOI: 10.1111/dom.14099. View

Iacobellis G, Penaherrera C, Bermudez L, Mizrachi E . Admission hyperglycemia and radiological findings of SARS-CoV2 in patients with and without diabetes. Diabetes Res Clin Pract. 2020; 164:108185. PMC: 7251996. DOI: 10.1016/j.diabres.2020.108185. View

Sardu C, DOnofrio N, Balestrieri M, Barbieri M, Rizzo M, Messina V . Hyperglycaemia on admission to hospital and COVID-19. Diabetologia. 2020; 63(11):2486-2487. PMC: 7335920. DOI: 10.1007/s00125-020-05216-2. View

Sardu C, DOnofrio N, Balestrieri M, Barbieri M, Rizzo M, Messina V . Outcomes in Patients With Hyperglycemia Affected by COVID-19: Can We Do More on Glycemic Control?. Diabetes Care. 2020; 43(7):1408-1415. PMC: 7305003. DOI: 10.2337/dc20-0723. View

10.

Zhang Y, Li H, Zhang J, Cao Y, Zhao X, Yu N . The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: A single-centre, retrospective, observational study in Wuhan. Diabetes Obes Metab. 2020; 22(8):1443-1454. PMC: 7273002. DOI: 10.1111/dom.14086. View

11.

Pasquel F, Umpierrez G . Individualizing Inpatient Diabetes Management During the Coronavirus Disease 2019 Pandemic. J Diabetes Sci Technol. 2020; 14(4):705-707. PMC: 7673193. DOI: 10.1177/1932296820923045. View

12.

Maddaloni E, Buzzetti R . Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev. 2020; 36(7):e33213321. PMC: 7228318. DOI: 10.1002/dmrr.3321. View

13.

Kumar A, Arora A, Sharma P, Anikhindi S, Bansal N, Singla V . Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020; 14(4):535-545. PMC: 7200339. DOI: 10.1016/j.dsx.2020.04.044. View

14.

Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R . Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol. 2020; 14(4):813-821. PMC: 7673150. DOI: 10.1177/1932296820924469. View

15.

Goyal A, Gupta S, Gupta Y, Tandon N . Proposed guidelines for screening of hyperglycemia in patients hospitalized with COVID-19 in low resource settings. Diabetes Metab Syndr. 2020; 14(5):753-756. PMC: 7258830. DOI: 10.1016/j.dsx.2020.05.039. View

16.

Wang S, Ma P, Zhang S, Song S, Wang Z, Ma Y . Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study. Diabetologia. 2020; 63(10):2102-2111. PMC: 7347402. DOI: 10.1007/s00125-020-05209-1. View

17.

Carrasco-Sanchez F, Carretero-Gomez J, Gomez-Huelgas R, Garcia-Ordonez M, Pardo-Ortega M, de Escalante-Yanguela B . Stress-induced hyperglycemia on complications in non-critically elderly hospitalized patients. Rev Clin Esp (Barc). 2018; 218(5):223-231. DOI: 10.1016/j.rce.2018.02.017. View

18.

Casas-Rojo J, Anton-Santos J, Millan-Nunez-Cortes J, Lumbreras-Bermejo C, Ramos-Rincon J, Roy-Vallejo E . [Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry]. Rev Clin Esp. 2021; 220(8):480-494. PMC: 7368900. DOI: 10.1016/j.rce.2020.07.003. View

19.

Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y . Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020; 146(1):110-118. PMC: 7152876. DOI: 10.1016/j.jaci.2020.04.006. View

20.

Li Z, Liu G, Wang L, Liang Y, Zhou Q, Wu F . From the insight of glucose metabolism disorder: Oxygen therapy and blood glucose monitoring are crucial for quarantined COVID-19 patients. Ecotoxicol Environ Saf. 2020; 197:110614. PMC: 7151413. DOI: 10.1016/j.ecoenv.2020.110614. View