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Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study.

Abstract

INTRODUCTION

With intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19.

RESEARCH DESIGN AND METHODS

We collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes.

RESULTS

Elevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes.

CONCLUSIONS

Elevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic.

Authors+Show Affiliations

Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Critical Care Medicine, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, China.Department of Critical Care Medicine, Wuhan Hankou Hospital, Wuhan, China.Department of Gastrointestinal Surgery, Wuhan Hankou Hospital, Wuhan, China.Science and Education Section, Wuhan Hankou Hospital, Wuhan, China.Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, China.Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China xiaohp@mail.sysu.edu.cn. Precision Medicine Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32503812

Citation

Wu, Jianfeng, et al. "Elevation of Blood Glucose Level Predicts Worse Outcomes in Hospitalized Patients With COVID-19: a Retrospective Cohort Study." BMJ Open Diabetes Research & Care, vol. 8, no. 1, 2020.
Wu J, Huang J, Zhu G, et al. Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study. BMJ Open Diabetes Res Care. 2020;8(1).
Wu, J., Huang, J., Zhu, G., Wang, Q., Lv, Q., Huang, Y., Yu, Y., Si, X., Yi, H., Wang, C., Liu, Y., Xiao, H., Zhou, Q., Liu, X., Yang, D., Guan, X., Li, Y., Peng, S., Sung, J., & Xiao, H. (2020). Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study. BMJ Open Diabetes Research & Care, 8(1). https://doi.org/10.1136/bmjdrc-2020-001476
Wu J, et al. Elevation of Blood Glucose Level Predicts Worse Outcomes in Hospitalized Patients With COVID-19: a Retrospective Cohort Study. BMJ Open Diabetes Res Care. 2020;8(1) PubMed PMID: 32503812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study. AU - Wu,Jianfeng, AU - Huang,Jianqiang, AU - Zhu,Guochao, AU - Wang,Qiongya, AU - Lv,Qingquan, AU - Huang,Ying, AU - Yu,Yang, AU - Si,Xiang, AU - Yi,Hui, AU - Wang,Cuiping, AU - Liu,Yihao, AU - Xiao,Han, AU - Zhou,Qian, AU - Liu,Xin, AU - Yang,Daya, AU - Guan,Xiangdong, AU - Li,Yanbing, AU - Peng,Sui, AU - Sung,Joseph, AU - Xiao,Haipeng, PY - 2020/04/17/received PY - 2020/05/15/revised PY - 2020/05/24/accepted PY - 2020/6/7/entrez PY - 2020/6/7/pubmed PY - 2020/6/20/medline KW - blood glucose KW - clinical study KW - infections JF - BMJ open diabetes research & care JO - BMJ Open Diabetes Res Care VL - 8 IS - 1 N2 - INTRODUCTION: With intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19. RESEARCH DESIGN AND METHODS: We collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes. RESULTS: Elevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes. CONCLUSIONS: Elevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic. SN - 2052-4897 UR - https://www.unboundmedicine.com/medline/citation/32503812/Elevation_of_blood_glucose_level_predicts_worse_outcomes_in_hospitalized_patients_with_COVID_19:_a_retrospective_cohort_study_ L2 - https://drc.bmj.com/lookup/pmidlookup?view=long&pmid=32503812 DB - PRIME DP - Unbound Medicine ER -