key: cord-0941286-dsgnrvyq
authors: Liu, Shuyi; Zhang, Bin; You, Jingjing; Chen, Luyan; Yuan, Huanchu; Zhang, Shuixing
title: Elevated fasting blood glucose at admission is associated with poor outcomes in patients with COVID-19
date: 2020-09-04
journal: Diabetes Metab
DOI: 10.1016/j.diabet.2020.08.004
sha: 5aa01e1dea78b4f8522b834b5acf90e692c3eec1
doc_id: 941286
cord_uid: dsgnrvyq

nan

factor for severe coronavirus disease 2019 infection. However, hyperglycaemia is more common in non-diabetic than in diabetic patients [2] and, thus, deserves more attention in clinical practice. To date, data about the prognostic value of different levels of admission fasting blood glucose (FBG) in patients with COVID-19 are scarce. Therefore, we aimed to explore the association between stratified FBG levels and poor outcomes in patients hospitalized for COVID-

A total of 449 patients admitted to six designated hospitals with laboratory-confirmed COVID-19 were enrolled in the study. All cases were diagnosed according to World Health Organization (WHO) interim guidelines [3] . Data on the patients' demographics, comorbidities, laboratory variables and chest computed tomography (CT) images at admission were collected from 1 January to 31 March 2020. Poor outcomes were defined as composite endpoints including at least one of the following conditions: intensive-care-unit (ICU) admission; respiratory failure requiring mechanical ventilation; shock; and/or death.

To identify risk factors for adverse outcomes, variables with P < 0.10 on univariable analyses were included in multivariable logistic regression analyses. Patients were categorized into three groups according to FBG levels: < 6.1 mmol/L (n = 291, 64.8%); 6.1-6.9 mmol/L (n = 52, 11.6%); and ≥ 7.0 mmol/L (n = 106, 23.6%). We used Kaplan-Meier curves to evaluate time from admission to death within 30 days in the three FBG groups.

Our institutional ethics committee approved the study and waived informed consent.

Median age of all enrolled patients was 52 years (interquartile range: 38-64), and 259 (57.7%) were male. A total of 45 (10.0%) patients reported having previous diabetes, of which nine (3.1%) had FBG < 6.1 mmol/L, six (11.5%) had FBG at 6.1-6.9 mmol/L and 30 (28.3%) had FBG ≥ 7.0 mmol/L. Compared with patients with normal FBG levels, patients with elevated FBG were older and more likely to have comorbidities. On multivariable analyses, patients with FBG at 6.1-6.9 mmol/L [odds ratio (OR): 5.38, 95% confidence interval (CI): 1.18-24.52; P = 0.030] had a higher risk of progression to critical illness than those with FBG ≥ 7.0 mmol/L (OR: 3.94, 95% CI:

1.03-15.15; P = 0.046; Table I ). Patients with FBG ≥ 7.0 mmol/L had the worst 30-day survival, followed by patients with FBG at 6.1-6.9 mmol/L (76.4% and 84.6%, respectively; P < 0.001 by log-rank test).

In conclusion, FBG levels at 6.1-6.9 mmol/L and ≥ 7.0 mmol/L at admission are both independent predictors of poor outcomes in patients with COVID-19. Therefore, serial FBG monitoring should be recommended for patients with COVID-19 infection, even in those with no known previous diabetes. During this pandemic of COVID-19, the timely identification of patients with hyperglycaemia can facilitate early symptomatic treatment to reduce the adverse outcomes of COVID-19 [4] . 

Patients with diabetes are at higher risk for severe illness from COVID-19

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

Available from www.who.int/publications-detail/laboratory-testing-for-2019-novelcoronavirus-in-suspected-human-cases-20200117

Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes

Each of the five lung lobes was evaluated for degree of involvement, and classified/scored as 0 (0%), 1 (1-25%), 2 (26-50%), 3 (51-75%) or 4 (76-100%); sum severity CT scores of the total lung were obtained by summing the five lobe scores

CT images were reviewed independently by two radiologists, each with > 10 years' experience

WBC, white blood cell

MB, myocardial band; hs-CRP, high-sensitivity C-reactive protein