Top

Published in:

01-10-2020 | COVID-19 | Article

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

Authors: Sufei Wang, Pei Ma, Shujing Zhang, Siwei Song, Zhihui Wang, Yanling Ma, Juanjuan Xu, Feng Wu, Limin Duan, Zhengrong Yin, Huilin Luo, Nian Xiong, Man Xu, Tianshu Zeng, Yang Jin

Published in: Diabetologia | Issue 10/2020

Abstract

Aims/hypothesis

Hyperglycaemia is associated with an elevated risk of mortality in community-acquired pneumonia, stroke, acute myocardial infarction, trauma and surgery, among other conditions. In this study, we examined the relationship between fasting blood glucose (FBG) and 28-day mortality in coronavirus disease 2019 (COVID-19) patients not previously diagnosed as having diabetes.

Methods

We conducted a retrospective study involving all consecutive COVID-19 patients with a definitive 28-day outcome and FBG measurement at admission from 24 January 2020 to 10 February 2020 in two hospitals based in Wuhan, China. Demographic and clinical data, 28-day outcomes, in-hospital complications and CRB-65 scores of COVID-19 patients in the two hospitals were analysed. CRB-65 is an effective measure for assessing the severity of pneumonia and is based on four indicators, i.e. confusion, respiratory rate (>30/min), systolic blood pressure (≤90 mmHg) or diastolic blood pressure (≤60 mmHg), and age (≥65 years).

Results

Six hundred and five COVID-19 patients were enrolled, including 114 who died in hospital. Multivariable Cox regression analysis showed that age (HR 1.02 [95% CI 1.00, 1.04]), male sex (HR 1.75 [95% CI 1.17, 2.60]), CRB-65 score 1–2 (HR 2.68 [95% CI 1.56, 4.59]), CRB-65 score 3–4 (HR 5.25 [95% CI 2.05, 13.43]) and FBG ≥7.0 mmol/l (HR 2.30 [95% CI 1.49, 3.55]) were independent predictors for 28-day mortality. The OR for 28-day in-hospital complications in those with FBG ≥7.0 mmol/l and 6.1–6.9 mmol/l vs <6.1 mmol/l was 3.99 (95% CI 2.71, 5.88) or 2.61 (95% CI 1.64, 4.41), respectively.

Conclusions/interpretation

FBG ≥7.0 mmol/l at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes. Glycaemic testing and control are important to all COVID-19 patients even where they have no pre-existing diabetes, as most COVID-19 patients are prone to glucose metabolic disorders.

WHO (2020) Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Available from www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Accessed 30 Mar 2020

WHO (2020) Rolling updates on coronavirus disease (COVID-19). Available from www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. Accessed 11 Apr 2020

WHO (2020) Coronavirus disease (COVID-19) pandemic. Available from www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed 7 June 2020

Bragg F, Holmes MV, Iona A et al (2017) Association between diabetes and cause-specific mortality in rural and urban areas of China. JAMA 317(3):280–289. https://doi.org/10.1001/jama.2016.19720CrossRefPubMedPubMedCentral

Gregg EW, Cheng YJ, Srinivasan M et al (2018) Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet 391(10138):2430–2440. https://doi.org/10.1016/s0140-6736(18)30314-3CrossRefPubMed

Pearson-Stuttard J, Blundell S, Harris T, Cook DG, Critchley J (2016) Diabetes and infection: assessing the association with glycaemic control in population-based studies. Lancet Diabetes Endocrinol 4(2):148–158. https://doi.org/10.1016/s2213-8587(15)00379-4CrossRefPubMed

Rao Kondapally Seshasai S, Kaptoge S, Thompson A et al (2011) Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 364(9):829–841. https://doi.org/10.1056/NEJMoa1008862CrossRefPubMedPubMedCentral

Ehrlich SF, Quesenberry CP Jr, Van Den Eeden SK, Shan J, Ferrara A (2010) Patients diagnosed with diabetes are at increased risk for asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and pneumonia but not lung cancer. Diabetes Care 33(1):55–60. https://doi.org/10.2337/dc09-0880CrossRefPubMed

Lepper PM, Ott S, Nuesch E et al (2012) Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study. BMJ 344:e3397. https://doi.org/10.1136/bmj.e3397

10.

McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ (2005) The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care 28(4):810–815. https://doi.org/10.2337/diacare.28.4.810CrossRefPubMed

11.

Yang JK, Feng Y, Yuan MY et al (2006) Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med 23(6):623–628. https://doi.org/10.1111/j.1464-5491.2006.01861.xCrossRefPubMed

12.

Alanazi KH, Abedi GR, Midgley CM et al (2020) Diabetes mellitus, hypertension, and death among 32 patients with MERS-CoV infection, Saudi Arabia. Emerg Infect Dis 26(1):166–168. https://doi.org/10.3201/eid2601.190952CrossRefPubMedPubMedCentral

13.

Bode B, Garrett V, Messler J et al (2020) Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J Diabetes Sci Technol:193229682092446. https://doi.org/10.1177/1932296820924469

14.

Zhu L, She ZG, Cheng X et al (2020) Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab 31(6):1068–1077.e3. https://doi.org/10.1016/j.cmet.2020.04.021CrossRefPubMedPubMedCentral

15.

WHO (2020) Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases. Available from www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117. Accessed 31 Mar 2020

16.

National Health Commission of the People’s Republic of China (2020) Diagnosis and treatment plan of coronavirus disease 2019 (COVID-19) (trial version 6) Available from www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2/files/b218cfeb1bc54639af227f922bf6b817.pdf. Accessed 31 Mar 2020 [document in Chinese]

17.

WHO (2020) Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. Available from https://apps.who.int/iris/handle/10665/331446. Accessed 30 Mar 2020

18.

Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395(10223):497–506. https://doi.org/10.1016/s0140-6736(20)30183-5CrossRefPubMedPubMedCentral

19.

Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120(4):c179–c184. https://doi.org/10.1159/000339789CrossRefPubMed

20.

Schneider GT, Maier SAN (2020) Cerebrovascular accident. In: Weissbrod PA, Francis DO (eds) Neurologic and neurodegenerative diseases of the larynx. Springer, Cham, pp 215–228. https://doi.org/10.1007/978-3-030-28852-5_18CrossRef

21.

Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395(10229):1054–1062. https://doi.org/10.1016/s0140-6736(20)30566-3CrossRefPubMedPubMedCentral

22.

Ewig S, Bauer T, Richter K et al (2013) Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groups. Eur Respir J 41(4):917–922. https://doi.org/10.1183/09031936.00065212CrossRefPubMed

23.

Ewig S, Birkner N, Strauss R et al (2009) New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax 64(12):1062–1069. https://doi.org/10.1136/thx.2008.109785CrossRefPubMed

24.

Shi H, Han X, Jiang N et al (2020) Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 20(4):425–434. https://doi.org/10.1016/s1473-3099(20)30086-4CrossRefPubMedPubMedCentral

25.

Yang X, Yu Y, Xu J et al (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 8(5):475–481. https://doi.org/10.1016/s2213-2600(20)30079-5CrossRefPubMedPubMedCentral

26.

Wu C, Chen X, Cai Y et al (2020) Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med https://doi.org/10.1001/jamainternmed.2020.0994

27.

Bauer TT, Ewig S, Marre R, Suttorp N, Welte T (2006) CRB-65 predicts death from community-acquired pneumonia. J Intern Med 260(1):93–101. https://doi.org/10.1111/j.1365-2796.2006.01657.xCrossRefPubMed

28.

Bar-Or D, Rael LT, Madayag RM et al (2019) Stress hyperglycemia in critically ill patients: insight into possible molecular pathways. Front Med (Lausanne) 6:54. https://doi.org/10.3389/fmed.2019.00054CrossRef

29.

Whitcomb BW, Pradhan EK, Pittas AG, Roghmann MC, Perencevich EN (2005) Impact of admission hyperglycemia on hospital mortality in various intensive care unit populations. Crit Care Med 33(12):2772–2777. https://doi.org/10.1097/01.ccm.0000189741.44071.25CrossRefPubMed

30.

Burcelin R, Amar J (2015) Diabetes: antibiotics or prodiabetics? Nat Rev Endocrinol 11(7):385–386. https://doi.org/10.1038/nrendo.2015.75CrossRefPubMed

31.

Johns EC, Reynolds RM (2019) Topical glucocorticoids and risk of type 2 diabetes mellitus. Nat Rev Endocrinol 15(7):379–380. https://doi.org/10.1038/s41574-019-0212-8CrossRefPubMed

32.

Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345(19):1359–1367. https://doi.org/10.1056/NEJMoa011300CrossRefPubMed

33.

Van den Berghe G, Wilmer A, Hermans G et al (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354(5):449–461. https://doi.org/10.1056/NEJMoa052521CrossRefPubMed

34.

Finfer S, Chittock DR, Su SY et al (2009) Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360(13):1283–1297. https://doi.org/10.1056/NEJMoa0810625CrossRefPubMed

35.

Stapleton RD, Heyland DK (2020) UpToDate: glycemic control and intensive insulin therapy in critical illness. Available from www.uptodate.com/contents/glycemic-control-and-intensive-insulin-therapy-in-critical-illness. Accessed 30 Mar 2020

Title: 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
Authors: Sufei Wang
Pei Ma
Shujing Zhang
Siwei Song
Zhihui Wang
Yanling Ma
Juanjuan Xu
Feng Wu
Limin Duan
Zhengrong Yin
Huilin Luo
Nian Xiong
Man Xu
Tianshu Zeng
Yang Jin
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: COVID-19
Hyperglycemia
Published in: Diabetologia / Issue 10/2020
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-020-05209-1

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Please log in to get access to this content

Other articles of this Issue 10/2020

Single-cell transcriptome analysis of the Akimba mouse retina reveals cell-type-specific insights into the pathobiology of diabetic retinopathy

Multi-layered epigenetic regulation of IRS2 expression in the liver of obese individuals with type 2 diabetes

CNS control of the endocrine pancreas

Efficacy of GAD-alum immunotherapy associated with HLA-DR3-DQ2 in recently diagnosed type 1 diabetes

Metformin improves blood glucose by increasing incretins independent of changes in gluconeogenesis in youth with type 2 diabetes

Type 1 and type 2 diabetes after gestational diabetes: a 23 year cohort study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page