Blood Glucose Is a Representative of the Clustered Indicators of Multi-Organ Injury for Predicting Mortality of COVID-19 in Wuhan, China

Abstract

Background: Most patients with Coronavirus Disease 2019 (COVID-19) were mild. Severe patients progressed rapidly to critical condition including multi-organ failure and even death. Identification of early predictive factors is urgently necessary to facilitate appropriate intensive care. Methods: We included all patient admitted to Wuhan Union Hospital and treated by the supportive medical team of Beijing Tongren Hospital as of March 20, 2020. Indicators of injuries for multiple organs, including the heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting primary outcomes (an intensive care unit (ICU) or death). Findings: The data of 120 patients with a severity equal to or greater than Moderate, discharged from the hospital or died were extracted. After excluding patients with chronic heart, kidney, liver disease and diabetes, 69 patients were included in the final analysis. There were 26 cases with primary outcomes including 16 deaths. Univariable analysis indicated that elevations of fasting blood glucose (FBG), lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with higher odds of primary outcomes and more hazards of death. Cox regression results indicated that FBG≥7mmol/L was the only independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Cluster analysis found more proximities of FBG (at the time of admission) with LDH, HDDH or Creatinine (at the time after 2-4 days of hospitalization) (r=0.43, 0.43 and 0.50, respectively, P<0.01 for all), indicating that FBG Among patients with primary outcomes, although FBG and LDH levels were much higher on admission, they dramatically decreased subsequently, while in deceased patients they increased continuously. Conclusions: FBG is a representative of the clustered indicators of multi-organ injury and the earliest predictor for poor outcomes and death in COVID patients. As it is easy to perform for clinical practices and self-monitoring, FBG testing will be much helpful for predicting critical condition to facilitate appropriate intensive care. Funding Statement: This study was funded by the National Key RD The Beijing Science and Technology Project. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Research Ethics Commission of Beijing Tongren Hospital, Capital Medical University (TRECKY2020-013) approved the study and the Ethics Commission waived the requirement for informed consent.