Abstract
BackgroundHyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19.MethodsConsecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms.ResultsAs expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels.ConclusionsBlood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.
Highlights
Since the first reports from China at the beginning of the COVID-19 pandemic, age, male sex, obesity, type 2 diabetes mellitus (T2D), arterial hypertension (AHT) and cardiovascular disease have been identified as established risk factors for a poor prognosis in patients with SARS-CoV-2 infection [1]
Within subjects admitted to the hospital, both obesity and hyperglycemia were independent predictors of admission in the intensive care unit (ICU) (Figure 2A)
BMI discriminated those subjects admitted to the ICU from subjects who did not need admission, but was unable to discriminate between individuals who died due to COVID-19 from those who survived, thereby corroborating the results from the logistic regression models
Summary
Since the first reports from China at the beginning of the COVID-19 pandemic, age, male sex, obesity, type 2 diabetes mellitus (T2D), arterial hypertension (AHT) and cardiovascular disease have been identified as established risk factors for a poor prognosis in patients with SARS-CoV-2 infection [1]. Different systematic reviews have substantiated that subjects with obesity are at higher risk for hospitalization, ICU admission and mortality [4, 5]. These studies did not mention the detailed comorbidities of patients with obesity, which may confound the role of obesity as an independent risk factor in COVID-19 [6]. Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. We aimed to identify and evaluate confounding factors affecting the prognostic value of Hyperglycemia, Obesity, and Outcomes of COVID-19 obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19
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