Abstract
BackgroundWe aimed to understand how glycaemic levels among COVID-19 patients impact their disease progression and clinical complications.MethodsWe enrolled 2,366 COVID-19 patients from Huoshenshan hospital in Wuhan. We stratified the COVID-19 patients into four subgroups by current fasting blood glucose (FBG) levels and their awareness of prior diabetic status, including patients with FBG<6.1mmol/L with no history of diabetes (group 1), patients with FBG<6.1mmol/L with a history of diabetes diagnosed (group 2), patients with FBG≥6.1mmol/L with no history of diabetes (group 3) and patients with FBG≥6.1mmol/L with a history of diabetes diagnosed (group 4). A multivariate cause-specific Cox proportional hazard model was used to assess the associations between FBG levels or prior diabetic status and clinical adversities in COVID-19 patients.ResultsCOVID-19 patients with higher FBG and unknown diabetes in the past (group 3) are more likely to progress to the severe or critical stage than patients in other groups (severe: 38.46% vs 23.46%-30.70%; critical 7.69% vs 0.61%-3.96%). These patients also have the highest abnormal level of inflammatory parameters, complications, and clinical adversities among all four groups (all p<0.05). On day 21 of hospitalisation, group 3 had a significantly higher risk of ICU admission [14.1% (9.6%-18.6%)] than group 4 [7.0% (3.7%-10.3%)], group 2 [4.0% (0.2%-7.8%)] and group 1 [2.1% (1.4%-2.8%)], (P<0.001). Compared with group 1 who had low FBG, group 3 demonstrated 5 times higher risk of ICU admission events during hospitalisation (HR=5.38, 3.46-8.35, P<0.001), while group 4, where the patients had high FBG and prior diabetes diagnosed, also showed a significantly higher risk (HR=1.99, 1.12-3.52, P=0.019), but to a much lesser extent than in group 3.ConclusionOur study shows that COVID-19 patients with current high FBG levels but unaware of pre-existing diabetes, or possibly new onset diabetes as a result of COVID-19 infection, have a higher risk of more severe adverse outcomes than those aware of prior diagnosis of diabetes and those with low current FBG levels.
Highlights
As of August 10, 2021, more than 204 million cases of coronavirus disease 2019 (COVID-19) have been reported worldwide, including more than 4.3 million COVID-19 related deaths [1]
Of the 3,059 patients, we excluded 214 patients who were diagnosed as having COVID-19 based on clinical symptoms without laboratory tests, 46 patients who were transferred to other medical institutions, 16 patients who were admitted to the hospital multiple times, 6 patients who were
Our results demonstrate that patients who had a high FBG level (≥6.1mmol/ L) at admission without a prior diagnosis of diabetes have the highest risk of a severe or critical severity of COVID-19, such as a severe inflammatory response and multiple clinical complications
Summary
As of August 10, 2021, more than 204 million cases of coronavirus disease 2019 (COVID-19) have been reported worldwide, including more than 4.3 million COVID-19 related deaths [1]. Previous studies have established that COVID-19 patients with diabetes are more susceptible to inflammatory storms, leading to worse severe adverse clinical outcomes [2,3,4]. These patients reportedly have a consistently higher risk of complications during hospitalisation, with more frequent mechanical ventilation, intensive care unit (ICU) admission, and deaths than otherwise [3,4,5]. Common proinflammatory molecules, such as IL-6 and CRP, are involved in pathways leading to inflammatory cytokine storm as a result of SARS-COV-2 infection and in diabetes contributing to an aberrant glucose metabolism [14]. We aimed to understand how glycaemic levels among COVID-19 patients impact their disease progression and clinical complications
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