IDF21-0272 Glycemic Variability in patients with SARS-CoV-2 admitted to the ICU

Abstract

Background: Glycemic variability (GV) is the measure of fluctuations in plasma glucose. An association between mortality and GV is evident in patients in the Intensive Care Unit (ICU). There are several indices for evaluating GV, including the coefficient of variation (CV). The evidence of GV as a possible prognostic factor in ICU patients diagnosed with SARS-CoV-2 is scarce and heterogeneous. Aim: Determine the probable impact of Glycemic Variability in patients with SARS-CoV-2 admitted in the ICU. Method: An observational, descriptive and retrospective study was conducted. Glycemic variability was evaluated in 324 patients, admitted to the ICU with diagnosis of Sars-CoV-2 between March - December 2020 at Hospital General Plaza de la Salud. Analysis included: sociodemographic, comorbidities, length of hospital stay, need for ventilatory support and mortality. For the calculation of the GV, “EasyGV'' version 9.0, a free software of the University of Oxford, was used. The exclusion criteria were intermittent glucose monitoring of less than 7 determinations and the diagnosis of Sars-CoV-2 without PCR. Results: A total of 324 patients (average age 62.7±14.9 years; 65.4% men; 34.6% women) were analyzed. They were divided into groups with low GV, (CV<36%; 68.8%, N=223) and with high GV, (CV>36%; 31.1%, N=101), patients with high GV had a higher frequency of Type 2 Diabetes Mellitus with 78.2% (79), compared to the group with low GV with 39.0% (87), renal insufficiency was present in the group with low GV in 17.4% (39) vs 41.5% (42) in the group with high GV. The average sum of comorbidities was 2.03 in the group with low GV and 2.3 in the group with high GV. Frequency of mortality in group with high GV, was 47.5% (48) vs 29.1% (65) in the group with low GV. There was no significant difference in the total number of days hospitalized in the ICU, however, in the total number of days hospitalized, patients with low GV had an average of 9.4 ±5.8 days, compared to the group with high GV 11.2 ±6.6 days. The need for ventilatory support in the group with high GV was 37.6% (38), compared to the group with low GV 28.2% (63). The APACHE had an average score in the group with Low GV of a 9.13 vs 9.6 of the high GV group. The SOFA had an average score in the group with Low GV of a 6.7 against a 6.6 of the high GV group. Discussion: For Chao et al, 2020, the mortality results in patients admitted to the ICU were similar to those of this study, 36.7% (high GV Group) vs. 26.6% (Low GV Group). It is necessary to include intermittent glucose monitoring in the follow-up of hospitalized patients due to its impact on their outcome, after showing that a CV ≥36% in patients diagnosed with SARS-CoV-2 resulted in a greater need for ventilatory support, longer hospital stay and greater mortality. Further research is required to evaluate GV as a prognostic factor to be considered.