IDF21-0411 Correlation of Chest CT severity score with blood glucose levels in patients with COVID-19

Abstract

Background: Coronavirus disease 2019 (COVID 19) is caused by severe acute respiratory syndrome corona virus 2 (SARS – CoV-2) which predominantly affects lungs and leads to COVID 19 pneumonia. Hyperglycemia is frequently associated with severe COVID-19 infection and with a worse prognosis. Evidence in the COVID-19 pandemic shows that hyperglycemia, not only in people with diabetes, worsens the prognosis and increases mortality. Studies have also shown that patients with new-onset hyperglycemia even without a frank diabetes due to any cause (Stress-induced/ COVID-19-induced/ pre-existing dysglycemia), are associated with a poorer outcome compared to the normoglycemic individuals as well as those with pre-existing diabetes and COVID-19. Aim: This retrospective study aims to evaluate the correlation of CT severity score with blood glucose levels among patients with COVID-19 infection. Method: In this observational study 174 patients with COVID-19 infection were included at a dedicated COVID hospital in Rural Maharashtra. The COVID19 positivity was defined on the basis of RT PCR done at government approved laboratory. Random blood glucose level done at the time of admission and chest CT examinations were retrospectively evaluated. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1: < 5%; 2: 5–25%; 3: 26–50%; 4: 51–75%; 5: > 75%; range 0–5; global score 0–25). Pearson correlation test was used to analyze the data. Results: Pearson correlation test showed that CT score had significant positive correlation with blood glucose levels with p: 0.001 (r = 0.257). Our study showed that as blood glucose value increases CT severity score increases in patients with COVID 19. Discussion: This observational study shows COVID-19 patients with increased blood glucose levels had significant pulmonary involvement on HRCT chest. Hyperglycemia in COVID 19 patients is more likely to cause more severe pneumonia with severe hypoxia. As patients with hyperglycemia have a dysregulated innate and adaptive immune response and their already having chronic low-grade inflammation which makes them more susceptible to more severe pulmonary disease (1). Hyperglycemia has been identified as an independent risk factor for developing respiratory infections. Persistent hyperglycemia can lead to endothelial dysfunction and inflammation which can lead to thrombus formation. Hyperglycemia induces glycosylation of ACE2 receptors which ultimately favours cellular intrusion of SARS-CoV2 leading to severe pulmonary involvement in COVID-19. Acute increase of blood glucose is accompanied by a huge increase of inflammatory mediators leading to cytokine storm. Various studies have shown that cytokine storm is more common in patients with hyperglycemia in COVID-19 (2). Therefore, fast normalization of hyperglycemia during COVID-19 is most important to decrease inflammatory cytokines release and ACE2 binding of the virus, two facts which consistently might help in improving the prognosis in patients affected by SARS-CoV-2.