Abstract

Background: Diabetes correlates with poor prognosis in patients with COVID-19, but very few studies have evaluated whether impaired fasting glucose (IFG) is also a risk factor for the poor outcomes of patients with COVID-19. Here we aimed to examine the associations between IFG and diabetes at admission with risks of complications and mortality among patients with COVID-19.Methods: In this multicenter retrospective cohort study, we enrolled 312 hospitalized patients with COVID-19 from 5 hospitals in Wuhan from Jan 1 to Mar 17, 2020. Clinical information, laboratory findings, complications, treatment regimens, and mortality status were collected. The associations between hyperglycemia and diabetes status at admission with primary composite end-point events (including mechanical ventilation, admission to intensive care unit, or death) were analyzed by Cox proportional hazards regression models.Results: The median age of the patients was 57 years (interquartile range 38–66), and 172 (55%) were women. At the time of hospital admission, 84 (27%) had diabetes (and 36 were new-diagnosed), 62 (20%) had IFG, and 166 (53%) had normal fasting glucose (NFG) levels. Compared to patients with NFG, patients with IFG and diabetes developed more primary composite end-point events (9 [5%], 11 [18%], 26 [31%]), including receiving mechanical ventilation (5 [3%], 6 [10%], 21 [25%]), and death (4 [2%], 9 [15%], 20 [24%]). Multivariable Cox regression analyses showed diabetes was associated increased risks of primary composite end-point events (hazard ratio 3.53; 95% confidence interval 1.48–8.40) and mortality (6.25; 1.91–20.45), and IFG was associated with an increased risk of mortality (4.11; 1.15–14.74), after adjusting for age, sex, hospitals and comorbidities.Conclusion: IFG and diabetes at admission were associated with higher risks of adverse outcomes among patients with COVID-19.

Highlights

  • The coronavirus disease 2019 (COVID-19) pandemic, a public health emergency of international concern, had affected more than 8.1 million cases and caused over 440,000 deaths globally by June 18, 2020 [1]

  • Diabetes correlates with poor prognosis in patients with COVID-19, but very few studies have evaluated whether impaired fasting glucose (IFG) is a risk factor for the poor outcomes of patients with COVID-19

  • Multivariable Cox regression analyses showed diabetes was IFG and Diabetes and the Severity of COVID-19 associated increased risks of primary composite end-point events and mortality (6.25; 1.91–20.45), and IFG was associated with an increased risk of mortality (4.11; 1.15–14.74), after adjusting for age, sex, hospitals and comorbidities

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Summary

Introduction

The coronavirus disease 2019 (COVID-19) pandemic, a public health emergency of international concern, had affected more than 8.1 million cases and caused over 440,000 deaths globally by June 18, 2020 [1]. Previous studies have reported that diabetes and uncontrolled glycemia were significant predictors of severity and mortality in patients infected with lower respiratory tract infections [7, 8], 2009 pandemic influenza A (H1N1) [9], severe acute respiratory syndrome coronavirus (SARS-CoV) [10], and Middle East respiratory syndrome coronavirus (MERS-CoV) [11, 12]. It remains controversial whether diabetes is related to adverse outcomes among patients with COVID-19 [13, 14]. We aimed to examine the associations between IFG and diabetes at admission with risks of complications and mortality among patients with COVID-19

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