COVID-19 patients with hyperglycaemia face grim outlook

Hyperglycaemia carries an unfavourable prognosis for patients hospitalized for COVID-19, according to a study.

The analysis included 271 hospitalized COVID-19 patients in Pisa, Italy. At admission, 149 of these patients had normal glucose levels (NG; 55.0 percent; median HbA1c, 5.99 mmol/L), 56 had known diabetes mellitus (DM; 20.7 percent; median HbA1c, 9.18 mmol/L), and 66 were hyperglycaemic but had no diabetes history (HG; 24.3 percent; median HbA1c, 8.57 mmol/L).

There was no difference in lipids or blood pressure (BP) across groups. Notably, compared with diabetics and normoglycaemic patients, those with hyperglycaemia had higher neutrophil (median, 5.8 x 10⁹ L; p<0.05) and lower lymphocyte (median, 0.7 x 10⁹ /L; p<0.05) counts. D-dimer was higher and inflammatory profiles were worse in the HG and DM vs the NG group. PaO2-to-FiO2 ratio was also poorer in hyperglycaemic patients (median, 227; p<0.05).

Over a mean observation period of 16.8 days, 67 patients died (24.7 percent). Mortality rate in the HG group (39.4 percent) was higher than in the NG group (16.8 percent; unadjusted hazard ratio [HR], 2.196, 95 percent confidence interval [CI], 1.27–3.81; p=0.005) but only marginally so relative to the DM group (28.6 percent; HR, 1.73, 95 percent CI, 0.92–3.25; p=0.086).

Multivariable Cox proportional hazard models confirmed that hyperglycaemia was associated with an excess risk of death (HR, 1.80, 95 percent CI, 1.03–3.15; p=0.04). On further analysis, when glucose levels were stratified into quintiles, mortality was higher in the fourth quintile (HR, 3.57, 95 percent CI, 1.46–8.76; p=0.005) and marginally in the highest quintile (HR, 2.32, 95 percent CI, 0.91–5.96; p=0.079) compared with the lowest quintile. This finding might be due to a threshold effect above which no further worsening in prognosis might occur.

Overall, the present data support the view that at-admission hyperglycaemia is a poor prognostic parameter requiring careful evaluation and proper treatment in patients hospitalized for COVID-19, the researchers said.