Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study
A Coppelli, R Giannarelli, Michele Aragona, Giuseppe Penno, Marco Falcone, Giusy Tiseo, Lorenzo Ghiadoni, Greta Barbieri, Fabio Monzani, Agostino Virdis, Francesco Menichetti, Stefano Del Prato, Pisa COVID-19 Study Group, Agostini o Degl’Innocenti Sabrina, Rachele Antognoli, Rubia Baldassarri, Bertini Pietro, B Martina, Matteo Borselli, Brizzi Giulia, Calsolario Valeria, Carrozzi Laura, Alessandro Celi, Cinotti Francesco, Cipriano Alessandro, Francesco Corradi, D. Salvatore, Della Rocca Alessandra, Francesco Forfori, Forotti Giovanna, Valentina Galfo, Guarracino Fabio, Paolo Malacarne, Stefano Masi, Alessandro Mengozzi, Monfroni Marco, Alessandra Morea, Nencini Elia, Park Naria, Paterni Simone, Piagnani Chiara, Ruberti Francesca, Santini Massimo, Sciuto Maria, S. Spinelli
Abstract
OBJECTIVE To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS Hospitalized COVID-19 patients (N = 271) were subdivided based on at-admission glycemic status: 1) glucose levels <7.78 mmol/L (NG) (N = 149 [55.0%]; median glucose 5.99 mmol/L [range 5.38–6.72]), 2) known diabetes mellitus (DM) (N = 56 [20.7%]; 9.18 mmol/L [7.67–12.71]), and 3) no diabetes and glucose levels ≥7.78 mmol/L (HG) (N = 66 [24.3%]; 8.57 mmol/L [8.18–10.47]). RESULTS Neutrophils were higher and lymphocytes and PaO2/FiO2 lower in HG than in DM and NG patients. DM and HG patients had higher D-dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs. 16.8%; unadjusted hazard ratio [HR] 2.20, 95% CI 1.27–3.81, P = 0.005) than in NG (16.8%) and marginally so in DM (28.6%; 1.73, 0.92–3.25, P = 0.086) patients. Upon multiple adjustments, only HG remained an independent predictor (HR 1.80, 95% CI 1.03–3.15, P = 0.04). After stratification by quintile of glucose levels, mortality was higher in quintile 4 (Q4) (3.57, 1.46–8.76, P = 0.005) and marginally in Q5 (29.6%) (2.32, 0.91–5.96, P = 0.079) vs. Q1. CONCLUSIONS Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19.