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Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study
  1. Jianfeng Wu1,
  2. Jianqiang Huang2,
  3. Guochao Zhu3,
  4. Qiongya Wang4,
  5. Qingquan Lv5,
  6. Ying Huang6,
  7. Yang Yu7,
  8. Xiang Si1,
  9. Hui Yi2,
  10. Cuiping Wang1,
  11. Yihao Liu8,9,
  12. Han Xiao10,
  13. Qian Zhou8,
  14. Xin Liu11,
  15. Daya Yang12,
  16. Xiangdong Guan1,
  17. Yanbing Li9,
  18. Sui Peng8,
  19. Joseph Sung13,
  20. Haipeng Xiao9,14
  1. 1Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  2. 2Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  3. 3Department of Critical Care Medicine, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, China
  4. 4Department of Critical Care Medicine, Wuhan Hankou Hospital, Wuhan, China
  5. 5Department of Gastrointestinal Surgery, Wuhan Hankou Hospital, Wuhan, China
  6. 6Science and Education Section, Wuhan Hankou Hospital, Wuhan, China
  7. 7Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, China
  8. 8Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  9. 9Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  10. 10Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  11. 11Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  12. 12Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  13. 13Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
  14. 14Precision Medicine Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  1. Correspondence to Professor Haipeng Xiao; xiaohp{at}mail.sysu.edu.cn

Abstract

Introduction With intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19.

Research design and methods We collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes.

Results Elevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes.

Conclusions Elevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic.

  • blood glucose
  • clinical study
  • infections
http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • SP and HaiX are joint senior authors.

  • JW, JH, GZ, QW, QL and YH are joint first authors.

  • JW, JH, GZ, QW, QL, YH and SP contributed equally.

  • Contributors HaiX supervised the study. HaiX, JW, JH, GZ, QW, QL and YH designed the study. XG, CW and JS helped to organize the study. JW, JH, GZ, QW, QL, YH, YaL, YY, XS and HY collected the data. QZ did the data analysis. JW, SP, YiL, HaiX, XL and DY wrote the draft report. JS performed critical revision on the manuscript. All authors contributed to the analysis and interpretation of data. All authors approved the final version before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study is approved by the ethics committees of Wuhan Hankou Hospital, No. Six Hospital of Wuhan and the First Affiliated Hospital of Sun Yat-sen University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data used during the study are available from the corresponding author by request.

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