FPG at hospital admission predicts COVID-19 complications, death in those without diabetes
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A fasting plasma blood glucose measurement at hospital admission was an independent predictor of 28-day mortality and in-hospital complications among people with COVID-19 but without diabetes, study data from Wuhan show.
“Previous studies have shown that diabetes and acute uncontrolled hyperglycemia are related to morbidity and/or mortality from COVID-19,” Sufei Wang, MD, of the department of respiratory and critical care medicine at Union Hospital and Huazhong University of Science and Technology in Hubei province, China, and colleagues wrote. “Nonetheless, so far, no research effort has been directed at whether the admission fasting blood glucose level is an independent predictor of mortality in COVID-19 patients without previously diagnosed diabetes. This two-center retrospective study shows, for the first time, that elevated fasting blood glucose at admission is independently associated with increased 28-day mortality and percentages of in-hospital complications in COVID-19 patients without previous diagnosis of diabetes.”
In a retrospective study, Wang and colleagues analyzed data from 605 adults without diabetes admitted to Wuhan Union West Hospital (n = 448) and Wuhan Red Cross Hospital (n = 157) between Jan. 24 and Feb. 10 (median age, 59 years; 53.2% men). All patients had an FPG measurement at admission and definitive outcomes (died, discharged or still hospitalized) within 28 days; all received standard treatment including antiviral therapy, respiratory support and antimicrobial therapy as appropriate. Patients were stratified by FPG measurement at admission: less than 110 mg/dL (n = 329); between 110 mg/dL and 125 mg/dL (n = 100) and at least 126 mg/dL (n = 176). Researchers assessed demographic and clinical data, 28-day outcomes, in-hospital complications and CRB-65 score, a clinical prediction rule that grades the severity of community-acquired pneumonia in terms of 30-day mortality. CRB-65 score is based on four indicators: confusion, respiratory rate, systolic blood pressure ( 90 mm Hg) or diastolic BP ( 60 mm Hg) and age ( 65 years).
Within the cohort, 114 patients died in hospital and 237 (39.2%) developed one or more in-hospital complications; 334 patients (55.2%) had a CRB-65 score of 0; 261 (43.1%) had a CRB-65 score of 1 to 2; 10 (1.7%) had a CRB-65 score of 3 to 4.
In Cox regression analysis, researchers found that an FPG of at least 126 mg/dL was an independent predictor of 28-day mortality (HR = 2.3; 95% CI, 1.49-3.55), as was age (HR = 1.02; 95% CI, 1-1.04), male sex (HR = 1.75; 95% CI, 1.17-2.6), CRB-65 score of 1 to 2 (HR = 2.68; 95% CI, 1.56-4.59), CRB-65 score of 3 to 4 (HR = 5.25; 95% CI, 2.05-13.43).
The percentage rate of 28-day COVID-related complications was 14.2% for patients with an FPG of less than 110 mg/dL, 7.9% for patients with an FPG between 110 mg/dL and 125 mg/dL and 17% for patients with an FPG of at least 126 mg/dL at admission.
Compared with patients with an FPG of less than 110 mg/dL at admission, those with an FPG of at least 126 mg/dL were nearly four times more likely to experience in-hospital COVID-19 complications (OR = 3.99; 95% CI, 2.71-5.88), whereas patients with an FPG between 110 mg/dL and 125 mg/dL at admission were 2.6 times more likely to experience COVID-19 complications within 28 days (95% CI, 1.64-4.41).
“Glycemic testing and control should be recommended for all COVID-19 patients even if they do not have preexisting diabetes, as most COVID-19 patients are prone to glucose metabolic disorders,” the researchers wrote. “During a pandemic of COVID-19, fasting blood glucose can facilitate the assessment of prognosis and early intervention of hyperglycemia to help improve the overall outcomes in treatment of COVID-19.”
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