Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
BMJ Open Diabetes Res Care. 2020 Jun;8(1). doi: 10.1136/bmjdrc-2020-001476.
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.
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.
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.
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.
在 COVID-19 大流行期间，医疗资源严重短缺，风险分层具有重要的战略意义。血糖水平是感染和危重症患者预后的重要危险因素。我们旨在研究血糖水平在 COVID-19 患者中的预后价值。
我们从武汉的两家医疗中心收集了 2041 例连续住院 COVID-19 患者的临床和生存信息。排除了没有血糖水平信息的患者。我们进行了多变量 Cox 回归分析，以计算血糖相关指标与非危重症患者进展为危重症/死亡风险、危重症患者住院死亡率的 HR。在无糖尿病患者中进行了敏感性分析。
入院时血糖升高是非危重症患者进展为危重症/死亡的独立危险因素（HR=1.30，95%CI 1.03 至 1.63，p=0.026）。危重症诊断时初始血糖升高是危重症患者住院死亡率的独立危险因素（HR=1.84，95%CI 1.14 至 2.98，p=0.013）。住院期间或危重症诊断后较高的中位血糖水平（≥6.1mmol/L）与非危重症患者进展为危重症/死亡风险增加以及危重症患者住院死亡率增加独立相关。在无糖尿病患者的敏感性分析中，上述结果一致。
血糖水平升高预示着 COVID-19 住院患者的预后更差。我们的发现可能为 COVID-19 住院患者提供一种简单实用的风险分层方法，特别是在大流行期间医疗资源严重短缺的情况下。
