Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
Diabetes Obes Metab. 2022 Mar;24(3):499-510. doi: 10.1111/dom.14604. Epub 2021 Dec 5.
To determine the risk of adverse outcomes across the spectrum of glycated haemoglobin (HbA1c) levels among hospitalized COVID-19 patients with and without diabetes.
Danish nationwide registries were used to study the association between HbA1c levels and 30-day risk of all-cause mortality and the composite of severe COVID-19 infection, intensive care unit (ICU) admission and all-cause mortality. The study population comprised patients hospitalized with COVID-19 (3 March 2020 to 31 December 2020) with a positive polymerase chain reaction (PCR) test and an available HbA1c ≤ 6 months before the first positive PCR test. All patients had at least 30 days of follow-up. Among patients with diabetes, HbA1c was categorized as <48 mmol/mol, 48 to 53 mmol/mol, 54 to 58 mmol/mol, 59 to 64 mmol/mol (reference) and >64 mmol/mol. Among patients without diabetes, HbA1c was stratified into <31 mmol/mol, 31 to 36 mmol/mol (reference), 37 to 41 mmol/mol and 42 to 47 mmol/mol. Thirty-day standardized absolute risks and standardized absolute risk differences are reported.
We identified 3295 hospitalized COVID-19 patients with an available HbA1c (56.2% male, median age 73.9 years), of whom 35.8% had diabetes. The median HbA1c was 54 and 37 mmol/mol among patients with and without diabetes, respectively. Among patients with diabetes, the standardized absolute risk difference of the composite outcome was higher with HbA1c < 48 mmol/mol (12.0% [95% confidence interval {CI} 3.3% to 20.8%]) and HbA1c > 64 mmol/mol (15.1% [95% CI 6.2% to 24.0%]), compared with HbA1c 59 to 64 mmol/mol (reference). Among patients without diabetes, the standardized absolute risk difference of the composite outcome was greater with HbA1c < 31 mmol/mol (8.5% [95% CI 0.5% to 16.5%]) and HbA1c 42 to 47 mmol/mol (6.7% [95% CI 1.3% to 12.1%]), compared with HbA1c 31 to 36 mmol/mol (reference).
Patients with COVID-19 and HbA1c < 48 mmol/mol or HbA1c > 64 mmol/mol had a higher associated risk of the composite outcome. Similarly, among patients without diabetes, varying HbA1c levels were associated with higher risk of the composite outcome.
确定患有和不患有糖尿病的住院 COVID-19 患者糖化血红蛋白（HbA1c）水平范围内不良结局的风险。
使用丹麦全国性登记处研究 HbA1c 水平与 30 天全因死亡率以及 COVID-19 严重感染、重症监护病房（ICU）入院和全因死亡率复合结局的相关性。研究人群包括 2020 年 3 月 3 日至 2020 年 12 月 31 日因 COVID-19 住院且首次 PCR 检测阳性前 3 个月内有 HbA1c 检测值的患者（阳性聚合酶链反应（PCR）检测）。所有患者均有至少 30 天的随访期。在患有糖尿病的患者中，HbA1c 分为 <48mmol/mol、48 至 53mmol/mol、54 至 58mmol/mol、59 至 64mmol/mol（参考值）和 >64mmol/mol。在没有糖尿病的患者中，HbA1c 分层为 <31mmol/mol、31 至 36mmol/mol（参考值）、37 至 41mmol/mol 和 42 至 47mmol/mol。报告 30 天标准化绝对风险和标准化绝对风险差异。
我们确定了 3295 名患有 COVID-19 且有 HbA1c 检测值（56.2%为男性，中位年龄 73.9 岁）的住院患者，其中 35.8%患有糖尿病。HbA1c 在有糖尿病和没有糖尿病的患者中分别为 54 和 37mmol/mol。在患有糖尿病的患者中，与 HbA1c 59 至 64mmol/mol（参考值）相比，HbA1c <48mmol/mol（12.0%[95%置信区间 {CI} 3.3%至 20.8%]）和 HbA1c >64mmol/mol（15.1%[95% CI 6.2%至 24.0%]）的复合结局标准化绝对风险差异更高。在没有糖尿病的患者中，与 HbA1c 31 至 36mmol/mol（参考值）相比，HbA1c <31mmol/mol（8.5%[95% CI 0.5%至 16.5%]）和 HbA1c 42 至 47mmol/mol（6.7%[95% CI 1.3%至 12.1%]）的复合结局标准化绝对风险差异更大。
COVID-19 患者的 HbA1c <48mmol/mol 或 HbA1c >64mmol/mol 与复合结局的风险增加相关。同样，在没有糖尿病的患者中，HbA1c 的不同水平与复合结局的风险增加相关。
