Le Viet Tran, Ha Quoc Hung, Tran Minh Triet, Le Ngoc Trong, Le Van Tuyen, Le Minh Khoi
COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, VNM.
Department of Endocrinology, University Medical Center, Ho Chi Minh City, VNM.
Cureus. 2022 Aug 2;14(8):e27611. doi: 10.7759/cureus.27611. eCollection 2022 Aug.
Hyperglycemia is commonly seen in critically ill patients. This disorder was also seen in coronavirus disease 2019 (COVID-19) patients and was associated with a worse prognosis. The current study determined the prevalence, risk factors, and prognostic implications of hyperglycemia in COVID-19 patients.
This was a retrospective observational study performed in an intensive care unit for COVID-19 patients. Electronic data of COVID-19 patients admitted to the intensive care unit from August 2nd to October 15th, 2021, were collected. Patients were divided into non-hyperglycemia, hyperglycemia in diabetic patients, and hyperglycemia in non-diabetic patients. Primary outcomes were 28-day and in-hospital mortalities. Multinomial logistic regression and multivariable Cox regression models were used to determine the risk factors for hyperglycemia and mortality, respectively.
Hyperglycemia was documented in 65.6% of patients: diabetic patients (44.8%) and new-onset hyperglycemia (20.8%). In-hospital and 28-day mortality rates were 30.2% and 26.1%, respectively. Respiratory failure, corticosteroid therapy, and a higher level of procalcitonin were risk factors for hyperglycemia in diabetic patients, whereas cardiovascular diseases, respiratory failure, and higher aspartate aminotransferase/glutamate aminotransferase ratio were risk factors for hyperglycemia in non-diabetic patients. The risk of the 28-day mortality rate was highest in the new-onset hyperglycemia (hazard ratio [HR] 3.535, 95% confidence interval [CI] 1.338-9.338, p=0.011), which was higher than hyperglycemia in type 2 diabetes mellitus patients (HR 1.408, 95% CI 0.513-3.862, p=0.506).
Hyperglycemia was common in COVID-19 patients in the intensive care unit. Hyperglycemia reflected the disease severity but was also secondary to therapeutic intervention. New-onset hyperglycemia was associated with poorer outcomes than that in diabetic patients.
高血糖在危重症患者中很常见。2019冠状病毒病（COVID-19）患者中也出现这种病症，且与预后较差相关。本研究确定了COVID-19患者高血糖的患病率、危险因素及预后影响。
这是一项在COVID-19患者重症监护病房进行的回顾性观察研究。收集了2021年8月2日至10月15日入住重症监护病房的COVID-19患者的电子数据。患者分为非高血糖、糖尿病患者高血糖和非糖尿病患者高血糖。主要结局为28天死亡率和住院死亡率。分别采用多项逻辑回归和多变量Cox回归模型确定高血糖和死亡率的危险因素。
65.6%的患者记录有高血糖：糖尿病患者（44.8%）和新发高血糖（20.8%）。住院死亡率和28天死亡率分别为30.2%和26.1%。呼吸衰竭、皮质类固醇治疗和降钙素原水平升高是糖尿病患者高血糖的危险因素，而心血管疾病、呼吸衰竭和较高的谷草转氨酶/谷丙转氨酶比值是非糖尿病患者高血糖的危险因素。新发高血糖患者28天死亡率风险最高（风险比[HR]3.535，95%置信区间[CI]1.338 - 9.338，p = 0.011），高于2型糖尿病患者的高血糖（HR 1.408，95%CI 0.513 - 3.862，p = 0.506）。
重症监护病房的COVID-19患者中高血糖很常见。高血糖反映了疾病的严重程度，但也是治疗干预的结果。新发高血糖患者的预后比糖尿病患者更差。
