Brigham and Women's Hospital, Boston, MA 02115, USA.
Harvard Medical School, Boston, MA 02115, USA.
J Clin Endocrinol Metab. 2023 Feb 15;108(3):718-725. doi: 10.1210/clinem/dgac587.
Diabetes or hyperglycemia at admission are established risk factors for adverse outcomes during hospitalization for COVID-19, but the impact of prior glycemic control is not clear.
We aimed to examine the associations between admission variables, including glycemic gap, and adverse clinical outcomes in patients hospitalized with COVID-19 infection.
We examined the relationship between clinical predictors, including acute and chronic glycemia, and clinical outcomes, including intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality among 1786 individuals with diabetes or hyperglycemia (glucose > 10 mmol/L twice in 24 hours) who were admitted from March 2020 through February 2021 with COVID-19 infection at 5 university hospitals in the eastern United States.
The cohort was 51.3% male, 53.3% White, 18.8% Black, 29.0% Hispanic, with age = 65.6 ± 14.4 years, BMI = 31.5 ± 7.9 kg/m2, glucose = 12.0 ± 7.5 mmol/L [216 ± 135 mg/dL], and HbA1c = 8.07% ± 2.25%. During hospitalization, 38.9% were admitted to the ICU, 22.9% received MV, and 10.6% died. Age (P < 0.001) and admission glucose (P = 0.014) but not HbA1c were associated with increased risk of mortality. Glycemic gap, defined as admission glucose minus estimated average glucose based on HbA1c, was a stronger predictor of mortality than either admission glucose or HbA1c alone (OR = 1.040 [95% CI: 1.019, 1.061] per mmol/L, P < 0.001). In an adjusted multivariable model, glycemic gap, age, BMI, and diabetic ketoacidosis on admission were associated with increased mortality, while higher estimated glomerular filtration rate (eGFR) and use of any diabetes medication were associated with lower mortality (P < 0.001).
Relative hyperglycemia, as measured by the admission glycemic gap, is an important marker of mortality risk in COVID-19.
糖尿病或入院时高血糖是 COVID-19 住院期间不良结局的既定危险因素，但先前血糖控制的影响尚不清楚。
我们旨在研究入院变量（包括血糖差距）与 COVID-19 感染住院患者不良临床结局之间的关系。
我们检查了临床预测因子（包括急性和慢性血糖）与临床结局（包括入住重症监护病房（ICU）、机械通气（MV）和死亡率）之间的关系，共纳入了 1786 名糖尿病或高血糖（血糖在 24 小时内两次超过 10mmol/L）患者，他们在 2020 年 3 月至 2021 年 2 月期间在美国东部的 5 所大学医院因 COVID-19 感染住院。
队列中 51.3%为男性，53.3%为白人，18.8%为黑人，29.0%为西班牙裔，年龄为 65.6 ± 14.4 岁，BMI 为 31.5 ± 7.9kg/m2，血糖为 12.0 ± 7.5mmol/L[216 ± 135mg/dL]，HbA1c 为 8.07%±2.25%。住院期间，38.9%患者入住 ICU，22.9%接受 MV，10.6%死亡。年龄（P＜0.001）和入院时血糖（P=0.014），而不是 HbA1c，与死亡率增加相关。血糖差距定义为入院时血糖减去基于 HbA1c 的估计平均血糖，其作为死亡率的预测指标比入院时血糖或 HbA1c 单独预测更准确（每 mmol/L 增加 1.040[95%CI：1.019，1.061]，P＜0.001）。在调整后的多变量模型中，血糖差距、年龄、BMI 和入院时的糖尿病酮症酸中毒与死亡率增加相关，而更高的估计肾小球滤过率（eGFR）和使用任何糖尿病药物与死亡率降低相关（P＜0.001）。
相对高血糖，即入院时的血糖差距，是 COVID-19 死亡风险的一个重要标志物。
