Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Med Res. 2022 May-Jun;155(5&6):554-564. doi: 10.4103/ijmr.ijmr_2605_21.
BACKGROUND & OBJECTIVES: The association between hyperglycaemia at admission, diabetes mellitus (DM) status and mortality in hospitalized SARS-CoV-2 infected patients is not clear. The purpose of this study was to determine the relationship between DM, at-admission hyperglycaemia and 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection requiring intensive care.
All consecutive moderate-to-severe patients with SARS-CoV-2 infection admitted to the intensive care units (ICUs) over six months were enrolled in this single-centre, retrospective study. The predicators for 28 day mortality were analysed from the independent variables including DM status and hyperglycaemia at-admission.
Four hundred and fifty two patients with SARS-CoV-2 were admitted to the ICU, with a mean age of 58.5±13.4 yr, 78.5 per cent being male, HbA of 7.2 per cent (6.3-8.8) and 63.7 per cent having DM. Overall, 28 day mortality was 48.9 per cent. In univariate analysis, mortality in diabetes patients was comparable with non-diabetes (47.9 vs. 50.6%, P=0.58), while it was significantly higher in hyperglycaemic group (60.4 vs. 35.8%, P<0.001). In multivariate Cox regression analysis, after adjusting for age, sex and comorbidities, hyperglycaemia at-admission was an independent risk factor of mortality [hazard ratio (HR) 1.45, 95% confidence interval (CI) (1.06-1.99), P<0.05].
INTERPRETATION & CONCLUSIONS: This study showed that the presence of hyperglycaemia at-admission in critically ill SARS-CoV-2 patients was an independent predictor of 28 day mortality. However, the findings may be susceptible to unmeasured confounding, and more research from prospective studies is required.
目前尚不清楚入院时高血糖、糖尿病（DM）状态与住院 SARS-CoV-2 感染患者死亡率之间的关系。本研究旨在确定入院时患有 DM 和高血糖与需要重症监护的中重度 SARS-CoV-2 感染患者 28 天死亡率之间的关系。
本单中心回顾性研究纳入了过去 6 个月内入住重症监护病房（ICU）的所有中重度 SARS-CoV-2 感染连续患者。从独立变量（包括 DM 状态和入院时高血糖）分析 28 天死亡率的预测因子。
共有 452 例 SARS-CoV-2 患者入住 ICU，平均年龄为 58.5±13.4 岁，78.5%为男性，HbA 为 7.2%（6.3-8.8），63.7%患有 DM。总体而言，28 天死亡率为 48.9%。在单变量分析中，糖尿病患者的死亡率与非糖尿病患者相当（47.9%比 50.6%，P=0.58），而高血糖组的死亡率明显更高（60.4%比 35.8%，P<0.001）。多变量 Cox 回归分析显示，在校正年龄、性别和合并症后，入院时高血糖是死亡率的独立危险因素[危险比（HR）1.45，95%置信区间（CI）（1.06-1.99），P<0.05]。
本研究表明，危重症 SARS-CoV-2 患者入院时存在高血糖是 28 天死亡率的独立预测因素。然而，这些发现可能容易受到未测量的混杂因素的影响，需要更多前瞻性研究的验证。
