Matias Alexandra A, Manique Inês, Sabino Teresa, Rego Teresa, Mihon Claudia, Panarra António, Rizzo Manfredi, Silva-Nunes José
Department of Endocrinology, Diabetes and Metabolism, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, 1069-166, Lisbon, Portugal.
Functional Unit of Internal Medicine 7.2, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, 1069-166, Lisbon, Portugal.
Diabetes Ther. 2023 Feb;14(2):335-346. doi: 10.1007/s13300-022-01347-4. Epub 2022 Dec 27.
Diabetes is a risk factor for greater severity of coronavirus disease 2019 (COVID-19). The stress hyperglycemia ratio (SHR) is an independent predictor of critical illness, and it is reported to have a stronger association than absolute hyperglycemia. The aim of this study was to assess the relationship of absolute hyperglycemia and SHR with the severity of COVID-19, since there are no studies investigating SHR in patients with COVID-19. We conducted a retrospective observational study on hospitalized patients with COVID-19 in the first months of the pandemic, regarding absolute hyperglycemia, SHR, and severity outcomes. Of the 374 patients, 28.1% had a previous diagnosis of type 2 diabetes. Absolute hyperglycemia (64.8% versus 22.7%; p < 0.01) and SHR [1.1 (IQR 0.9-1.3) versus 1.0 (IQR 0.9-1.2); p < 0.001] showed a statistically significant association with previous diabetes. Absolute hyperglycemia showed a significant association with clinical severity of COVID-19 (79.0% versus 62.7%; p < 0.001), need for oxygen therapy (74.8% versus 54.4%; p < 0.001), invasive mechanical ventilation (28.6% versus 11.6%; p < 0.001), and intensive care unit (30.3% versus 14.9%; p = 0.002), but not with mortality; by contrast, there was no statistically significant association between SHR and all these parameters. Our results are in agreement with the literature regarding the impact of absolute hyperglycemia on COVID-19 severity outcomes, while SHR was not a significant marker. We therefore suggest that SHR should not be evaluated in all patients admitted in the hospital for COVID-19, and we encourage the standard measures at admission of blood glucose and HbA1c levels.
糖尿病是2019冠状病毒病（COVID-19）病情加重的一个风险因素。应激性高血糖比率（SHR）是危重症的独立预测指标，据报道其关联强度高于单纯的高血糖。本研究旨在评估COVID-19患者的单纯高血糖和SHR与疾病严重程度之间的关系，因为此前尚无关于COVID-19患者SHR的研究。我们对疫情最初几个月住院的COVID-19患者进行了一项回顾性观察研究，涉及单纯高血糖、SHR和严重程度结局。在374例患者中，28.1%既往诊断为2型糖尿病。单纯高血糖（64.8%对22.7%；p＜0.01）和SHR[1.1（四分位间距0.9 - 1.3）对1.0（四分位间距0.9 - 1.2）；p＜0.001]与既往糖尿病存在统计学显著关联。单纯高血糖与COVID-19的临床严重程度（79.0%对62.7%；p＜0.001）、吸氧需求（74.8%对54.4%；p＜0.001）、有创机械通气（28.6%对11.6%；p＜0.001）及入住重症监护病房（30.3%对14.9%；p = 0.002）存在显著关联，但与死亡率无关；相比之下，SHR与所有这些参数之间无统计学显著关联。我们的结果与关于单纯高血糖对COVID-19严重程度结局影响的文献一致，而SHR并非一个显著标志物。因此，我们建议对所有因COVID-19入院的患者不应评估SHR，同时我们鼓励入院时常规检测血糖和糖化血红蛋白水平。
