Is elevated blood glucose at admission associated with poor outcomes in hospitalized COVID-19 patients?

OBJECTIVE

Hyperglycemia has been suggested as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19). The aim of our work was to evaluate the association between blood glucose levels at admission (BGA) and disease outcomes in hospitalized COVID-19 patients.

SUBJECTS AND METHODS

Retrospective study including all adult COVID-19 patients admitted to a Portuguese hospital from March to August 2020 with BGA measurement. Subjects were categorized into two groups: BGA < 140 mg/dL and ≥ 140 mg/dL. Statistical analysis was performed using SPSSv26 (significance defined as < 0.05).

RESULTS

We included 202 patients: median age 74 (60-86) years; 43.1% female; 31.2% with diabetes. The median BGA was 130.5 (108-158) mg/dL. When compared to normoglycemic, patients with BGA ≥ 140 mg/dL were older ( = 0.013), more vaccinated for ( = 0.025) and had more comorbidities (hypertension, heart failure and peripheral arterial disease, < 0.05). The last group presented higher leucocyte and neutrophile count, higher procalcitonin and prothrombin time, and lower lymphocyte count. Concerning prognosis, BGA ≥ 140 mg/dL was associated with higher rates of mechanical ventilation requirement and intensive care unit admission ( < 0.001), shock ( = 0.011), in-hospital mortality ( = 0.022) and 30-day mortality ( = 0.037). Considering only non-diabetic patients (n = 139), those with hyperglycemia presented higher rates of severity indicators (polypnea, SatO ≤ 93% and PaO/FiO ≤ 300) and an association with poor outcomes was also found, namely mechanical ventilation requirement and in-hospital/30-day mortality ( < 0.05).

CONCLUSION

Hyperglycemia at admission was associated with poor outcomes in COVID-19 patients, even in those without known pre-existing diabetes. Glycemic testing should be recommended for all COVID-19 patients.