Ferlicolak L, Yildiz B, Altintas N D
Dept. of Internal Medicine, Ankara University, Faculty of Medicine, Ankara, Turkey.
Division of Intensive Care, Ankara University, Faculty of Medicine, Ankara, Turkey.
Acta Endocrinol (Buchar). 2023 Jan-Mar;19(1):49-53. doi: 10.4183/aeb.2023.49. Epub 2023 Aug 14.
We know that mortality had increased in diabetic patients with COVID-19 pneumonia. The aim of this study was to compare the mortality and inflammation parameters difference in critically ill COVID-19 patients according to their admission HbA1c levels and diabetes mellitus status. Secondary aim was to evaluate the effect of the first week hyperglycemic episode frequency on mortality.
Critically ill COVID-19 patients who were tested for HbA1c levels on ICU admission were analyzed retrospectively.
Of 218 COVID PCR(+) patients, 139 met the inclusion criteria in study period. The median age was 67 [57-76] years and 55(40%) of them were female. Seventy-six (55%) of the patients required invasive mechanical ventilation (IMV). The IMV requirement was higher in diabetic patients (p=0.01). When the groups were compared in terms of inflammatory parameters no significant difference was found except for admission and first week's highest fibrinogen levels (p=0.02 and p=0.03, respectively). In multivariate analysis, fibrinogen levels were not determined as a risk factor for mortality. Overall ICU mortality was 43% (60/139). In group-1 23 (37%), in group-2 27 (57%), and in group-3 10 (34%) patients had died. There was no statistically significant difference between groups in terms of mortality (p=0.05). Records of 96 (69%) patients revealed there were more than five glucose readings over 180mg/dL during the first week. Mortality was higher in patients with more frequently hyperglycemic recordings (p=0.03).
There was no significant mortality and inflammatory parameters difference in patients with and without diabetes. However, more than five glucose readings over 180mg/dL during the first week were found with increased mortality.
我们知道，2019冠状病毒病（COVID-19）肺炎糖尿病患者的死亡率有所上升。本研究的目的是根据入住时糖化血红蛋白（HbA1c）水平和糖尿病状态，比较危重症COVID-19患者的死亡率和炎症参数差异。次要目的是评估首周高血糖发作频率对死亡率的影响。
对入住重症监护病房（ICU）时检测HbA1c水平的危重症COVID-19患者进行回顾性分析。
在218例COVID PCR（+）患者中，139例在研究期间符合纳入标准。中位年龄为67[57-76]岁，其中55例（40%）为女性。76例（55%）患者需要有创机械通气（IMV）。糖尿病患者的IMV需求更高（p=0.01）。在比较各亚组的炎症参数时，除入住时和首周最高纤维蛋白原水平外，未发现显著差异（分别为p=0.02和p=0.03）。在多变量分析中，纤维蛋白原水平未被确定为死亡风险因素。总体ICU死亡率为43%（60/139）。第1组23例（37%）、第2组27例（57%）和第3组10例（34%）患者死亡。各亚组之间的死亡率无统计学显著差异（p=0.05）。96例（69%）患者的记录显示，首周血糖读数超过180mg/dL的次数超过5次。高血糖记录更频繁的患者死亡率更高（p=0.03）。
糖尿病患者和非糖尿病患者的死亡率和炎症参数无显著差异。然而，发现首周血糖读数超过180mg/dL的次数超过5次时，死亡率会增加。
