应激性高血糖与 COVID-19 患者的疾病严重程度相关。

The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China.

Department of Endocrinology, General Hospital of Central Theater Command, Wuhan, Hubei Province, China.

Endokrynol Pol. 2023;74(5):528-535. doi: 10.5603/ep.93597.

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is a global pandemic that has affected millions of people worldwide. In this paper, we analyse the relationship between stress hyperglycaemia and disease severity in patients with COVID-19.

MATERIAL AND METHODS

A total of 252 patients with COVID-19 were included in this study. The patients were divided into the following groups: COVID-19 with stress hyperglycaemia (SHG), COVID-19 with diabetes (DM), and COVID-19 with normal blood glucose (NG). The stress hyperglycaemia rate (SHR) was calculated using the fasting blood glucose (FBG)/glycated haemoglobin (HbA1c) ratio. To further compare the disease characteristics of different SHRs, we divided the SHR into low SHR and high SHR according to the SHR median. Correlations between the severity of the disease and other factors were analysed after adjusting for sex and age. Multivariate analysis was performed using logistic regression to analyse the risk factors predicting the severity of COVID-19.

RESULTS

Compared with the NG group, the SHG group had higher disease severity (p < 0.001); the SHG group had higher HbA1c, FBG, SHR, blood urea nitrogen (BUN), interleukin 6 (IL-6), and neutrophil levels, while lymphocyte, CD3+ T cell, CD8+ T cell, CD4+ T cell, CD16+CD56 cell, and CD19+ cell counts were lower (p < 0.05). Compared with the NG group, the DM group had higher HbA1c, blood glucose, BUN, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and neutrophils, while CD8+ T cell counts were lower (p < 0.05). Compared with the DM group, the SHG group had higher SHR and lower HbA1c, CD3+ T cell, CD4+ T cell, CD16+CD56 cell, and T cell ratio levels (p < 0.05). Compared to the low SHR group, the high SHR group had patients with more severe COVID-19 (p = 0.004). Also, the high SHR grouphad higher age, HbA1c, FBG, asparate aminotransferaze (AST), BUN, LDH, uric acid (UA), CRP, IL-6, and procalcitonin (PCT), while lymphocyte, CD3+ T cell, CD4+ T cell, CD8+ T cell, and CD19+ cell counts were lower (p < 0.05).Binary logistic regression analysis showed that SHR, gender, and lymphocyte count wererisk factorsfor the severity of COVID-19.

CONCLUSION

Stress hyperglycaemia, as indicated by a higher SHR, is independently associated with the severity of COVID-19.

简介

2019 年冠状病毒病（COVID-19）是一种全球性大流行疾病，已影响到全球数百万人。在本文中，我们分析了 COVID-19 患者应激性高血糖与疾病严重程度之间的关系。

材料和方法

本研究共纳入 252 例 COVID-19 患者。患者分为以下几组：COVID-19 伴应激性高血糖（SHG）、COVID-19 伴糖尿病（DM）和 COVID-19 伴正常血糖（NG）。应激性高血糖率（SHR）使用空腹血糖（FBG）/糖化血红蛋白（HbA1c）比值计算。为了进一步比较不同 SHR 患者的疾病特征，我们根据 SHR 中位数将 SHR 分为低 SHR 和高 SHR。在调整性别和年龄后，分析疾病严重程度与其他因素之间的相关性。使用逻辑回归进行多变量分析，以分析预测 COVID-19 严重程度的危险因素。

结果

与 NG 组相比，SHG 组疾病严重程度更高（p<0.001）；SHG 组的 HbA1c、FBG、SHR、血尿素氮（BUN）、白细胞介素 6（IL-6）和中性粒细胞水平更高，而淋巴细胞、CD3+T 细胞、CD8+T 细胞、CD4+T 细胞、CD16+CD56 细胞和 CD19+细胞计数更低（p<0.05）。与 NG 组相比，DM 组的 HbA1c、血糖、BUN、乳酸脱氢酶（LDH）、红细胞沉降率（ESR）、C 反应蛋白（CRP）和中性粒细胞水平更高，而 CD8+T 细胞计数更低（p<0.05）。与 DM 组相比，SHG 组的 SHR 更高，HbA1c、CD3+T 细胞、CD4+T 细胞、CD16+CD56 细胞和 T 细胞比值水平更低（p<0.05）。与低 SHR 组相比，高 SHR 组 COVID-19 患者更严重（p=0.004）。此外，高 SHR 组患者年龄更大，HbA1c、FBG、天门冬氨酸氨基转移酶（AST）、BUN、LDH、尿酸（UA）、CRP、IL-6 和降钙素原（PCT）水平更高，而淋巴细胞、CD3+T 细胞、CD4+T 细胞、CD8+T 细胞和 CD19+细胞计数更低（p<0.05）。二项逻辑回归分析显示，SHR、性别和淋巴细胞计数是 COVID-19 严重程度的危险因素。