Hendi Mohamed F, Alrais Zeyad F, Syed Fahimuddin, Elkholy Hesham M, Alsayed Hawra, Moin Muneeba, Mukhtar Sara H
Intensive Care Unit, Rashid Hospital, Dubai, ARE.
Cureus. 2024 Apr 3;16(4):e57551. doi: 10.7759/cureus.57551. eCollection 2024 Apr.
Aim We aimed to find out the prevalence of diabetes, ketosis, and ketoacidosis in coronavirus disease 2019 (COVID-19) critically ill patients and to explore the clinical impact of the development of ketosis and ketoacidosis on the outcome of COVID-19 critically ill patients and identify them as potential risk factors for these patients. Methods We collected data on COVID-19 patients admitted to the intensive care unit (ICU) retrospectively. The study population will be classified into two groups based on the presence of diabetes or ketosis. Results The study comprises data on 253 ICU patients admitted with COVID-19 pneumonia. Two hundred patients (79.05%) had diabetes or prediabetes on admission. Seventy-six patients (30%) presented with ketosis. Nine patients had progressed to diabetic ketoacidosis during their ICU stay. Concerning the outcome, among 150 patients who died (59.3%), there was significantly higher mortality among the ketotic patients (69.7%) compared to nonketotic patients (54.8%) with a P-value < 0.027. We noted that the peak blood glucose level during ICU stay was statistically significantly higher in nonsurvivors (mean 345 mg/dl) compared to survivors (mean 298 mg/dl) with a P-value of 0.006. Our data showed that peak serum levels of lactate, procalcitonin (PCT), C-reactive protein, white blood cells (WBC), D dimer, and lactate dehydrogenase strongly positively correlated to the length of ICU stay. We used the ROC curve (receiver operating characteristic curve) to assess the relation between many laboratories and mortality. We noted that uncontrolled hyperglycemia and other laboratory variables are significant predictors of mortality of COVID-19 patients (e.g., peak blood glucose (P = 0.004), PCT (P = 0.047), and P < 0.001 of other laboratories (e.g. lactate, PH, WBC, D dimer, ferritin). Conclusion We reported a high prevalence of diabetes and ketosis among COVID-19 patients admitted to the ICU. Ketosis is associated with an increased mortality risk. Uncontrolled hyperglycemia is a significant predictor of mortality in critically ill COVID-19 patients.
目的 我们旨在了解2019冠状病毒病（COVID-19）重症患者中糖尿病、酮症和酮症酸中毒的患病率，探讨酮症和酮症酸中毒的发生对COVID-19重症患者预后的临床影响，并将其确定为这些患者的潜在危险因素。方法 我们回顾性收集了入住重症监护病房（ICU）的COVID-19患者的数据。研究人群将根据是否存在糖尿病或酮症分为两组。结果 该研究包含253例因COVID-19肺炎入住ICU患者的数据。200例患者（79.05%）入院时患有糖尿病或糖尿病前期。76例患者（30%）出现酮症。9例患者在ICU住院期间进展为糖尿病酮症酸中毒。关于预后，在150例死亡患者（59.3%）中，酮症患者的死亡率（69.7%）显著高于非酮症患者（54.8%），P值<0.027。我们注意到，与幸存者（平均298mg/dl）相比，非幸存者在ICU住院期间的血糖峰值水平在统计学上显著更高（平均345mg/dl），P值为0.006。我们的数据显示，血清乳酸、降钙素原（PCT）、C反应蛋白、白细胞（WBC）、D二聚体和乳酸脱氢酶的峰值水平与ICU住院时间呈强烈正相关。我们使用ROC曲线（受试者工作特征曲线）评估多个实验室指标与死亡率之间的关系。我们注意到，血糖控制不佳和其他实验室指标是COVID-19患者死亡率的重要预测因素（例如，血糖峰值（P = 0.004）、PCT（P = 0.047），以及其他实验室指标（如乳酸、PH值、白细胞、D二聚体、铁蛋白）的P<0.001）。结论 我们报告了入住ICU的COVID-19患者中糖尿病和酮症的高患病率。酮症与死亡风险增加相关。血糖控制不佳是COVID-19重症患者死亡的重要预测因素。
