Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study

Diabetologia. 2020 Oct;63(10):2102-2111. doi: 10.1007/s00125-020-05209-1. Epub 2020 Jul 10.

Abstract

Aims/hypothesis: Hyperglycaemia is associated with an elevated risk of mortality in community-acquired pneumonia, stroke, acute myocardial infarction, trauma and surgery, among other conditions. In this study, we examined the relationship between fasting blood glucose (FBG) and 28-day mortality in coronavirus disease 2019 (COVID-19) patients not previously diagnosed as having diabetes.

Methods: We conducted a retrospective study involving all consecutive COVID-19 patients with a definitive 28-day outcome and FBG measurement at admission from 24 January 2020 to 10 February 2020 in two hospitals based in Wuhan, China. Demographic and clinical data, 28-day outcomes, in-hospital complications and CRB-65 scores of COVID-19 patients in the two hospitals were analysed. CRB-65 is an effective measure for assessing the severity of pneumonia and is based on four indicators, i.e. confusion, respiratory rate (>30/min), systolic blood pressure (≤90 mmHg) or diastolic blood pressure (≤60 mmHg), and age (≥65 years).

Results: Six hundred and five COVID-19 patients were enrolled, including 114 who died in hospital. Multivariable Cox regression analysis showed that age (HR 1.02 [95% CI 1.00, 1.04]), male sex (HR 1.75 [95% CI 1.17, 2.60]), CRB-65 score 1-2 (HR 2.68 [95% CI 1.56, 4.59]), CRB-65 score 3-4 (HR 5.25 [95% CI 2.05, 13.43]) and FBG ≥7.0 mmol/l (HR 2.30 [95% CI 1.49, 3.55]) were independent predictors for 28-day mortality. The OR for 28-day in-hospital complications in those with FBG ≥7.0 mmol/l and 6.1-6.9 mmol/l vs <6.1 mmol/l was 3.99 (95% CI 2.71, 5.88) or 2.61 (95% CI 1.64, 4.41), respectively.

Conclusions/interpretation: FBG ≥7.0 mmol/l at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes. Glycaemic testing and control are important to all COVID-19 patients even where they have no pre-existing diabetes, as most COVID-19 patients are prone to glucose metabolic disorders. Graphical abstract.

Keywords: Coronavirus disease 2019; Fasting blood glucose; Mortality.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus / isolation & purification*
  • Betacoronavirus / pathogenicity
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • COVID-19
  • COVID-19 Testing
  • China / epidemiology
  • Clinical Laboratory Techniques
  • Coronavirus Infections / blood*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / virology
  • Fasting / blood*
  • Female
  • Hospital Mortality*
  • Host Microbial Interactions
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Patient Admission*
  • Pneumonia, Viral / blood*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / virology
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • SARS-CoV-2
  • Time Factors

Substances

  • Biomarkers
  • Blood Glucose