Inflammatory biomarkers predict higher risk of hyperglycemic crises but not outcomes in diabetic patients with COVID-19

Front Endocrinol (Lausanne). 2024 Feb 15:15:1287795. doi: 10.3389/fendo.2024.1287795. eCollection 2024.

Abstract

Background: Inflammation is a predictor of severe complications in patients with COVID-19 infection under a variety of clinical settings. A few studies suggested that COVID-19 infection was a trigger of hyperglycemic crises including diabetic ketoacidosis (DKA) and/or hyperglycemic hyperosmolar state (HHS). However, the association between inflammation and hyperglycemic crises in diabetic patients with COVID-19 infection is unclear.

Methods: One hundred and twenty-four patients with type 2 diabetes mellitus (T2DM) and COVID-19 infection from January 2023 to March 2023 were retrospectively analyzed. Demographic, clinical, and laboratory data, especially inflammatory markers including white blood cell (WBC), neutrophils, neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP) and procalcitonin (PCT) were collected and compared between patients with or without DKA and/or HHS. Multivariable logistic regression analysis was conducted to explore the association between inflammatory biomarkers and the prevalence of hyperglycemic crises. Patients were followed up 6 months for outcomes.

Results: Among 124 diabetic patients with COVID-19, 9 were diagnosed with DKA or HHS. Comparing COVID-19 without acute diabetic complications (ADC), patients with DKA or HHS showed elevated levels of c-reactive protein (CRP, P=0.0312) and procalcitonin (PCT, P=0.0270). The power of CRP and PCT to discriminate DKA or HHS with the area under the receiver operating characteristics curve (AUROC) were 0.723 and 0.794, respectively. Multivariate logistic regression indicated 1.95-fold and 1.97-fold increased risk of DKA or HHS with 1-unit increment of CRP and PCT, respectively. However, neither CRP nor PCT could predict poor outcomes in diabetic patients with COVID-19.

Conclusion: In this small sample size study, we firstly found that elevated serum CRP and PCT levels increased the risk of hyperglycemic crises in T2DM patients with COVID-19 infection. More study is needed to confirm our findings.

Keywords: C-reactive protein; diabetic ketoacidosis; hyperglycemic hyperosmolar state; procalcitonin; type 2 diabetes mellitus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers
  • C-Reactive Protein
  • COVID-19* / complications
  • Diabetes Mellitus, Type 2* / complications
  • Diabetic Ketoacidosis* / complications
  • Humans
  • Hyperglycemic Hyperosmolar Nonketotic Coma* / diagnosis
  • Hyperglycemic Hyperosmolar Nonketotic Coma* / epidemiology
  • Hyperglycemic Hyperosmolar Nonketotic Coma* / etiology
  • Inflammation / complications
  • Procalcitonin
  • Retrospective Studies

Substances

  • C-Reactive Protein
  • Procalcitonin
  • Biomarkers

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the National Natural Science Foundation of China (NSFC) grants 82170356 and Top talent of Changzhou “The 14th Five-Year Plan” High-Level Health Talents Training Project (2022260).