Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection
Abstract
Introduction. Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease.
Objective. To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection.
Materials and methods. A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed.
Results. A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia).
Conclusions. Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.
Downloads
References
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-33. https://doi.org/10.1056/NEJMoa2001017
World Health Organization. Coronavirus disease (COVID-19) pandemic. Diseases. 2020. Accessed: January 20, 2022. Available at: https://www.who.int/emergencies/diseases/novelcoronavirus-2019
Instituto Nacional de Salud. COVID-19 en Colombia. Accessed: September 20, 2022. Available at: https://www.ins.gov.co/Noticias/Paginas/Coronavirus.aspx
Khunti K, Del Prato S, Mathieu C, Kahn SE, Gabbay RA, Buse JB. COVID-19, hyperglycemia, and new-onset diabetes. Diabetes Care. 2021;44:2645-55. https://doi.org/10.2337/dc21-1318
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395:1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1,591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323:1574-81. https://doi.org/10.1001/jama.2020.5394
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052-9. https://doi.org/10.1001/jama.2020.6775
Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020;36:e3319. https://doi.org/10.1002/dmrr.3319
Jivanji CJ, Asrani VM, Windsor JA, Petrov MS. New-onset diabetes after acute and critical illness. Mayo Clin Proc. 2017;92:762-73. https://doi.org/10.1016/j.mayocp.2016.12.020
Yang JK, Feng Y, Yuan MY, Yuan SY, Fu HJ, Wu BY, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med. 2006;23:623-8. https://doi.org/10.1111/j.1464-5491.2006.01861.x
International Diabetes Federation. Colombia diabetes report 2000-2045. Atlas Diabetes 10th edition. 2021. Accessed: May 1st, 2022. Available at: https://diabetesatlas.org/data/en/country/43/co.html
Cuenta de Alto Costo. Magnitud, tendencia y acceso a los servicios de salud en las personas con enfermedades de alto costo. Accessed: October 23, 2022. Available at: https://cuentadealtocosto.org/site/general/dia-mundial-de-la-diabetes-2021/
Instituto Nacional de Salud. COVID-19 en Colombia. Accessed: December 6, 2021. Available at: https://www.ins.gov.co/Noticias/Paginas/coronavirus-comunicaciones.aspx
Seisa MO, Saadi S, Nayfeh T, Muthusamy K, Shah SH, Firwana M, et al. A Systematic review supporting the endocrine society clinical practice guideline for the management of hyperglycemia in adults hospitalized for non-critical illness or undergoing elective surgical procedures. J Clin Endocrinol Metab. 2022;107:2139-47. https://doi.org/10.1210/clinem/dgac277
Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J Diabetes Sci Technol. 2020;14:813-21. https://doi.org/10.1177/1932296820924469
Vedantam D, Poman DS, Motwani L, Asif N, Patel A, Anne KK. Stress-induced hyperglycemia: Consequences and management. Cureus. 2022;14:e26714. https://doi.org/10.7759/cureus.26714
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604-12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-20. https://doi.org/10.1001/jama.2013.284427
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377-81. https://doi.org/10.1016/j.jbi.2008.08.010
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208
Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5. https://doi.org/10.1016/j.ijid.2020.03.017
Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): Challenges and recommendations. Lancet Respir Med. 2020;8:506-17. https://doi.org/10.1016/S2213-2600(20)30161-2
Zangrillo A, Beretta L, Silvani P, Colombo S, Scandroglio AM, Dell’Acqua A, et al. Fast reshaping of intensive care unit facilities in a large metropolitan hospital in Milan, Italy: Facing the COVID-19 pandemic emergency. Crit Care Resusc. 2020;22:91-4. https://doi.org/10.51893/2020.2.pov1
Mantovani A, Byrne CD, Zheng MH, Targher G. Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis. 2020;30:1236-48. https://doi.org/10.1016/j.numecd.2020.05.014
Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020;14:535-45. https://doi.org/10.1016/j.dsx.2020.04.044
de Almeida-Pititto B, Dualib PM, Zajdenverg L, Dantas JR, de Souza FD, Rodacki M, et al. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: A meta-analysis. Diabetol Metab Syndr. 2020;12:75. https://doi.org/10.1186/s13098-020-00586-4
Iryaningrum MR, Supriyadi R, Lawrensia S, Henrina J, Soetedjo NN. Diabetes and mortality among patients with chronic kidney disease and COVID-19: A systematic review, metaanalysis, and meta-regression. Indian J Nephrol. 2022;32:327-33. https://doi.org/10.4103/ijn.ijn_293_21
Levin AT, Hanage WP, Owusu-Boaitey N, Cochran KB, Walsh SP, Meyerowitz-Katz G. Assessing the age specificity of infection fatality rates for COVID-19: Systematic review, meta-analysis, and public policy implications. Eur J Epidemiol. 2020;35:1123-38. https://doi.org/10.1007/s10654-020-00698-1
Machado-Alba JE, Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, Sánchez-Ramírez N, Usma-Valencia AF, et al. Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia. PLoS One. 2021;16:1-15. https://doi.org/10.1371/journal.pone.0260169
Leazer S, Collen J, Alcover K, Tompkins E, Ambardar S, Allard RJ, et al. Outcomes associated with intensive care and organ support among patients with COVID-19: A systematic review and meta-analysis. Mil Med. 2022;188:541-6. https://doi.org/10.1093/milmed/usac143
Smith SM, Boppana A, Traupman JA, Unson E, Maddock DA, Chao K, et al. Impaired glucose metabolism in patients with diabetes, prediabetes, and obesity is associated with severe COVID-19. J Med Virol. 2021;93:409-15. https://doi.org/10.1002/jmv.26227
Gerganova A, Assyov Y, Kamenov Z. Stress hyperglycemia, diabetes mellitus and COVID-19 infection: Risk factors, clinical outcomes and post-discharge implications. Front Clin Diabetes Health. 2022:3:826006. https://doi.org/10.3389/fcdhc.2022.826006
Mazori AY, Bass IR, Chan L, Mathews KS, Altman DR, Saha A, et al. Hyperglycemia is associated with increased mortality in critically Ill patients with COVID-19. Endocr Pract. 2021;27:95-100. https://doi.org/10.1016/j.eprac.2020.12.015
Al-Salameh A, Lanoix JP, Bennis Y, Andrejak C, Brochot E, Deschasse G, et al. Characteristics and outcomes of COVID-19 in hospitalized patients with and without diabetes. Diabetes Metab Res Rev. 2021;37:e3388. https://doi.org/10.1002/dmrr.3388
Dennis JM, Mateen BA, Sonabend R, Thomas NJ, Patel KA, Hattersley AT, et al. Type 2 diabetes and COVID-19-related mortality in the critical care setting: A National Cohort Study in England, March-July 2020. Diabetes Care. 2021;44:50-7. https://doi.org/10.2337/dc20-1444
Wang W, Snell LB, Ferrari D, Goodman AL, Price NM, Wolfe CD, et al. Real-world effectiveness of steroids in severe COVID-19: A retrospective cohort study. BMC Infect Dis. 2022;22:776. https://doi.org/10.1186/s12879-022-07750-3
Thakur M, Kumar Datusalia A, Kumar A. Use of steroids in COVID-19 patients: A metaanalysis. Eur J Pharmacol. 2022;914:174579. https://doi.org/10.1016/j.ejphar.2021.174579
Sardu C, D’Onofrio N, Balestrieri ML, Barbieri M, Rizzo MR, Messina V, et al. Outcomes in patients with hyperglycemia affected by COVID-19: Can we do more on glycemic control? Diabetes Care. 2020;43:1408-15. https://doi.org/10.2337/dc20-0723
Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003;26:510-3. https://doi.org/10.2337/diacare.26.2.510
Pearson-Stuttard J, Blundell S, Harris T, Cook DG, Critchley J. Diabetes and infection: Assessing the association with glycaemic control in population-based studies. Lancet Diabetes Endocrinol. 2016;4:148-58. https://doi.org/10.1016/S2213-8587(15)00379-4
Kulcsar KA, Coleman CM, Beck SE, Frieman MB. Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight. 2019;4:e131774. https://doi.org/10.1172/jci.insight.131774
Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009;373:1798-807. https://doi.org/10.1016/S0140-6736(09)60553-5
Vargas-Uricoechea H, Casas-Figueroa LÁ. An epidemiologic analysis of diabetes in Colombia. Ann Glob Health. 2015;81:742-53. https://doi.org/10.1016/j.aogh.2015.11.001
Some similar items:
- Juan Carlos Miguel, Ariana Erazo, Fernanda Beduino, Juan Carlos Picena, María Isabel Luciano, Gustavo Pizzuti, María Cristina Tarrés, Silvana Montenegro, Stella Maris Martínez, Chronic bronchial dilatations in different colonies of laboratory rats , Biomedica: Vol. 22 No. 2 (2002)
Copyright (c) 2024 Biomedica
This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
