Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study.

Abstract

To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for coronavirus disease 2019 (COVID-19). Hospitalized COVID-19 patients (<i>N</i> = 271) were subdivided based on at-admission glycemic status: <i>1</i>) glucose levels <7.78 mmol/L (NG) (<i>N</i> = 149 [55.0%]; median glucose 5.99 mmol/L [range 5.38-6.72]), <i>2</i>) known diabetes mellitus (DM) (<i>N</i> = 56 [20.7%]; 9.18 mmol/L [7.67-12.71]), and <i>3</i>) no diabetes and glucose levels ≥7.78 mmol/L (HG) (<i>N</i> = 66 [24.3%]; 8.57 mmol/L [8.18-10.47]). Neutrophils were higher and lymphocytes and PaO₂/FiO₂ lower in HG than in DM and NG patients. DM and HG patients had higher D-dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs. 16.8%; unadjusted hazard ratio [HR] 2.20, 95% CI 1.27-3.81, <i>P</i> = 0.005) than in NG (16.8%) and marginally so in DM (28.6%; 1.73, 0.92-3.25, <i>P</i> = 0.086) patients. Upon multiple adjustments, only HG remained an independent predictor (HR 1.80, 95% CI 1.03-3.15, <i>P</i> = 0.04). After stratification by quintile of glucose levels, mortality was higher in quintile 4 (Q4) (3.57, 1.46-8.76, <i>P</i> = 0.005) and marginally in Q5 (29.6%) (2.32, 0.91-5.96, <i>P</i> = 0.079) vs. Q1. Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19.