Admission glycemia associated with mortality and hospital stay in a multidisciplinary service of a Peruvian national hospital

Authors

  • Víctor Raúl García-Ruiz Hospital Nacional Edgardo Rebagliati Martins , EsSalud, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú.
  • Julio Álvarez-Gamero Hospital Nacional Edgardo Rebagliati Martins , EsSalud, Lima, Perú; Universidad Peruana Cayetano Heredia, Lima, Perú.
  • Carolina Salas-Rodríguez Hospital Nacional Edgardo Rebagliati Martins , EsSalud, Lima, Perú; Universidad Privada Ricardo Palma, Lima, Perú.
  • Fernando Quinto-Reyes Hospital Nacional Edgardo Rebagliati Martins , EsSalud, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú.
  • Sofia Sáenz-Bustamante Instituto Nacional de Ciencias Médica y Nutrición Salvador Zubirán, México DF, México; Universidad Nacional Mayor de San Marcos, Lima, Perú.
  • José Paz-Ibarra Hospital Nacional Edgardo Rebagliati Martins , EsSalud, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú.

DOI:

https://doi.org/10.35434/rcmhnaaa.2022.154.1555

Keywords:

Blood Glucose, Diabetes Mellitus, COVID-19, SARS-CoV-2, Mortality, Mechanical Ventilation, Hospital Stay

Abstract

Objective: Evaluate the association between glycemia on admission and adverse outcomes in hospitalized patients with COVID19 in a Peruvian national hospital. 

Methods: Retrospective, observational cohort study. We collected data from electronic medical records of COVID19 patients in a medical specialties service. Patients were classified according to blood glucose levels on admission: ≤ and >140mg/dL. Primary outcome was mortality, and the secondary a composite that included mortality, septic shock, mechanical ventilation, or transfer to ICU. We also evaluated hospital stay and a multivariate logistic regression sub analysis was performed in diabetic patients.

Results: 169 patients were evaluated. The mean age was 61 years, 64.5% were male. 71% had at least one comorbidity, the most frequent: arterial hypertension (34%), obesity (30%) and diabetes (26%). 70% presented tomographic gravity. Median blood glucose at admission was 126.5mg/dL (IQR: 109-157mg/dL), one of every 3 had blood glucose levels >140mg/dL. Mortality rate was 9700 deaths per 100000 person-weeks, with a frequency of 21.3%. No significant difference was found between hyperglycemia and normoglycemia, mortality and in composite outcome. Patients with hyperglycemia on admission had longer hospital stay than normoglycemic patients (19 vs 13 days, p<0.01). In sub-analysis with multivariate logistic regression for composite outcome among diabetic patients, admission blood glucose >180mg/dL presented OR of 6.42 (95% CI: 1.07-38.6) for composite outcome, adjusted for age and clinical severity at admission.

Conclusions: Hyperglycemia at admission was associated with a longer hospital stay and diabetic patients with hyperglycemia >180mg/dL had a 6-fold increased risk of presenting an adverse outcome.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Víctor Raúl García-Ruiz , Hospital Nacional Edgardo Rebagliati Martins , EsSalud, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú.

  1. Médico especialista en Endocrinología.

Julio Álvarez-Gamero , Hospital Nacional Edgardo Rebagliati Martins , EsSalud, Lima, Perú; Universidad Peruana Cayetano Heredia, Lima, Perú.

  1. Médico especialista en Endocrinología.

References

WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020 [Internet]. [citado 24 de enero de 2021]. Disponible en: https://www.who.int/director-general/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020

COVID-19 Map - Johns Hopkins Coronavirus Resource Center [Internet]. [citado 24 de enero de 2021]. Disponible en: https://coronavirus.jhu.edu/map.html

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 Lond Engl. 2020 Mar 28;395(10229):1054–62.

Paz-Ibarra J. Manejo de la diabetes mellitus en tiempos de COVID-19. Acta Médica Peru. 2020 Apr;37(2):176–85.

Paz-Ibarra J. Manejo del paciente hospitalizado con diabetes mellitus y COVID-19. An Fac Med. 2020 Apr;81(2):242–4.

Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020 May;55(5):2000547.

Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol Off J Ger Card Soc. 2020 May;109(5):531–8.

Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol. 2020 Sep;8(9):782–92.

Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020 Aug;14(4):395–403.

Shi Q, Zhang X, Jiang F, Zhang X, Hu N, Bimu C, et al. Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study. Diabetes Care. 2020 Jul;43(7):1382–91.

American Diabetes Association. 15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020 Jan;43(Suppl 1):S193–202.

Forbes A, Murrells T, Mulnier H, Sinclair AJ. Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018 Jun;6(6):476–86.

Xu M, Liu PP, Li H. Innate Immune Signaling and Its Role in Metabolic and Cardiovascular Diseases. Physiol Rev. 2019 Jan 1;99(1):893–948.

Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003 Jun 4;289(21):2801–9.

Zhang Y, Li H, Zhang J, Cao Y, Zhao X, Yu N, et al. The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: A single-centre, retrospective, observational study in Wuhan. Diabetes Obes Metab. 2020 Aug;22(8):1443–54.

Li H, Tian S, Chen T, Cui Z, Shi N, Zhong X, et al. Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19. Diabetes Obes Metab. 2020 Oct;22(10):1897–906.

Ministerio de Salud del Perú (MINSA). Documento técnico: Prevención y Atención de personas afectadas por COVID-19 en el Perú. Resolución Ministerial No 139-2020-MINSA. 2020; Disponible en: https://cdn.www.gob.pe/uploads/document/file/574295/resolucion-ministerial-139-2020-MINSA.PDF

Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med. 2020 May;35(5):1545–9.

Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol. 2020 Oct;92(10):1902–14.

Zhou Y, Yang Q, Chi J, Dong B, Lv W, Shen L, et al. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2020 Oct;99:47–56.

Carrasco-Sánchez FJ, López-Carmona MD, Martínez-Marcos FJ, Pérez-Belmonte LM, Hidalgo-Jiménez A, Buonaiuto V, et al. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Ann Med. 2021 Dec;53(1):103–16.

Fadini GP, Morieri ML, Boscari F, Fioretto P, Maran A, Busetto L, et al. Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. Diabetes Res Clin Pract. 2020 Oct;168:108374.

Vojtková J, Ciljaková M, Michnová Z, Turčan T. Chronic complications of diabetes mellitus related to the respiratory system. Pediatr Endocrinol Diabetes Metab. 2012;18(3):112–5.

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 J Br Diabet Assoc. 2006 Jun;23(6):623–8.

Singh AK, Singh R. At-admission hyperglycemia is consistently associated with poor prognosis and early intervention can improve outcomes in patients with COVID-19. Diabetes Metab Syndr. 2020 Dec;14(6):1641–4.

Wang S, Ma P, Zhang S, Song S, Wang Z, Ma Y, et al. 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):2102–11.

Coppelli A, Giannarelli R, Aragona M, Penno G, Falcone M, Tiseo G, et al. Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study. Diabetes Care. 2020 Oct;43(10):2345–8.

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 Jul;43(7):1408–15.

Brufsky A. Hyperglycemia, hydroxychloroquine, and the COVID-19 pandemic. J Med Virol. 2020 Jul;92(7):770–5.

Rees EM, Nightingale ES, Jafari Y, Waterlow NR, Clifford S, B Pearson CA, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med. 2020 Sep 3;18(1):270.

Published

2023-02-06

How to Cite

1.
García-Ruiz VR, Álvarez-Gamero J, Salas-Rodríguez C, Quinto-Reyes F, Sáenz-Bustamante S, Paz-Ibarra J. Admission glycemia associated with mortality and hospital stay in a multidisciplinary service of a Peruvian national hospital. Rev. Cuerpo Med. HNAAA [Internet]. 2023 Feb. 6 [cited 2024 May 15];15(4):555-60. Available from: http://cmhnaaa.org.pe/ojs/index.php/rcmhnaaa/article/view/1555