Hyperglycemia On Hospital Admission Tied To COVID-19 Mortality

Blood glucose level on hospital admission is an independent predictor of all-cause mortality during hospitalization for COVID-19, according to Spanish researchers.

Based on the findings, Dr. Francisco Javier Carrasco-Sanchez of Juan Ramon Jimenez University Hospital, in Huelva, told Reuters Health by email that blood-glucose testing should be "mandatory" in all COVID-19 patients whether or not they have diabetes.

Acute hyperglycemia in general has been associated with in-hospital complications in non-critically ill patients with and without diabetes mellitus, Dr. Carrasco-Sanchez and colleagues note in the Annals of Medicine.

The researchers examined data in the Spanish SEMI-COVID-19 Registry covering 109 hospitals on more than 11,000 patients who "were treated at their attending physician's discretion, according to local protocols." Their mean age was 67 years.

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19% of the patients had diabetes, and 20% died during hospitalization. In patients with blood glucose levels below 140 mg/dL, the in-hospital mortality rate was 16%; for levels between 140 and 180 mg/dL it was 34% and beyond 180 mg/dL, 41% (P<0.001).

Patients with higher admission blood glucose levels were older and more often male and more frequently had a history of diabetes, hypertension and other comorbidities.

Regardless of pre-existing diabetes, the cumulative probability of mortality was significantly higher in patients with hyperglycemia than in those with normoglycemia. After adjusting for age, diabetes, hypertension and other confounders, the hazard ratio was 1.50 for highest versus lowest blood glucose levels and 1.48 for those with midrange levels.

There were similar findings for the composite outcome of admission to the intensive-care unit, mechanical ventilation and/or death. The odds for this outcome were twice as high for those with the highest blood glucose levels and 70% higher for those with midrange levels.

"Hence," the researchers conclude, "admission hyperglycemia should not be overlooked, but rather detected and appropriately treated to improve the outcomes of COVID-19 patients with and without diabetes."

—David Douglas

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