Prognostic value of fasting hyperglycemia in patients with COVID-19 - Diagnostic test accuracy meta-analysis

Dewi Ratih Handayani; Henny Juliastuti; Eka Noneng Nawangsih; Yudith Yunia Kusmala; Iis Inayati Rakhmat; Arief Wibowo; Raymond Pranata

doi:10.1016/j.obmed.2021.100333

Prognostic value of fasting hyperglycemia in patients with COVID-19 - Diagnostic test accuracy meta-analysis

Obes Med. 2021 May:23:100333. doi: 10.1016/j.obmed.2021.100333. Epub 2021 Apr 4.

Authors

Dewi Ratih Handayani¹, Henny Juliastuti¹, Eka Noneng Nawangsih², Yudith Yunia Kusmala³, Iis Inayati Rakhmat¹, Arief Wibowo⁴, Raymond Pranata^{4

5}

Affiliations

¹ Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
² Department of Microbiology, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
³ Department of Internal Medicine, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
⁴ Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
⁵ Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.

Abstract

Aims: This meta-analysis aimed to assess the prognostic value of fasting hyperglycemia in patients with COVID-19.

Methods: A systematic literature search on PubMed, Embase, and Scopus were performed up until February 18, 2021. Fasting hyperglycemia was defined as fasting plasma glucose level above the reference value. The outcome of interest was poor outcome, which was a composite of mortality and severe COVID-19. The effect estimate was in odds ratio (OR).

Results: There were 9045 patients from 12 studies included in this systematic review and meta-analysis. The prevalence of fasting hyperglycemia was 29%. The incidence of poor outcome was 15%. Fasting hyperglycemia was associated with poor outcome in COVID-19 (OR 4.72 [3.32, 6.72], p < 0.001; I²: 69.8%, p < 0.001). Subgroup analysis in patients without prior history of diabetes showed that fasting hyperglycemia was associated with poor outcome in COVID-19 (OR 3.387 [2.433, 4.714], p < 0.001; I²: 0, p = 0.90). Fasting hyperglycemia has a sensitivity of 0.57 [0.45, 0.68], specificity of 0.78 [0.70, 0.84], PLR of 2.6 [2.0, 3.3], NLR of 0.55 [0.44, 0.69], DOR of 5 [3, 7], and AUC of 0.74 [0.70, 0.78] for predicting poor outcome. In this pooled analysis, fasting hyperglycemia has a 32% post-test probability for poor outcome, and absence of fasting hyperglycemia confers to a 9% post-test probability. Meta-regression and subgroup analysis showed that the sensitivity and specificity varies by chronic kidney disease but not by age, male (gender), hypertension, and chronic kidney disease.

Conclusion: Fasting hyperglycemia was associated with mortality in COVID-19 patients, with or without diabetes.

Prospero: CRD42021237997.

Keywords: Coronavirus; Glucose; Mortality; SARS-CoV-2; Severity.