Impact of Hyperglycemia on Cardiovascular Events and Clinical Outcomes in Patients Hospitalized With COVID-19 Pneumonia

Abstract

Objective: To study cardiovascular events and clinical outcomes in patients with elevated glycated hemoglobin (HbA1c) levels and/or admission hyperglycemia and those with type 2 diabetes hospitalized with SARS-CoV-2 pneumonia.

Methods: This was a multicenter retrospective study of 1645 patients hospitalized with SARS-CoV-2 pneumonia. Diagnosis of SARS-CoV-2 pneumonia required a positive reverse transcription-polymerase chain reaction result for SARS-CoV-2, presence of new or worsening pulmonary infiltrates on computed tomography scan or chest x-ray, and at least one of following: (1) new or increased cough, (2) temperature of >37.8 °C, or (3) dyspnea. Outcomes included in-hospital cardiovascular events, intensive care unit admission, and mortality. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for association of elevated HbA1c levels and/or admission hyperglycemia and type 2 diabetes for individual outcomes.

Results: Among 1645 adults hospitalized with SARS-CoV-2 pneumonia, 18 with type 1 diabetes were excluded from the analysis. Of 1627 adults, 634 (39%) had known diagnosis of type 2 diabetes, and among 993 patients with no diabetes, 107 (10.8%) patients were identified with elevated HbA1c levels and/or admission hyperglycemia. Patients with elevated HbA1c levels and/or admission hyperglycemia had increased odds of developing acute in-hospital cardiovascular events (OR, 1.73; 95% CI, 1.07-2.80), intensive care unit admissions (OR, 1.61; 95% CI, 1.10-2.34), and mortality (OR, 1.77; 95% CI, 1.02-3.07) compared to patients with type 2 diabetes and no diabetes.

Conclusion: Patients with elevated HbA1c levels and/or admission hyperglycemia hospitalized with SARS-CoV-2 pneumonia have increased risk of developing acute in-hospital cardiovascular complications and overall poor clinical outcomes compared with patients with type 2 diabetes and no diabetes.

Keywords: COVID-19; SARS-CoV-2; cardiovascular events; hyperglycemia; mortality; pneumonia.