Hyperglycemia in Severe and Critical COVID-19 Patients: Risk Factors and Outcomes

Viet Tran Le; Quoc Hung Ha; Minh Triet Tran; Ngoc Trong Le; Van Tuyen Le; Minh Khoi Le

doi:10.7759/cureus.27611

Hyperglycemia in Severe and Critical COVID-19 Patients: Risk Factors and Outcomes

Cureus. 2022 Aug 2;14(8):e27611. doi: 10.7759/cureus.27611. eCollection 2022 Aug.

Authors

Viet Tran Le¹, Quoc Hung Ha¹, Minh Triet Tran², Ngoc Trong Le¹, Van Tuyen Le¹, Minh Khoi Le^{3

1}

Affiliations

¹ COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, VNM.
² Department of Endocrinology, University Medical Center, Ho Chi Minh City, VNM.
³ Critical Care Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM.

Abstract

Background: Hyperglycemia is commonly seen in critically ill patients. This disorder was also seen in coronavirus disease 2019 (COVID-19) patients and was associated with a worse prognosis. The current study determined the prevalence, risk factors, and prognostic implications of hyperglycemia in COVID-19 patients.

Method: This was a retrospective observational study performed in an intensive care unit for COVID-19 patients. Electronic data of COVID-19 patients admitted to the intensive care unit from August 2nd to October 15th, 2021, were collected. Patients were divided into non-hyperglycemia, hyperglycemia in diabetic patients, and hyperglycemia in non-diabetic patients. Primary outcomes were 28-day and in-hospital mortalities. Multinomial logistic regression and multivariable Cox regression models were used to determine the risk factors for hyperglycemia and mortality, respectively.

Results: Hyperglycemia was documented in 65.6% of patients: diabetic patients (44.8%) and new-onset hyperglycemia (20.8%). In-hospital and 28-day mortality rates were 30.2% and 26.1%, respectively. Respiratory failure, corticosteroid therapy, and a higher level of procalcitonin were risk factors for hyperglycemia in diabetic patients, whereas cardiovascular diseases, respiratory failure, and higher aspartate aminotransferase/glutamate aminotransferase ratio were risk factors for hyperglycemia in non-diabetic patients. The risk of the 28-day mortality rate was highest in the new-onset hyperglycemia (hazard ratio [HR] 3.535, 95% confidence interval [CI] 1.338-9.338, p=0.011), which was higher than hyperglycemia in type 2 diabetes mellitus patients (HR 1.408, 95% CI 0.513-3.862, p=0.506).

Conclusion: Hyperglycemia was common in COVID-19 patients in the intensive care unit. Hyperglycemia reflected the disease severity but was also secondary to therapeutic intervention. New-onset hyperglycemia was associated with poorer outcomes than that in diabetic patients.

Keywords: corticosteroid; covid-19; diabetes; hyperglycemia; intensive care.