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      Mean Blood Glucose Level During ICU Hospitalization is a Strong Predictor of the Mortality of COVID-19

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          Abstract

          Objective

          To investigate the potential prognostic value of mean blood glucose (MBG) in hospital for prognosis of COVID-19 adult patients in the intensive unit care unit (ICU).

          Methods

          A single-site and retrospective study enrolled 107 patients diagnosed as COVID-19 from department of critical care medicine in the Second Xiangya Hospital between October 2022 and June 2023. Demographic information including glucose during ICU hospitalization, comorbidity, clinical data, types of medications and treatment, and clinical outcome were collected. The multivariate logistic and cox regression was used to explore the relationship between blood glucose changes and clinical outcomes of COVID-19 during ICU stay.

          Results

          In total, 107 adult patients confirmed with COVID-19 were included. Multivariate logistic regression results showed an increase in MBG was associated with ICU mortality rate. Compared with normal glucose group (MBG <= 7.8 mmol/L), the risk of ICU mortality, 7-day mortality and 28-day mortality from COVID-19 were significantly increased in high glucose group (MBG >7.8mmol/L).

          Conclusion

          MBG level during ICU hospitalization was strongly correlated to all-cause mortality and co-infection in COVID-19 patients. These findings further emphasize the importance of overall glucose management in severe cases of COVID-19.

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          Most cited references26

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          COVID-19 pandemic, coronaviruses, and diabetes mellitus

          Ranganath Muniyappa, Sriram Gubbi (2020)
          The pandemic of coronavirus disease (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is causing substantial morbidity and mortality. Older age and presence of diabetes mellitus, hypertension, and obesity significantly increases the risk for hospitalization and death in COVID-19 patients. In this Perspective, informed by the studies on SARS-CoV-2, Middle East respiratory syndrome (MERS-CoV), and the current literature on SARS-CoV-2, we discuss potential mechanisms by which diabetes modulates the host-viral interactions and host-immune responses. We hope to highlight gaps in knowledge that require further studies pertinent to COVID-19 in patients with diabetes.
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            Intensive insulin therapy in critically ill patients.

            G. Van den Berghe, P Wouters, F Weekers … (2001)
            Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter [4.4 and 6.1 mmol per liter]) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter [11.9 mmol per liter] and maintenance of glucose at a level between 180 and 200 mg per deciliter [10.0 and 11.1 mmol per liter]). At 12 months, with a total of 1548 patients enrolled, intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). The benefit of intensive insulin therapy was attributable to its effect on mortality among patients who remained in the intensive care unit for more than five days (20.2 percent with conventional treatment, as compared with 10.6 percent with intensive insulin therapy, P=0.005). The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus. Intensive insulin therapy also reduced overall in-hospital mortality by 34 percent, bloodstream infections by 46 percent, acute renal failure requiring dialysis or hemofiltration by 41 percent, the median number of red-cell transfusions by 50 percent, and critical-illness polyneuropathy by 44 percent, and patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care. Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
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              Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection

              Laura Montefusco, Moufida Ben Nasr, Francesca D’Addio … (2021)
              Patients with coronavirus disease 2019 (COVID-19) are reported to have a greater prevalence of hyperglycaemia. Cytokine release as a consequence of severe acute respiratory syndrome coronavirus 2 infection may precipitate the onset of metabolic alterations by affecting glucose homeostasis. Here we describe abnormalities in glycometabolic control, insulin resistance and beta cell function in patients with COVID-19 without any pre-existing history or diagnosis of diabetes, and document glycaemic abnormalities in recovered patients 2 months after onset of disease. In a cohort of 551 patients hospitalized for COVID-19 in Italy, we found that 46% of patients were hyperglycaemic, whereas 27% were normoglycaemic. Using clinical assays and continuous glucose monitoring in a subset of patients, we detected altered glycometabolic control, with insulin resistance and an abnormal cytokine profile, even in normoglycaemic patients. Glycaemic abnormalities can be detected for at least 2 months in patients who recovered from COVID-19. Our data demonstrate that COVID-19 is associated with aberrant glycometabolic control, which can persist even after recovery, suggesting that further investigation of metabolic abnormalities in the context of long COVID is warranted.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabetes Metab Syndr Obes
                Journal ID (iso-abbrev): Diabetes Metab Syndr Obes
                Journal ID (publisher-id): dmso
                Title: Diabetes, Metabolic Syndrome and Obesity
                Publisher: Dove
                ISSN (Electronic): 1178-7007
                Publication date (Electronic): 01 May 2024
                Publication date Collection: 2024
                Volume: 17
                Pages: 1903-1909
                Affiliations
                [1 ]Critical Care Medicine Center, The Second Xiangya Hospital, Central South University , Changsha, People’s Republic of China
                [2 ]National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, Key Laboratory Diseases Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University , Changsha, Hunan, People’s Republic of China
                [3 ]Department of Critical Care Medicine Center, Guilin Hospital of the Second Xiangya Hospital, The Second Xiangya Hospital of Central South University , Changsha, Hunan, People’s Republic of China
                Author notes
                Correspondence: Can Hou, National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, Key Laboratory Diseases Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University , Changsha, Hunan, People’s Republic of China, Email houcan84@csu.edu.cn
                Yanjun Zhong, Critical Care Medicine Center, The Second Xiangya Hospital, Center South University, Changsha, People’s Republic of China, Email zhongyanjun@csu.edu.cn
                [*]

                These authors contributed equally to this work

                Article
                Publisher ID: 450489
                DOI: 10.2147/DMSO.S450489
                PMC ID: 11070158
                PubMed ID: 38706805
                SO-VID: bb05b0cb-6030-4a49-82f9-9fb24f645cb9
                Copyright © © 2024 Hu et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 30 November 2023
                Date accepted : 16 April 2024
                Page count
                Figures: 1, Tables: 4, References: 26, Pages: 7
                Funding
                Funded by: Hunan Province Clinical Medical Technology Innovation Guidance;
                Funded by: Hunan Provincial Natural Science Foundation, open-funder-registry 10.13039/501100004735;
                Funded by: Research Project of Hunan Provincial Health Commission;
                Funded by: the China Scholarship Council;
                This work was supported by grants from Hunan Province Clinical Medical Technology Innovation Guidance (2020SK53403), Hunan Provincial Natural Science Foundation (2021JJ30931), Research Project of Hunan Provincial Health Commission (202103060770) and the China Scholarship Council (202206375025).
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: mean blood glucose,intensive care medicine,icu mortality,covid-19
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: mean blood glucose, intensive care medicine, icu mortality, covid-19

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