Background
Evaluation of the impact of at-admission hyperglycemia and its management on the outcome of non-diabetic COVID-19 patients concerning development of critical illness.
Methods
In total, 364 patients were categorized according to at-admission random blood glucose (RBG) as persistent hyperglycemic (PHG) if at-admission and 6-hr RBG was >140 mg/dl or as stress hyperglycemic (SHG) if at-admission RBG was >140 mg/dl but decreased 6 hr later. Only PHG patients received intensive insulin therapy (IIT) using dose titration schedule according to Leuven titration protocol. All patients were evaluated for critical illness risk using the COVID-GRAM Critical Illness Risk (CG-CIR) score. Study outcomes are the incidence of critical illness and mortality rate (MR) and its relation with the levels of at-admission RBG and inflammatory markers.
Results
One hundred and twenty-three patients had PHG and received IIT, and 241 had SHG. Unfortunately, 138 patients developed critical illness and 58 of them deceased with significantly lower incidences among patients who received IIT. Progress to critical disease and mortality were significantly correlated with high CG-CIS scores, RBG and serum levels of CRP and IL-6 but showed negative significant correlation with the application of IIT. The automatic linear modeling analysis defined high at-admission RBG as the most important predictor for progress to critical illness (57%) and mortality (60%), and the Mentel-Haenszel statistic defined IIT as a significant independent predictor for survival of critical COVID patients with at-admission hyperglycemia.
Conclusion
Admission hyperglycemia worsens the outcomes of non-diabetic COVID patients, and this effect is positively correlated with RBG. IIT is a safe and effective management and improves outcomes.