Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry

Carrasco-Sánchez, Francisco Javier; López-Carmona, Mª Dolores; Martínez-Marcos, Francisco Javier; Pérez-Belmonte, Luis M.; Hidalgo-Jiménez, Alicia; Buonaiuto, Verónica; Suárez Fernández, Carmen; Freire Castro, Santiago Jesús; Luordo, Davide; Pesqueira Fontan, Paula Maria; Blázquez Encinar, Julio César; Magallanes Gamboa, Jeffrey Oskar; de la Peña Fernández, Andrés; Torres Peña, José David; Fernández Solà , Joaquim; Napal Lecumberri, Jose Javier; Amorós Martínez, Francisco; Guisado Espartero, María Esther; Jorge Ripper, Carlos; Gómez Méndez, Raquel; Vicente López, Natalia; Román Bernal, Berta; Rojano Rivero, María Gloria; Ramos Rincón, José Manuel; Gómez Huelgas, Ricardo

BACKGROUND: Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. METHODS: This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140–180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. RESULTS: Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140–180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31–1.73) (BG 140–180 mg/dL; HR 1.48; 95%CI: 1.29–1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. CONCLUSIONS: KEY MESSAGE: Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.