Hyperglycemia is Associated with Increased Mortality in Critically Ill Patients with COVID-19

Mazori, Alon Y.; Bass, Ilana Ramer; Chan, Lili; Mathews, Kusum S.; Altman, Deena; Saha, Aparna; Soh, Howard; Wen, Huei Hsun; Bose, Sonali; Leven, Emily; Wang, Jing Gennie; Mosoyan, Gohar; Pattharanitima, Pattharawin; Greco, Giampaolo; Gallagher, Emily J.

OBJECTIVE: To explore the relationship between hyperglycemia in the presence and absence of diabetes mellitus (DM) and adverse outcomes in critically ill patients with coronavirus disease 2019 (COVID-19). METHODS: The study population comprised 133 patients with COVID-19 admitted to an intensive care unit (ICU) at an academic, urban, quaternary-care center between March 10 and April 8, 2020. Patients were categorized based on the presence of DM and early-onset hyperglycemia (EHG), defined as a blood glucose >180 mg/dL during the first two days of ICU admission. The primary outcome was 14-day, all-cause, in-hospital mortality; also examined were 60-day, all-cause, in-hospital mortality and the levels of C-reactive protein (CRP), interleukin 6, procalcitonin, and lactate. RESULTS: Compared to non-DM patients without EHG, non-DM patients with EHG exhibited higher adjusted hazard ratios (HR) for mortality at 14 days (HR 7.51, confidence interval [CI] 1.70-33.24) and 60 days (HR 6.97, CI 1.86-26.13). Non-DM patients with EHG also featured higher levels of median CRP (306.3 mg/L, p=0.036), procalcitonin (1.26 ng/mL, p=0.028), and lactate (2.2 mmol/L, p=0.023). CONCLUSION: In patients with critical illness from COVID-19, those without DM with EHG were at greatest risk of 14-day and 60-day in-hospital mortality. The limitations of our study include its retrospective design and relatively small cohort. However, our results suggest that the combination of elevated glucose and lactate may identify a specific cohort of individuals at high mortality risk from COVID-19, and suggest that glucose testing and control are important in individuals with COVID-19, even in those without pre-existing diabetes.