Hyperglycemia as a metabolic factor associated with death from COVID 19
Keywords:
biomarkers, COVID-19, hyperglycemiaAbstract
Introduction: COVID-19 most frequently affects adults with comorbidities and risk factors that promote a proinflammatory state. Hyperglycemia is among the factors most frequently associated with severity.
Objective: To epidemiologically and humorally characterize the deaths of diabetic and non-diabetic patients with COVID-19 who had abnormalities in baseline blood glucose levels upon admission.
Methods: A cross-sectional, analytical study was conducted from March 2020 to January 2022, including 309 deceased patients. The following variables were included: age, sex, previous diagnosis of diabetes mellitus, presence of other comorbidities, clinical presentation, hospital stay, and clinical laboratory variables. Descriptive statistics and chi-square tests were applied.
Results: Altered baseline blood glucose levels were primarily associated with age over 60 years (55.5% vs. 62.5%), respiratory symptoms (90.5% vs. 65.1%), and having three or more comorbidities (61.5% vs. 56.7%). In diabetic patients, a personal medical history and abnormal laboratory parameters predominated, while in non-diabetic patients, prolonged hospital stays and delays in seeking medical care were more common.
Conclusions: Patients who died from COVID-19 and had abnormal baseline blood glucose levels on admission were characterized by older age, respiratory symptoms, and multiple comorbidities.
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References
1. Zhu N, Zhang D, Wang W, Yang B, Song J, Tan W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019 [Internet]. New Engl J Med. 2020 [acceso: 15/07/2023]; 382(8):727-33. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31978945/
2. Galbán-García E, Más-Bermejo P. COVID-19 in Cuba: Assessing the National Response [Internet]. MEDICC Review. 2021 [acceso: 15/07/2023]; 22(4):29-34. Disponible en: https://www.scielosp.org/article/medicc/2020.v22n4/29-34/en/#
3. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019 [Internet]. J Clin Invest. 2020 [acceso: 15/07/2023]; 130(5):2620-9. Disponible en: https://www.jci.org/articles/view/137244/pdf
4. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China [Internet]. Clin Infect Dis. 2020 [acceso: 15/07/2023]: 71(15):762-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32161940/
5. Wang L, Shen Y, Li M, Chuang H, Ye Y, Zhao H, et al. Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis [Internet]. Journal of neurology. 2020; 267(10):2777-89. DOI: 10.1007/s00415-020-09974-2
6. Miranda-Ruiz R, Castañón-González JA. Hiperglucemia en pacientes graves y en estado crítico. Implicaciones clínicas para su tratamiento [Internet]. Cir Cir. 2004 [acceso: 26/04/2024]; 72(6):517-24. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen..cgi?IDARTICULO=1445#
7. Bar-Or D, Rael LT, Madayag RM, Baton KL, Tanner A, Acuna DL, et al. Stress hyperglycemia in critically ill patients: insight into possible molecular pathways [Internet]. Front Med (Lausanne). 2019 [acceso: 16/07/2023]; 6:54. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30972338/
8. Cely C, Arora P, Quartin A, Kett D, Schein R. Relationship of baseline glucose homeostasis of hyperglycemia during medical critical illness [Internet]. Chest. 2004 [acceso: 16/07/2023]; 126(3):879-87. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15364770/
9. Alanazi KH, Abedi GR, Midgley CM, Alkhamis A, Alsarger T, Almoaddi A, et al . Diabetes mellitus, hypertension, and death among 32 patients with MERS CoV infection, Saudi Arabia [Internet]. Emerg Infect Dis. 2020 [acceso: 16/07/2023]; 26(1):166–8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924889/
10. Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, et al. Glycemic characteristicsand clinical outcomes of COVID-19 patients hospitalized in the United States [Internet]. J Diabetes Sci Technol. 2020 [acceso: 16/07/2023]; 14(4):813-21. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32389027/
11. Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes [Internet]. CellMetab. 2020; 31(6):1068–77. DOI: 10.1016/j.cmet.2020.04.021
12. Chen R, Liang W, Jiang M, Guan W, Zhan C, Wang T, et al. Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China [Internet]. Chest. 2020 [acceso: 16/07/2023]; 158(1):97-105. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32304772/
13. Fériz-Bonelo K. Inpatient management of diabetes and COVID-19 [Internet]. Revista Colombiana De Endocrinología, Diabetes & Amp Metabolismo. 2020; 7(2S):76–9. DOI: 10.53853/encr.7.2S.588
14. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021 [Internet]. Diabetes Care. 2021; 44(9):2182. DOI: 10.2337/dc21-S002
15. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2025 [Internet]. Diabetes Care. 2024; 48(Supplement_1):pS27-S49. DOI: 10.2337/dc25-S002
16. Rodríguez Puga R. Actualización de la Declaración de Helsinki, avances en ética y protección de la investigación médica [Internet]. Rev Cubana Med Milit. 10 de enero de 2025 [acceso: 22/02/2025]; 54(1):e025076247. Disponible en: https://revmedmilitar.sld.cu/index.php/mil/article/view/76247
17. Aguero-Figueredo C, Agüero-Figueredo M, López-Barrero Y, Zúñiga-Fernández L. Manifestaciones digestivas en pacientes hospitalizados con la COVID-19 [Internet]. Revista Cubana de Medicina Militar. 2022 [acceso: 17/07/2023]; 51(2):e1884. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572022000200016
18. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy [Internet]. JAMA. 2020 [acceso: 17/07/2023]; 323(18): 1775–6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32203977/
19. Bonanad C, García-Blas S, Tarazona-Santabalbina F, Sanchis J, Bertomeu-González V, Fácila L, et al.The Effect of Age on Mortality in Patients with COVID-19: A Meta-Analysis with 611,583 Subjects [Internet]. J Am Med Dir Assoc. 2020 [acceso: 17/07/2023]; 21(7):915-8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247470/pdf/main.pdf
20. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li, M, et al. Predictors of mortality for patients with COVID19 pneumonia caused by SARS-CoV-2: a prospective cohort study [Internet]. EurRespir J. 2020 [acceso: 15/07/2023]; 55:2000524. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144257/pdf/ERJ-00524-2020.pdf
21. Guo L, Wei D, Zhang X, Wu Y, Li Q, Zhou M, et al. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTAscore [Internet]. Front Microbiol. 2019 [acceso: 17/07/2023]; 102752. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31849894/
22. Mejía-Vilet JM, Córdova-Sánchez BM, Fernández-Camargo DA, Méndez-Pérez RA, Morales-Buenrostro LE, Hernández-Gilsoul T. A risk score to predict admission to the intensive care unit in patients with Covid-19: the ABC-GOALS score [Internet]. Salud pública Méx. 2021; 63(1):1-11. DOI: 10.6084/m9.figshare.12611174
23. Pascual Gómez NF, Monge Lobo I, Granero Cremades I, FiguerolaTejerina A, Ramasco Rueda F, VonWernitzTeleki A, et al. Potencial biomarcadores predictores de mortalidad en pacientes COVID-19 en el Servicio de Urgencias [Internet]. Rev EspQuimioter. 2020 [acceso: 17/07/2023]; 33(4):267-73. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374038/pdf/revespquimioter-33-267.pdf
24. Wanhella KJ, Fernandez-Patron C. Biomarkers of ageing and frailty may predict COVID-19 severity. Ageing Research Reviews [Internet]. 2022 [acceso: 15/07/2023]; 73:101513. Disponible en: https://www.sciencedirect.com/science/article/pii/S1568163721002609
25. Sirvent JM, Baro A, Morales M, Sebastian P, Saiz X. Predictive biomarkers of mortality in critically ill patients with COVID-19 [Internet]. Medicina Intensiva. 2022 Feb [acceso: 15/07/2023]; 46(2):94-6. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8635425/
26. Gutiérrez Suárez J, Almonacid Urrego CC, Hernández Roja E, Mendieta Zerón H. Valor pronóstico de los marcadores bioquímicos en pacientes con COVID-19 [Internet]. NOVA. 2020 [acceso: 15/07/2023]; 18(35):53-60. Disponible en: http://www.scielo.org.co/pdf/nova/v18nspe35/1794-2470-nova-18-spe35-53.pdf
27. Dietz W, Santos-Burgoa C. Obesity and its Implications for COVID-19 Mortality [Internet]. Obesity. 2020; 28(6):1005. DOI: 10.1002/oby.22818
28. Huyut MT, Ilkbahar F. The effectiveness of blood routine parameters and some biomarkers as a potential diagnostic tool in the diagnosis and prognosis of Covid-19 disease [Internet]. International Immunopharmacology. 2021 [acceso: 15/07/2023]; 98:107838. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34303274/
29. Basbus L, Lapidus MI, Martingano I. Índice neutrófilo-linfocito como factor pronóstico de COVID-19 [Internet]. MEDICINA (Buenos Aires). 2020 [acceso: 17/07/2023]; 80(Suppl 3):31-6. Disponible en: https://www.medicinabuenosaires.com/indices-de-2020/volumen-80-ano-2020-s-3-indice/indice_covid/
30. Hurtado-de-Mendoza-Amat J, Montero-González T, Borrajero-Martínez I, Capó-de-Paz V, López-Marín L, Domínguez-Álvarez C. Experiencias de autopsias a fallecidos por la COVID-19 [Internet]. Revista Cubana de Medicina Militar. 2022 [acceso: 15/07/2023]; 51(2):e181934. Disponible en: http://revmedmilitar.sld.cu/index.php/mil/article/view/181934
31. Romanova ES, Vasilyev VV, Startseva G, Karev V, Rybakova MG, PG P. Cause of death based onsystematic post-mortem studies in patients with positive SARS-CoV-2 tissue PCR during the COVID-19 pandemic [Internet]. J Intern Med. 2021 [acceso: 15/07/2023]; 290(3):655-65. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250818/
32. Capó-de-Paz V, Borrajero-Martínez I, Montero-González T, Hurtado-de-Mendoza-Amat J, de-Armas-Rodríguez Y, Domínguez-Álvarez C. Hallazgos de autopsias de 50 fallecidos con SARS-CoV-2 en Cuba entre abril y septiembre de 2020 [Internet]. Anales de la Academia de Ciencias de Cuba. 2021 [acceso: 15/07/2023]; 11(2):e994. Disponible en: http://www.revistaccuba.cu/index.php/revacc/article/view/994
33. Carsana L, Sonzogni A, Nasr A, Rossi RS, Pellegrinelli A, Zerbi PMD, et al. Pulmonary post-mortem findings in a large series of COVID-19 cases from Northern Italy [Internet]. MedRxivpreprint. 2020; DOI: 10.1101/2020.04.19.20054262
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