Increased Fasting Glucose Doubles COVID-19 Mortality Risk

New data from a pair of Wuhan-based hospital suggests fasting glucose levels could be used as an independent predictor for mortality in patients with coronavirus disease 2019 (COVID-19)—even in those without diabetes.

Results of the study, which assessed rates of 28-day mortality, found a fasting blood glucose level of 7.0 mmol/L or greater was associated with 2 times greater odds of death in a population of more than 600 COVID-19 patients.

“Blood sugar testing and control should be recommended to all COVID-19 patients even if they do not have pre-existing diabetes, as most COVID-19 patients are prone to glucose metabolic disorders,” wrote study investigators. “During a pandemic of COVID-19, measuring fasting blood glucose can facilitate the assessment of prognosis and early intervention of hyperglycaemia to help improve the overall outcomes in treatment of COVID-19."

To further evaluate and identify potential risk factors for increased mortality and disease severity, a team of investigators from Huazhong University of Science and Technology designed a retrospective study of patients from the Wuhan Union West Hospital and Wuhan Red Cross Hospital. Specifically, investigators designed their study to include all consecutive patients admitted between January 24, 2020 and February 10, 2020.

For inclusion in the study, patients needed to have a definitive outcome within 28 days of index hospitalization. Outcomes of interest included in the analysis were death, discharge, or still being hospitalized. Of note, the investigators analysis also assessed associations between CRB-65 scores and odds of mortality at 28 days.

In total, 1258, peopled were assessed for eligibility. Of these, 605 were included in the analysis. All patients included in the study received standard treatment, which included antiviral therapy, respiratory support, symptomatic and supportive treatment as well as antimicrobial therapy, when appropriate, to prevent or treat secondary infections. Of the 605 patients included in the study, 114 died within 28 days of index hospitalization.

In multivariable Cox regression analysis, results suggested age (HR, 1.02; 95% CI, 1.00-1.04), male sex (HR, 1.75; 95% CI, 1.17-2.60), a CRB-65 score of 1-2 (HR, 2.68; 95% CI, 1.56-4.59), a CRB-65 score of 3-4 (HR, 5.25; 95% CI, 2.05-13.43), and a fasting blood glucose level of 7.0 mmol/L or more (HR, 2.30; 95% CI, 1.49-3.55) were all independent predictors of mortality. Results of the analysis also indicated patients with fasting glucose levels of 7 mmol/L or greater (HR, 3.99; 95% CI, 2.71-5.88) and 6.1-6.9 mmol/L (HR, 2.61; 95% CI, 1.64-4.41) were associated with increased odds of mortality compared to those with a fasting glucose level of 6.1 mmol/L.

“Similarly to what was found in a previous study, COVID-19 patients might suffer from high blood sugar brought about by other conditions, and critically ill patients may develop acute insulin resistance, manifested by high levels of blood sugar and insulin levels,” investigators added.

Investigators cautioned against overinterpretation of results without considering its limitations. Limitations noted by investigators included the retrospective nature of the study, inability to assess glycated HbA1c, and insufficient data to study the effects of glucose-lowering therapies on the outcomes of the patients.

This study, “Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study,” was published in Diabetologia.