ECE2022 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (202 abstracts)
Hyperglycemia, but not previous diagnosis of diabetes mellitus, is an independent indicator of poor outcome in patients hospitalized for severe COVID-19
Elisa Eletto 1 , Alessandra Dei Cas 1 , Antonio Nouvenne 2 , Andrea Ticinesi 1 , Beatrice Prati 2 , Valentina Spigoni 1 , Raffaella Aldigeri 1 , Gloria Cinquegrani 1 , Silvia Schirò 1 , Livia Ruffini 3 , Nicola Sverzellati 1 , Tiziana Meschi 1 & Riccardo C. Bonadonna 1
1University of Parma, Department of Medicine and Surgery, Parma, Italy; 2Azienda Ospedaliera-Universitaria di Parma, Department of General and Specialistic Medicine, Parma, Italy; 3Azienda Ospedaliera-Universitaria di Parma, Department. of Medical Imaging, Parma, Italy
Background: Both diabetes mellitus and hyperglycemia are reported to be strong risk factors for poor outcome(s) in patients hospitalized for COVID-19. However, their relative roles in affecting patient prognosis are under debate.
Aims: To evaluate the independent influence of known diabetes mellitus and hyperglycemia on death/admission to intensive care unit (ICU) in patients hospitalized for COVID-19 during the first wave of SARS-Co-V2 pandemic.
Experimental Design: We retrieved the clinical data/records of the patients admitted with COVID-19 between 23rd February 2020 and 31st March 2020 to the Covid-1 macro-unit of the University Hospital of Parma. Known diabetes was defined by self-reported history, electronic medical records or ongoing medications. The readout of hyperglycemia was fasting plasma glucose at admission. The primary outcome (follow-up: 6 weeks) was a composite of transfer to the Intensive Care Unit or death. Logistic regression analysis was used to identify independent risk indicators of the primary end-point by univariable and multivariable models. We used Receiver Operating Characteristic (ROC) curves to assess the overall predictive power of the different regression models.
Results: 757 subjects were included, 143 of whom (19.2%) had known diabetes. Patients with diabetes were older and had more frequently comorbidities associated. The primary outcome occurred in 61.5% of patients with diabetes compared to 43.1% in those without (log-rank test < 0.001). Among variables associated with COVID-19 severity, age, obesity, arterial hypertension, previous CV event, eGFR, glucose levels at admission (but not known diabetes), C-reactive protein and HR-CT visual score of pneumonia extension, were independent risk indicators of poor outcome in logistic regression models undergoing progressively more and more adjustments for potential confounders. The ROC curves showed remarkably good accuracy (up to AUC=0.89) in predicting the primary composite end-point in all models, including the one which used the simplest, most immediate clinical parameters.
Conclusions: Known diabetes indicated poor COVID-19 outcomes, but not when adjusted for other baseline clinical variables and comorbidities, suggesting that its impact was mostly driven by concomitant factors and complications. Fasting hyperglycemia was a powerful and independent predictor of poor outcomes, together with age and biomarkers of inflammation (CRP) and lung tissue damage (HR-CT visual score). The molecular mechanism(s) underlying the tight association between high glucose and poor COVID-19 outcome remain(s) to be elucidated.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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