Endocrine Abstracts

According to modern concepts, stress hyperglycemia and diabetes mellitus (DM) are often found in hospitals and are associated with an increase in complications, length of hospitalization and mortality. The analysis of data on the COVID-19 pandemic indicates a worse prognosis and a high risk of hospital complications in patients with DM.

Aim: The aim of the study was to evaluate clinical and laboratory parameters that can be used to predict an unfavorable outcome of Covid-19.

Materials and Methods: A retrospective analysis of data from of 320 patients with Covid-19 infection, who was treated in the intensive care unit of the infectious Minsk hospital from June 2020 to March 2022, was carried out. The following groups were formed: 224 people with transient hyperglycemia (the main group); 51 patients with DM (comparison group); 45 people without glycemic disorders (control group). Also, patients were divided into subgroups based on the outcome (favorable or unfavorable outcome).

Results and Discussion: The mean age of deceased patients was significantly higher than that of surviving patients (67.0 (59.3; 74.0) years vs 57.0 (47.0; 66.8) years, P<0.001), indicating the fact that the age of the patient is a prognostically unfavorable criterion for the outcome of the disease. Among deceased patients, higher glycemic values were recorded, mainly in the DM group (20.9 (14.9; 23.9) mmol/l vs 13.4 (10.9; 17.7) mmol/l, P=0.005). Patients with an unfavorable outcome had differences in laboratory parameters already on the first day of hospitalization and was characterized by higher values of inflammation indicators (leukocyte level (P=0.002), LDH (P=0.008), CRP (P=0.003 ), procalcitonin (P<0.001), D-dimers (P<0.001), as well as greater severity of lymphopenia (P=0.006). In patients with an unfavorable outcome, starting from the 4th day of stay in the ICU, a tendency to persistent hyperglycemia was noted. Negative dynamics of glycemia was noted on day 7 in the observation groups, depending on the unfavorable outcome: DM (13.4 (8.1; 19.8) vs10.1 (5.6; 11.9), P=0.014), HG (8.7 (7.2; 11.8 6.4 vs (5.7; 7.6), P=0.017), control (6.2 (4.0; 7.2) vs 5.3 (5.1; 5.9), P=0.123). Moreover, the glucose levels in the DM and HH group increased most significantly on day 7.

Conclusions: Thus, diabetes mellitus and in-hospital hyperglycemia are significant risk factors for the severe course of COVID-19, as well as its poor outcome. From the 4th day patients with an unfavorable outcome showed a tendency to persistent hyperglycemia, which potentially indicates its role as a prognostic parameter.