Does inpatient hyperglycemia predict a worse outcome in COVID-19 intensive care unit patients?
Aisha R Saand, Monica Flores, Tariq Kewan, Sura Alqaisi, Mahmoud Alwakeel, Lori Griffiths, Xiaofeng Wang, Xiaozhen Han, Robert Burton, Mohammed J Al-Jaghbeer, Francois Abi Fadel
Author Information
Aisha R Saand: Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, USA.
Monica Flores: Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, USA. ORCID
Tariq Kewan: Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, USA.
Sura Alqaisi: Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, USA.
Mahmoud Alwakeel: Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, USA.
Lori Griffiths: Cleveland Clinic, Quality Data Registries, Cleveland, Ohio, USA.
Xiaofeng Wang: Cleveland Clinic, Quantitative Health Sciences, Cleveland, Ohio, USA.
Xiaozhen Han: Cleveland Clinic, Quantitative Health Sciences, Cleveland, Ohio, USA.
Robert Burton: Cleveland Clinic, Business Intelligence, Cleveland, Ohio, USA.
Mohammed J Al-Jaghbeer: Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA.
Francois Abi Fadel: Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA.
BACKGROUND: We undertook this study to evaluate the association between hyperglycemia and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU). METHODS: We conducted a multicenter retrospective study involving all adults with COVID-19 admitted to the ICU between March and May 2020. Patients were divided into normoglycemic (average blood glucose <140 mg/dL) and hyperglycemic (average blood glucose ≥140 mg/dL) groups. Outcomes such as mortality, need and duration of mechanical ventilation, and length of hospital and ICU stays were measured. RESULTS: Among 495 patients, 58.4% were male with a median age of 68 years (interquartile range [IQR]: 58.00-77.00), and baseline average blood glucose was 186.6 (SD ± 130.8). Preexisting diabetes was present in 35.8% of the studied cohort. Combined ICU and hospital mortality rates were 23.8%; mortality and mechanical ventilation rates were significantly higher in the hyperglycemic group with 31.4% vs 16.6% (P = .001) and 50.0% vs 37.2% (P = .004), respectively. Age above 60 years (hazard ratio [HR] 3.21; 95% CI 1.78, 5.78) and hyperglycemia (HR 1.79; 95% CI 1.14, 2.82) were the only significant predictors of in-hospital mortality. Increased risk for hyperglycemia was found in patients with steroid use (odds ratio [OR] 1.521; 95% CI 1.054, 2.194), triglycerides ≥150 mg/dL (OR 1.62; 95% CI 1.109, 2.379), and African American race (OR 0.79; 95% CI 0.65, 0.95). CONCLUSIONS: Hyperglycemia in patients with COVID-19 is significantly associated with a prolonged ICU length of stay, higher need of mechanical ventilation, and increased risk of mortality in the critical care setting. Tighter blood glucose control (≤140 mg/dL) might improve outcomes in COVID-19 critically ill patients; evidence from ongoing clinical trials is needed.
