Open Access住院期间的高血糖是否预示重症监护病房的新冠肺炎患者预后更差?
Author(s) -
Saand Aisha R.,
Flores Monica,
Kewan Tariq,
Alqaisi Sura,
Alwakeel Mahmoud,
Griffiths Lori,
Wang Xiaofeng,
Han Xiaozhen,
Burton Robert,
AlJaghbeer Mohammed J.,
Abi Fadel Francois
Publication year - 2021
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.13137
Subject(s) - medicine , covid-19 , intensive care unit , diabetes mellitus , outcome (game theory) , intensive care medicine , emergency medicine , medline , virology , disease , endocrinology , infectious disease (medical specialty) , outbreak , mathematics , mathematical economics , political science , law
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.