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. 2022 Nov 12;14(1):168.
doi: 10.1186/s13098-022-00941-7.

Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19

Sara Madaschi #  1 , Eugenia Resmini #  2 , Silvia Bonfadini  1 , Giulia Massari  1 , Paola Gamba  3 , Marco Sandri  3 , Stefano Calza  3 , Elena Cimino  1 , Emanuela Zarra  1 , Silvia Dotti  1 , Cristina Mascadri  1 , Barbara Agosti  1 , Emirena Garrafa  4   5 , Angela Girelli  1
Affiliations

Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19

Sara Madaschi et al. Diabetol Metab Syndr. .

Abstract

Introduction: The role of glycemic control, both prior and during hospitalization, on mortality from COVID-19 in diabetic patients is debated. Furthermore, it is not clear whether hyperglycemia has a direct effect or requires inflammatory mechanisms.

Objective: To identify predictors of clinical outcomes (in-hospital mortality, length of hospitalization, respiratory failure, need for intensive care), considering hyperglycemia, inflammation markers and clinical history.

Methods: Retrospective observational study of 291 diabetic patients hospitalized with COVID-19 in the Spedali Civili di Brescia from February 1th 2020 to March 31th 2021, with also outpatient electronic records. Glucose, inflammatory parameters, creatinine were collected within 24 h after admission to the hospital. A causal mediation analysis allowed the estimation of the direct and indirect effects of hyperglycemia on mortality.

Results: Glucose at admission ≥ 165 mg/dL and reduced renal function were associated with an increased risk of in-hospital mortality and length of hospitalization (all p < 0.001), while an increase in inflammatory parameters was significantly associated with an increased risk of all outcomes. High basophil count was associated with reduced mortality (p < 0.001). Hyperglycemia had a direct effect on mortality (p < 0.001); the indirect, through inflammatory markers, was significant only for absolute neutrophil count, C-Reactive protein and procalcitonin (p = 0.007, p = 0.029, p = 0.042). Patients with microvascular complications and with chronic kidney disease showed higher mortality (p = 0.03, p = 0.01).

Conclusions: Hyperglycemia at admission, renal function and inflammatory parameters were found to be predictors of in-hospital mortality, while an increased basophil count was protective. Hyperglycemia had a direct effect on mortality, the indirect effect was only through few markers and markedly lower than the direct one.

Keywords: COVID-19; Clinical outcomes; Diabetes mellitus; Hyperglycemia; Inflammation.

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Conflict of interest statement

The authors have no financial or proprietary interests in any material discussed in this article.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves depicting the association between in-hospital mortality and glucose levels (a) and renal function at admission (b)
See this image and copyright information in PMC

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