Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 16;23(1):173.
doi: 10.1186/s12890-023-02439-y.

Dysglycemias in patients admitted to ICUs with severe acute respiratory syndrome due to COVID-19 versus other causes - a cohort study

Rosângela Roginski Réa  1 , Rafaella Stradiotto Bernardelli  2   3 , Amanda Christina Kozesinski-Nakatani  2   4 , Marcia Olandoski  3 , Marcelo José Martins-Junior  2 , Mirella Cristine Oliveira  2   5 , Álvaro Réa-Neto  6   7   8
Affiliations

Dysglycemias in patients admitted to ICUs with severe acute respiratory syndrome due to COVID-19 versus other causes - a cohort study

Rosângela Roginski Réa et al. BMC Pulm Med. .

Abstract

Background: Dysglycemias have been associated with worse prognosis in critically ill patients with COVID-19, but data on the association of dysglycemia with COVID-19 in comparison with other forms of severe acute respiratory syndrome are lacking. This study aimed to compare the occurrence of different glycemic abnormalities in patients with severe acute respiratory syndrome and COVID-19 admitted to intensive care units versus glycemic abnormalities in patients with severe acute respiratory syndrome from other causes, to evaluate the adjusted attributable risk associated with COVID-19 and dysglycemia and to assess the influence of these dysglycemias on mortality.

Methods: We conducted a retrospective cohort of consecutive patients with severe acute respiratory syndrome and suspected COVID-19 hospitalized in intensive care units between March 11 and September 13, 2020, across eight hospitals in Curitiba-Brazil. The primary outcome was the influence of COVID-19 on the variation of the following parameters of dysglycemia: highest glucose level at admission, mean and highest glucose levels during ICU stay, mean glucose variability, percentage of days with hyperglycemia, and hypoglycemia during ICU stay. The secondary outcome was the influence of COVID-19 and each of the six parameters of dysglycemia on hospital mortality within 30 days from ICU admission.

Results: The sample consisted of 841 patients, of whom 703 with and 138 without COVID-19. Comparing patients with and without COVID-19, those with COVID-19 had significantly higher glucose peaks at admission (165 mg/dL vs. 146 mg/dL; p = 0.002) and during ICU stay (242 mg/dL vs. 187md/dL; p < 0.001); higher mean daily glucose (149.7 mg/dL vs. 132.6 mg/dL; p < 0.001); higher percentage of days with hyperglycemia during ICU stay (42.9% vs. 11.1%; p < 0.001); and greater mean glucose variability (28.1 mg/dL vs. 25.0 mg/dL; p = 0.013). However, these associations were no longer statistically significant after adjustment for Acute Physiology and Chronic Health Evaluation II scores, Sequential Organ Failure Assessment scores, and C-reactive protein level, corticosteroid use and nosocomial infection. Dysglycemia and COVID-19 were each independent risk factors for mortality. The occurrence of hypoglycemia (< 70 mg/dL) during ICU stay was not associated with COVID-19.

Conclusion: Patients with severe acute respiratory syndrome due to COVID-19 had higher mortality and more frequent dysglycemia than patients with severe acute respiratory syndrome due to other causes. However, this association did not seem to be directly related to the SARS-CoV-2 infection.

Keywords: COVID-19; Critical illness; Glycemic control; Hyperglycemia; Intensive care units.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Process of selection of the study sample
See this image and copyright information in PMC

References

    1. Aramendi I, Burghi G, Manzanares W. Dysglycemia in the critically ill patient: current evidence and future perspectives. Rev Bras Ter Intensiva [Internet]. 2017;29(3). Available from: http://www.gnresearch.org/doi/10.5935/0103-507X.20170054. - PMC - PubMed
    1. Krinsley JStephe. Glycemic control in the critically ill: What have we learned since NICE-SUGAR? Hosp Pract (1995) [Internet]. 2015 [cited 2022 Jul 4];43(3):191–7. Available from: https://pubmed.ncbi.nlm.nih.gov/26224425/. - PubMed
    1. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc [Internet]. 2003 [cited 2022 Jul 4];78(12):1471–8. Available from: https://pubmed.ncbi.nlm.nih.gov/14661676/. - PubMed
    1. Krinsley JS, Preiser J-C. Time in blood glucose range 70 to 140 mg/dl > 80% is strongly associated with increased survival in non-diabetic critically ill adults. Crit Care. 2015 Dec 1;19(1):179. - PMC - PubMed
    1. Yegneswaran B, Parket R, Gawel S, Pritchard-Bell A, Ho T, Clermont G. Association between average glucose levels and hospital mortality among critically ill patients. Crit Care [Internet]. 2013 Apr 19;17(S2):P458. Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc12396.