Hyperglycaemia on admission to hospital and COVID-19
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LETTER
Hyperglycaemia on admission to hospital and COVID-19 Celestino Sardu 1 & Nunzia D’Onofrio 2 & Maria Luisa Balestrieri 2 & Michelangela Barbieri 1 & Maria Rosaria Rizzo 1 & Vincenzo Messina 3 & Paolo Maggi 3 & Nicola Coppola 4 & Giuseppe Paolisso 1 & Raffaele Marfella 1 Received: 12 June 2020 / Accepted: 18 June 2020 # The Author(s) 2020
Keywords Covid-19 . Hyperglycaemia . Inflammatory cytokines . Mechanical ventilation . Non-invasive ventilation
Abbreviation COVID-19 Coronavirus disease-2019
To the Editor: We read with great interest the article by Bertrand Cariou and coworkers on people with diabetes hospitalised for coronavirus disease-2019 (COVID-19) [1]. The analysis of the data obtained on a very large population (1317 patients) provided important information, highlighting a role for BMI in disease severity, but did not correctly interpret the data on the role of hyperglycaemia at admission to hospital. In fact, the authors observed an age- and sex-independent association between increased admission plasma glucose and the severity of COVID-19. Nevertheless, they postulate that this observation is rather the consequence of the severity of the infection than a causal primary factor’. This interpretation of the data underestimates the importance of glycaemic control in COVID-19 and may result in caregivers focusing attention on therapeutic management of hyperglycaemic patients. To investigate the importance of glucose management of COVID-19 patients, we analysed recent data on glycaemic control and COVID-19 outcomes. Acute hyperglycaemia occurs in about 50% of patients hospitalised for COVID-19, while the prevalence of diabetes is about 7% [2]. Moreover, increased plasma glucose on admission to hospital was associated with poorer outcomes in * Raffaele Marfella [email protected] 1
Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy
2
Department of Precision Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
3
Department of Infectious Diseases, Sant’Anna Hospital, Caserta, Italy
4
Department of Mental and Physical Health and Preventive Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
patients with mild, moderate and severe COVID-19 [2–4]. Increased concentrations of proinflammatory cytokines, including IL-2 receptors (IL-2Rs), IL-6 and TNF-α, may have a pivotal role in the mechanism(s) underlying this association. Elevated levels of these proteins were common in both COVID-19 and in hyperglycaemia [5–7]. Thus, an over-activation of the innate immune system may be responsible for poorer outcomes in hyperglycaemic patients affected by COVID-19, including those treated with tocilizumab, an inhibitor of IL-6 [7]. Therefore, to date, despite full therapy, including oxygen therapy, hydroxychloroquine and antiviral treatment, hyperglycaemic patients with COVID-19 have a worse prognosis. In this context, we hypothesise that achievement of rapid control of hyperglycaemia in the first
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