Admission Hyperglycemia in Non-diabetics Predicts Mortality and Disease Severity in COVID-19: a Pooled Analysis and Meta
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COVID-19
Admission Hyperglycemia in Non-diabetics Predicts Mortality and Disease Severity in COVID-19: a Pooled Analysis and Meta-summary of Literature Sonali Sachdeva 1 & Rupak Desai 2
&
Udita Gupta 3 & Anupam Prakash 3 & Abhinav Jain 4 & Ankita Aggarwal 5
Accepted: 4 October 2020 # Springer Nature Switzerland AG 2020
Abstract In the latter part of 2019, a cluster of unexplained pneumonia cases were reported in Wuhan, China. In less than a year, SARSCoV-2 has infected over 27 million people and claimed more than 800,000 deaths worldwide. Diabetes is a highly prevalent chronic metabolic disease, and recent reports have suggested a possible existence of COVID-19 related new-onset diabetes. Hyperglycemia induces an inflammatory state in the body, which coupled with coronavirus associated immune response is a possible explanation for clinical worsening of patients. We present a summary and pooled analysis of available evidence to ascertain the relationship between hyperglycemia in undiagnosed diabetics and outcomes of COVID-19 disease. Our results showed that hyperglycemia in non-diabetics was associated with higher risk of severe/critical illness (OR 1.837 (95% CI 1.368– 2.465, P < 0.001) and mortality (2.822, 95% CI 1.587–5.019, P < 0.001) compared with those with normal values of blood glucose. The management of hyperglycemia in COVID-19 poses significant challenges in clinical practice, and the need to develop strategies for optimal glucose control in these patients cannot be overlooked. Keywords COVID-19 . SARS-CoV-2 . Hyperglycemia . Diabetes . Infectious disease
Introduction The first case of novel coronavirus pneumonia, also known as SARS-CoV-2 (severe acute respiratory distress syndrome coronavirus-2), emerged in December 2019 in Wuhan, China. Designated as coronavirus disease 2019 (COVID-19), it affects the lungs primarily and has a high transmission rate [1]. This article is part of the Topical Collection on Covid-19 * Rupak Desai [email protected]; [email protected] 1
Department of Anesthesiology and Critical Care Medicine, Maulana Azad Medical College, New Delhi, India
2
Division of Cardiology, Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA, USA
3
Division of General Medicine, Lady Hardinge Medical College, New Delhi, India
4
Department of Cardiology, Ascension Genesys Hospital, Grand Blanc, MI, USA
5
Department of Internal Medicine, Wayne State University, Detroit, MI, USA
Diabetes as a risk factor for severe COVID-19 disease has already been studied and reported in detail [2]. SARS-CoV2 interacts with the body’s glucose metabolism via a variety of pathways, the commonest being ACE-2 expression in the pancreas [3]. It is well established that hyperglycemia increases the risk of lower respiratory tract infections and is linked to poor outcomes [4]. Since an acute rise in blood glucose is associated with increased inflammatory mediators [5], it is conceivable that hyperglycemia can potentiate the harmful effects of cytokine storm in patients with COVID-19 pneumonia. Hence, t
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