Journal Article

Hyperglycemia and glucose variability are associated with worse survival in mechanically ventilated COVID-19 patients: the prospective Maastricht Intensive Care Covid Cohort

van Herpt, Thijs T.W., van der Horst, Iwan C.C., Jetten, Robin, van Bussel, Bas C.T., van Kuijk, Sander M.J., de Galan, Bastiaan E., van Rosmalen, Frank, van der Horst-Schrivers, Anouk N.A., Hulsewé, Hendrica P.M.G., Zelis, Noortje, Driessen, Mariëlle

2023

Overview

Background Data on hyperglycemia and glucose variability in relation to diabetes mellitus, either known or unknown in ICU-setting in COVID-19, are scarce. We prospectively studied daily glucose variables and mortality in strata of diabetes mellitus and glycosylated hemoglobin among mechanically ventilated COVID-19 patients. Methods We used linear-mixed effect models in mechanically ventilated COVID-19 patients to investigate mean and maximum difference in glucose concentration per day over time. We compared ICU survivors and non-survivors and tested for effect-modification by pandemic wave 1 and 2, diabetes mellitus, and admission HbA1c. Results Among 232 mechanically ventilated COVID-19 patients, 21.1% had known diabetes mellitus, whereas 16.9% in wave 2 had unknown diabetes mellitus. Non-survivors had higher mean glucose concentrations (ß 0.62 mmol/l; 95%CI 0.20–1.06; ß 11.2 mg/dl; 95% CI 3.6–19.1; P  = 0.004) and higher maximum differences in glucose concentrations per day (ß 0.85 mmol/l; 95%CI 0.37–1.33; ß 15.3; 95%CI 6.7–23.9; P  = 0.001). Effect modification by wave, history of diabetes mellitus and admission HbA1c in associations between glucose and survival was not present. Effect of higher mean glucose concentrations was modified by pandemic wave (wave 1 (ß 0.74; 95% CI 0.24–1.23 mmol/l) ; (ß 13.3; 95%CI 4.3–22.1 mg/dl)) vs. (wave 2 (ß 0.37 (95%CI 0.25–0.98) mmol/l) (ß 6.7 (95% ci 4.5–17.6) mg/dl)). Conclusions Hyperglycemia and glucose variability are associated with mortality in mechanically ventilated COVID-19 patients irrespective of the presence of diabetes mellitus.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Cardiovascular disease / Cohort analysis / Comparative analysis / COVID-19 / Dextrose / Diabetes / Diabetes and Covid-19 / Diabetes mellitus / Endocrinology / Glucose / Glycemic variability / Glycosylated hemoglobin / Hemoglobin / Hospital patients / Hyperglycemia / Insulin / Intensive care / Intubation / Medical prognosis / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Metabolic Diseases / Mortality / Netherlands / Pandemics / Patient outcomes / Patients / Prognosis / Severe acute respiratory syndrome coronavirus 2 / Steroids / Survival / Type 2 diabetes / Ventilators