Glycemic control prior to admission is an important determinant of prognosis in patients with Coronavirus Disease 2019.

AIM: This study aimed to explore the association between glycemic control prior to admission with severity and mortality of COVID-19, and tried to reveal the mechanism METHODS: 77 inpatients were grouped into sufficient control group (HbA1c<6 5%, n=49) and insufficient control group (HbA1c ≥ 6 5%, n=28) Regression models were used to analyze the clinical data RESULTS: Compared with patients with HbA1C < 6 5, patients with HbA1C ≥ 6 5 showed higher heart rate (101 vs 89 beats per min, P=0 012), lower percutaneous oxygen saturation (93% vs 97%, P=0 001), higher levels of multiple indicators of inflammation, such as white blood cell count (7 9 vs 5 9 ×10⁹/L, P=0 019), neutrophil count (6 5 vs 4 1 ×10⁹/L, P=0 001), high-sensitivity C-reactive protein (52 vs 30 mg/L, P=0 025), and serum ferritin (1287 vs 716 μg/L, P=0 023), as well as lower level of lymphocyte count (0 7 vs 0 8 ×10⁹/L P=0 049) at hospital admission Thus, patients with HbA1C ≥ 6 5 were more likely to develop secondary respiratory infections (25 [89%] vs 33 [67%], P=0 032) and acute respiratory distress syndrome (ARDS) (17 [61%] vs 14 [29%], P=0 006) than patients with HbA1C < 6 5, resulting in a higher proportion of critically ill cases (19 [68%] vs 18 [37%], P=0 009) and non-survivors (13 [46%] vs 11 [22%], P=0 029) After adjustment for potential risk factors, HbA1C was independently associated with in-hospital death CONCLUSION: HbA1c was an independent risk factor for poor outcomes in COVID-19 patients Severe pulmonary infection and consequent ARDS might be the primary causes of death in insufficient glycemic control patients