Does Inpatient Hyperglycemia predict a worse outcome in COVID-19 Intensive Care Unit Patients?

BACKGROUND Evaluate the association between hyperglycemia and outcomes in patients with COVID-19 admitted to the intensive care unit (ICU). METHODS We conducted a multi-center retrospective study involving all adults with COVID-19 admitted to the ICU between March and May 2020. Patients were divided into normoglycemic (average blood glucose 140 mg/dL) groups. Outcomes such as mortality, need and duration of mechanical ventilation, and length of hospital and ICU stays were measured. RESULTS Among 495 patients, 58.4% were male with a median age of 68 years (IQR: 58.00-77.00), and baseline average blood glucose was 186.6 (SD+130.8). Pre-existing diabetes was present in 35.8% of the studied cohort. Combined ICU and hospital mortality rates were 23.8%; mortality rate and mechanical ventilation were significantly higher in the hyperglycemic group (31.4 % vs. 16.6%, p=0.001) and (50.0% vs. 37.2%, p=0.004) respectively. Age above 60 years (HR:3.21 [95% CI 1.78, 5.78]) and hyperglycemia (HR:1.79 [95% CI 1.14, 2.82]) were the only significant predictors of in-hospital mortality. Increased risk for hyperglycemia was found in patients with steroids use (OR:1.521 [95% CI 1.054, 2.194]), triglycerides > 150 mg/dL (OR:1.62 [95% CI 1.109, 2.379]), and African-American race (OR:0.79 [95% CI 0.65, 0.95]). CONCLUSIONS Hyperglycemia in COVID-19 patients is significantly associated with prolonged ICU length of stay, higher need of mechanical ventilation, and increased risk of mortality in the critical care setting. Tighter blood glucose control (<140 mg/dL) might improve outcomes in COVID-19 critically-ill patients, evidence from ongoing clinical trials is needed. This article is protected by copyright. All rights reserved.