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Tsikala Vafea M, Traboulsi C, Stefanovic-Racic M. Lower Glycosylated Hemoglobin Is Associated With Lower In-Hospital Mortality in Patients With COVID-19: A Systematic Review of the Literature and Meta-Analysis. Endocr Pract 2024; 30:70-77. [PMID: 37769967 DOI: 10.1016/j.eprac.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Poor glycemic control during COVID-19 hospitalization is associated with higher mortality. However, the association between long-term glycemic control, as reflected by the glycosylated hemoglobin (HbA1c) and outcomes has yet to be clarified, with some studies reporting no association. The aim of this study is to determine the association between HbA1c and in-hospital mortality in patients with COVID-19. METHODS Pubmed, Embase, and Web of Science databases were searched for studies examining the association between HbA1c level and in-hospital COVID-19 mortality. Random-effects meta-analysis was performed. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed using funnel plots. RESULTS Among 4142 results, 22 studies were included in the final analysis with a total of 11 220 patients. Lower Hba1c was associated with lower in-hospital mortality [odds ratio (OR), 0.53; 95% CI, 0.37-0.76; I2 81%], in using HbA1c as a dichotomous variable. When only patients with diabetes were included in the analysis, the association remained statistically significant (OR, 0.67; 95% CI, 0.47-0.96). In the subgroup analysis, the association remained statistically significant in studies using as cutoff the HbA1c value of 6.5% (OR, 0.34; 95% CI, 0.15-0.77) and 7% (OR, 0.54; 95% CI 0.32-0.90), but not with greater HbA1c cutoff values; 7.5% and ≥8%. In studies using HbA1C as a continuous variable, HbA1c level did not have a statistically significant association with in-hospital mortality, either in univariate or multivariate analyses. CONCLUSION A better glycemic control prior to hospitalization, as reflected by lower HbA1c, is associated with lower in-hospital mortality in patients with COVID-19.
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Affiliation(s)
- Maria Tsikala Vafea
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Cindy Traboulsi
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maja Stefanovic-Racic
- Department of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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2
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Guo BC, Wu KH, Chen CY, Lin WY, Chang YJ, Lee TA, Lin MJ, Wu HP. Mesenchymal Stem Cells in the Treatment of COVID-19. Int J Mol Sci 2023; 24:14800. [PMID: 37834246 PMCID: PMC10573267 DOI: 10.3390/ijms241914800] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Since the emergence of the coronavirus disease 2019 (COVID-19) pandemic, many lives have been tragically lost to severe infections. The COVID-19 impact extends beyond the respiratory system, affecting various organs and functions. In severe cases, it can progress to acute respiratory distress syndrome (ARDS) and multi-organ failure, often fueled by an excessive immune response known as a cytokine storm. Mesenchymal stem cells (MSCs) have considerable potential because they can mitigate inflammation, modulate immune responses, and promote tissue regeneration. Accumulating evidence underscores the efficacy and safety of MSCs in treating severe COVID-19 and ARDS. Nonetheless, critical aspects, such as optimal routes of MSC administration, appropriate dosage, treatment intervals, management of extrapulmonary complications, and potential pediatric applications, warrant further exploration. These research avenues hold promise for enriching our understanding and refining the application of MSCs in confronting the multifaceted challenges posed by COVID-19.
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Affiliation(s)
- Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs’ Taichung Metro Harbor Hospital, Taichung 43503, Taiwan;
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Wen-Ya Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung 43503, Taiwan
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Tai-An Lee
- Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 50544, Taiwan;
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Ali El Chab Parolin S, Benicio Stocco R, Kneipp Lopes JDC, Curcio Pereira MR, Massae Yamashita M, Domareski Goulart ME, Demeneck H, Olandoski M, Hermann de Souza Nunes L, Keniche Morisawa V, Fanhani Cracco LA, Busto Silva I, Silva Motta Júnior J, Veit Barreto D, Lenci Marques G, Proença de Moraes T, Pellegrino Baena C. Association between inpatient glycemic variability and COVID-19 mortality: a prospective study. Diabetol Metab Syndr 2023; 15:185. [PMID: 37697407 PMCID: PMC10494398 DOI: 10.1186/s13098-023-01157-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND This study aimed to determine the association between glycemic variability (GV) and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS We prospectively analyzed data from inpatients (> 18 years old) with RT-PCR confirmed COVID-19 admitted between March 2020 and July 2021. All patients were hospitalized for more than 48 h and had at least six point-of-care capillary glucose tests obtained three times daily in the pre-prandial period during hospitalization. GV was measured using the glucose standard deviation (SD) and coefficient of variation (CV). ROC curve was adjusted to determine the SD and CV cutoff values associated with mortality (44.7 mg/dL and 27.5%, respectively); values above these were considered indicative of high GV. Logistic regression models were fitted to explore the association between GV and mortality in patients with and without diabetes. RESULTS A total of 628 patients were stratified into SD < 44.7 mg/dL (n = 357) versus ≥ 44.7 mg/dL (n = 271) and CV < 27.5% (n = 318) versus ≥ 27.5% (n = 310) groups. After controlling for age, sex, presence of diabetes mellitus (DM) and cardiovascular disease, we found a significant association between high GV and mortality (odds ratio 2.99 [1.88-4.77] for SD and 2.43 [1.54-3.85] for CV; p values < 0.001). The mortality rate was higher with SD ≥ 44.7 mg/dL and CV ≥ 27.5% compared to that with SD < 44.7 mg/dL and CV < 27.5%, regardless of DM (p < 0.001 for all). CONCLUSION High glycemic variability was independently associated with mortality in patients with and without DM, who were hospitalized with COVID-19.
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Affiliation(s)
- Salma Ali El Chab Parolin
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil.
| | - Rebecca Benicio Stocco
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Julia do Carmo Kneipp Lopes
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Marcos Roberto Curcio Pereira
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Milena Massae Yamashita
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | | | - Henrique Demeneck
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Marcia Olandoski
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | | | - Victor Keniche Morisawa
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Luiz Augusto Fanhani Cracco
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Isabela Busto Silva
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Jarbas Silva Motta Júnior
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Daniela Veit Barreto
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Gustavo Lenci Marques
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Thyago Proença de Moraes
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Cristina Pellegrino Baena
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
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Bellaver P, Schneider L, Schaeffer AF, Henrique LR, Camargo JL, Gerchman F, Leitão CB, Rech TH. Diabetes associates with mortality in critically ill patients with SARS-CoV-2 pneumonia: No diabetes paradox in COVID-19. Heliyon 2023; 9:e18554. [PMID: 37576227 PMCID: PMC10412986 DOI: 10.1016/j.heliyon.2023.e18554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background Diabetes mellitus (DM) is not associated with increased mortality in critically ill patients, a phenomenon known as the "diabetes paradox". However, DM is a risk factor for increased mortality in patients with COVID-19. This study aims to investigate the association of DM and stress-induced hyperglycemia at intensive care unit (ICU) with mortality in this population. Methods This is a retrospective study. Electronic medical records from patients admitted from March 2020 to September 2020 were reviewed. Primary outcome was mortality. Secondary outcomes were ICU and hospital mortality and stay, and need for mechanical ventilation and renal replacement therapy. Results 187 patients were included. Overall mortality was 43.2%, higher in patients with DM (55.7% vs. 34%; p = 0.007), even after adjustment for age, hypertension, and disease severity. When patients were separated into groups, named normoglycemia (without DM and glycemia ≤140 mg/dL), stress-induced hyperglycemia (without DM and glycemia >140 mg/dL), and DM (previous diagnosis or HbA1c ≥ 6.5%), the mortality rate was 25.8%, 37.3%, and 55.7%, respectively (p = 0.021). Mortality was higher in patients with higher glycemic variability. No statistical difference related to secondary outcomes was observed. Conclusions DM, hyperglycemia, and glycemic variability associated with increased mortality in critically ill patients with severe COVID-19, but did not increase the rates of other clinical outcomes. More than stress-induced hyperglycemia, DM was associated with mortality.
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Affiliation(s)
- Priscila Bellaver
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Larissa Schneider
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ariell F. Schaeffer
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lilian Rodrigues Henrique
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fernando Gerchman
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cristiane B. Leitão
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Tatiana H. Rech
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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5
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Barreto EA, Cruz AS, Veras FP, Martins R, Bernardelli RS, Paiva IM, Lima TM, Singh Y, Guimarães RC, Damasceno S, Pereira N, Alves JM, Gonçalves TT, Forato J, Muraro SP, Souza GF, Batah SS, Proenca-Modena JL, Mori MA, Cunha FQ, Louzada-Junior P, Cunha TM, Nakaya HI, Fabro A, de Oliveira RDR, Arruda E, Réa R, Réa Neto Á, Fernandes da Silva MM, Leiria LO. COVID-19-related hyperglycemia is associated with infection of hepatocytes and stimulation of gluconeogenesis. Proc Natl Acad Sci U S A 2023; 120:e2217119120. [PMID: 37186819 PMCID: PMC10214153 DOI: 10.1073/pnas.2217119120] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Occurrence of hyperglycemia upon infection is associated with worse clinical outcome in COVID-19 patients. However, it is still unknown whether SARS-CoV-2 directly triggers hyperglycemia. Herein, we interrogated whether and how SARS-CoV-2 causes hyperglycemia by infecting hepatocytes and increasing glucose production. We performed a retrospective cohort study including patients that were admitted at a hospital with suspicion of COVID-19. Clinical and laboratory data were collected from the chart records and daily blood glucose values were analyzed to test the hypothesis on whether COVID-19 was independently associated with hyperglycemia. Blood glucose was collected from a subgroup of nondiabetic patients to assess pancreatic hormones. Postmortem liver biopsies were collected to assess the presence of SARS-CoV-2 and its transporters in hepatocytes. In human hepatocytes, we studied the mechanistic bases of SARS-CoV-2 entrance and its gluconeogenic effect. SARS-CoV-2 infection was independently associated with hyperglycemia, regardless of diabetic history and beta cell function. We detected replicating viruses in human hepatocytes from postmortem liver biopsies and in primary hepatocytes. We found that SARS-CoV-2 variants infected human hepatocytes in vitro with different susceptibility. SARS-CoV-2 infection in hepatocytes yields the release of new infectious viral particles, though not causing cell damage. We showed that infected hepatocytes increase glucose production and this is associated with induction of PEPCK activity. Furthermore, our results demonstrate that SARS-CoV-2 entry in hepatocytes occurs partially through ACE2- and GRP78-dependent mechanisms. SARS-CoV-2 infects and replicates in hepatocytes and exerts a PEPCK-dependent gluconeogenic effect in these cells that potentially is a key cause of hyperglycemia in infected patients.
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Affiliation(s)
- Ester A. Barreto
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Amanda S. Cruz
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Flavio P. Veras
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Ronaldo Martins
- Department of Cell Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Rafaella S. Bernardelli
- Federal University of Paraná, Center for Study and Research in Intensive Care Medicine, Curitiba82530-200, Brazil
| | - Isadora M. Paiva
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Thais M. Lima
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Youvika Singh
- Hospital Israelita Albert Einstein, São Paulo05652-900, Brazil
| | - Raphael C. Guimarães
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas13083-970, Brazil
| | - Samara Damasceno
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Nayara Pereira
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - João Manoel Alves
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Tiago T. Gonçalves
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Julia Forato
- Department of Genetics, Microbiology and Immunology, Laboratory of Emerging Viruses, Institute of Biology, University of Campinas, Campinas13083-970, Brazil
| | - Stéfanie P. Muraro
- Department of Genetics, Microbiology and Immunology, Laboratory of Emerging Viruses, Institute of Biology, University of Campinas, Campinas13083-970, Brazil
| | - Gabriela F. Souza
- Department of Genetics, Microbiology and Immunology, Laboratory of Emerging Viruses, Institute of Biology, University of Campinas, Campinas13083-970, Brazil
| | - Sabrina Setembre Batah
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - José L. Proenca-Modena
- Department of Genetics, Microbiology and Immunology, Laboratory of Emerging Viruses, Institute of Biology, University of Campinas, Campinas13083-970, Brazil
- Experimental Medicine Research, Cluster University of Campinas, Campinas13083-970, Brazil
| | - Marcelo A. Mori
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas13083-970, Brazil
- Experimental Medicine Research, Cluster University of Campinas, Campinas13083-970, Brazil
- Obesity and Comorbidities Research Center, University of Campinas, Campinas13083-864, Brazil
| | - Fernando Q. Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Paulo Louzada-Junior
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Divisions of Clinical Immunology, Emergency, Infectious Diseases, and Intensive Care Unit, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Thiago M. Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Helder I. Nakaya
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Hospital Israelita Albert Einstein, São Paulo05652-900, Brazil
| | - Alexandre Fabro
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Renê D. R. de Oliveira
- Divisions of Clinical Immunology, Emergency, Infectious Diseases, and Intensive Care Unit, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Eurico Arruda
- Department of Cell Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
| | - Rosângela Réa
- Federal University of Paraná, Center for Study and Research in Intensive Care Medicine, Curitiba82530-200, Brazil
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba80060-900, Brazil
| | - Álvaro Réa Neto
- Federal University of Paraná, Center for Study and Research in Intensive Care Medicine, Curitiba82530-200, Brazil
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba80060-900, Brazil
| | | | - Luiz Osório Leiria
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
- Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto14049-900, Brazil
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Chander S, Deepak V, Kumari R, Leys L, Wang HY, Mehta P, Sadarat FNU. Glycemic Control in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072555. [PMID: 37048638 PMCID: PMC10094858 DOI: 10.3390/jcm12072555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Given the mortality risk in COVID-19 patients, it is necessary to estimate the impact of glycemic control on mortality rates among inpatients by designing and implementing evidence-based blood glucose (BG) control methods. There is evidence to suggest that COVID-19 patients with hyperglycemia are at risk of mortality, and glycemic control may improve outcomes. However, the optimal target range of blood glucose levels in critically ill COVID-19 patients remains unclear, and further research is needed to establish the most effective glycemic control strategies in this population. Methods: The investigation was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data sources were drawn from Google Scholar, ResearchGate, PubMed (MEDLINE), Cochrane Library, and Embase databases. Randomized controlled trials, non-randomized controlled trials, retrospective cohort studies, and observational studies with comparison groups specific to tight glycemic control in COVID-19 patients with and without diabetes. Results: Eleven observational studies (26,953 patients hospitalized for COVID-19) were included. The incidence of death was significantly higher among COVID-19 patients diagnosed with diabetes than those without diabetes (OR = 2.70 [2.11, 3.45] at a 95% confidence interval). Incidences of death (OR of 3.76 (3.00, 4.72) at a 95% confidence interval) and complications (OR of 0.88 [0.76, 1.02] at a 95% confidence interval) were also significantly higher for COVID-19 patients with poor glycemic control. Conclusion: These findings suggest that poor glycemic control in critically ill patients leads to an increased mortality rate, infection rate, mechanical ventilation, and prolonged hospitalization.
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Affiliation(s)
- Subhash Chander
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
- Correspondence:
| | - Vishal Deepak
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Roopa Kumari
- Department of Pathology, Mount Sinai Morningside, and Mount Sinai West, New York, NY 10025, USA
| | - Lorenzo Leys
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Mount Sinai Morningside, and Mount Sinai West, New York, NY 10025, USA
| | - Hong Yu Wang
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
| | - Puja Mehta
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT 06510, USA
| | - FNU Sadarat
- Department of Internal Medicine, University of Buffalo, New York, NY 14215, USA
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7
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Manfra A, Chen C, Batra K, Min Tun K, Kioka MJ. Factors associated with improved outcome of inhaled corticosteroid use in COVID-19: A single institutional study. Medicine (Baltimore) 2022; 101:e32420. [PMID: 36595838 PMCID: PMC9794212 DOI: 10.1097/md.0000000000032420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Asthmatics seem less prone to adverse outcomes in coronavirus disease 2019 (COVID-19) and some data shows that inhaled corticosteroids (ICS) are protective. We gathered data on anecdotal ICS and outcomes of patients hospitalized with COVID-19, given there is literature supporting ICS may reduce risk of severe infection. In addition, we fill gaps in current literature evaluating Charlson Comorbidity Index (CCI) as a risk assessment tool for COVID-19. This was a single-center, retrospective study designed and conducted to identify factors associated intubation and inpatient mortality. A multivariate logistic regression model was fit to generate adjusted odds ratios (OR). Intubation was associated with male gender (OR, 2.815; 95% confidence interval [CI], 1.348-5.881; P = .006) and increasing body mass index (BMI) (OR, 1.053; 95% CI, 1.009-1.099; P = .019). Asthma was associated with lower odds for intubation (OR, 0.283; 95% CI, 0.108-0.74; P = .01). 80% of patients taking pre-hospital ICS were not intubated (n = 8). In-patient mortality was associated with male gender (OR, 2.44; 95% CI, 1.167-5.1; P = .018), older age (OR, 1.096; 95% CI, 1.052-1.142; P = <.001), and increasing BMI (OR, 1.079; 95% CI, 1.033-1.127; P = .001). Asthma was associated with lower in-patient mortality (OR, 0.221; 95% CI, 0.057-0.854; P = .029). CCI did not correlate with intubation (OR, 1.262; 95% CI, 0.923-1.724; P = .145) or inpatient mortality (OR, 0.896; 95% CI, 0.665-1.206; P = .468). Asthmatics hospitalized for COVID-19 had less adverse outcomes, and most patients taking pre-hospital ICS were not intubated. CCI score was not associated with intubation or inpatient mortality.
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Affiliation(s)
- Andrew Manfra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Claire Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Kavita Batra
- Department of Medical Education and Office of Research, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Kyaw Min Tun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Mutsumi John Kioka
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
- * Correspondence: Mutsumi John Kioka, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, 1701 W. Charleston Blvd., Suite 230, Las Vegas, NV 89102, USA (e-mail: )
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Tallon EM, Ebekozien O, Sanchez J, Staggs VS, Ferro D, McDonough R, Demeterco-Berggren C, Polsky S, Gomez P, Patel N, Prahalad P, Odugbesan O, Mathias P, Lee JM, Smith C, Shyu CR, Clements MA. Impact of diabetes status and related factors on COVID-19-associated hospitalization: A nationwide retrospective cohort study of 116,370 adults with SARS-CoV-2 infection. Diabetes Res Clin Pract 2022; 194:110156. [PMID: 36400172 PMCID: PMC9663407 DOI: 10.1016/j.diabres.2022.110156] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/01/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022]
Abstract
AIMS We examined diabetes status (no diabetes; type 1 diabetes [T1D]; type 2 diabetes [T2D]) and other demographic and clinical factors as correlates of coronavirus disease 2019 (COVID-19)-related hospitalization. Further, we evaluated predictors of COVID-19-related hospitalization in T1D and T2D. METHODS We analyzed electronic health record data from the de-identified COVID-19 database (December 2019 through mid-September 2020; 87 US health systems). Logistic mixed models were used to examine predictors of hospitalization at index encounters associated with confirmed SARS-CoV-2 infection. RESULTS In 116,370 adults (>=18 years old) with COVID-19 (93,098 no diabetes; 802 T1D; 22,470 T2D), factors that independently increased risk for hospitalization included diabetes, male sex, public health insurance, decreased body mass index (BMI; <25.0-29.9 kg/m2), increased BMI (>25.0-29.9 kg/m2), vitamin D deficiency/insufficiency, and Elixhauser comorbidity score. After further adjustment for concurrent hyperglycemia and acidosis in those with diabetes, hospitalization risk was substantially higher in T1D than T2D and in those with low vitamin D and elevated hemoglobin A1c (HbA1c). CONCLUSIONS The higher hospitalization risk in T1D versus T2D warrants further investigation. Modifiable risk factors such as vitamin D deficiency/insufficiency, BMI, and elevated HbA1c may serve as prognostic indicators for COVID-19-related hospitalization in adults with diabetes.
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Affiliation(s)
- Erin M Tallon
- Institute for Data Science and Informatics, University of Missouri, 22 Heinkel Building, Columbia, MO 65211, USA.
| | - Osagie Ebekozien
- T1D Exchange, 11 Avenue de Lafayette, Boston, MA 02111, USA; School of Population Health, University of Mississippi, 2500 North State Street, Jackson, MS 39216, USA
| | - Janine Sanchez
- University of Miami, 1601 NW 12th Avenue, Miami, FL 33136, USA
| | - Vincent S Staggs
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Diana Ferro
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Ryan McDonough
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | | | - Sarit Polsky
- Barbara Davis Center for Diabetes, Adult Clinic, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, MS A140, Aurora, CO 80045, USA
| | - Patricia Gomez
- University of Miami, 1601 NW 12th Avenue, Miami, FL 33136, USA
| | - Neha Patel
- Penn State Health Children's Hospital, 12 Briarcrest Square, Hershey, PA 17033, USA
| | - Priya Prahalad
- Stanford University, 730 Welch Road, Palo Alto, CA 94304, USA
| | - Ori Odugbesan
- T1D Exchange, 11 Avenue de Lafayette, Boston, MA 02111, USA
| | - Priyanka Mathias
- Albert Einstein College of Medicine, Montefiore Medical Center, 1800 Morris Park Avenue, Bronx, NY 10461, USA
| | - Joyce M Lee
- University of Michigan, Pediatric Endocrinology, Susan B. Meister Child Health Evaluation and Research Center, 2800 Plymouth Rd NCRC Building 16, Ann Arbor, MI 48109-2800, USA
| | - Chelsey Smith
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, 22 Heinkel Building, Columbia, MO 65211, USA; Department of Electrical Engineering and Computer Science, University of Missouri, 201 Naka Hall, Columbia, MO 65211, USA; School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| | - Mark A Clements
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
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