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McDonnell ME, Garg R, Gopalakrishnan G, Mitri J, Weinstock RS, Greenfield M, Katta S, Lebastchi J, Palermo NE, Radhakrishnan R, Westcott GP, Johnson M, Simonson DC. Glycemic Gap Predicts Mortality in a Large Multicenter Cohort Hospitalized With COVID-19. J Clin Endocrinol Metab 2023; 108:718-725. [PMID: 36217580 PMCID: PMC9619706 DOI: 10.1210/clinem/dgac587] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Diabetes or hyperglycemia at admission are established risk factors for adverse outcomes during hospitalization for COVID-19, but the impact of prior glycemic control is not clear. OBJECTIVE We aimed to examine the associations between admission variables, including glycemic gap, and adverse clinical outcomes in patients hospitalized with COVID-19 infection. METHODS We examined the relationship between clinical predictors, including acute and chronic glycemia, and clinical outcomes, including intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality among 1786 individuals with diabetes or hyperglycemia (glucose > 10 mmol/L twice in 24 hours) who were admitted from March 2020 through February 2021 with COVID-19 infection at 5 university hospitals in the eastern United States. RESULTS The cohort was 51.3% male, 53.3% White, 18.8% Black, 29.0% Hispanic, with age = 65.6 ± 14.4 years, BMI = 31.5 ± 7.9 kg/m2, glucose = 12.0 ± 7.5 mmol/L [216 ± 135 mg/dL], and HbA1c = 8.07% ± 2.25%. During hospitalization, 38.9% were admitted to the ICU, 22.9% received MV, and 10.6% died. Age (P < 0.001) and admission glucose (P = 0.014) but not HbA1c were associated with increased risk of mortality. Glycemic gap, defined as admission glucose minus estimated average glucose based on HbA1c, was a stronger predictor of mortality than either admission glucose or HbA1c alone (OR = 1.040 [95% CI: 1.019, 1.061] per mmol/L, P < 0.001). In an adjusted multivariable model, glycemic gap, age, BMI, and diabetic ketoacidosis on admission were associated with increased mortality, while higher estimated glomerular filtration rate (eGFR) and use of any diabetes medication were associated with lower mortality (P < 0.001). CONCLUSION Relative hyperglycemia, as measured by the admission glycemic gap, is an important marker of mortality risk in COVID-19.
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Affiliation(s)
- Marie E McDonnell
- Corresponding Author: Marie E. McDonnell, M.D. Division of Endocrinology, Diabetes and Hypertension Brigham and Women’s Hospital 221 Longwood Avenue Boston, MA 02115 E-mail: phone: 617-732-5693
| | - Rajesh Garg
- University of Miami, Miller School of Medicine, Miami, FL
| | - Geetha Gopalakrishnan
- Rhode Island Hospital, Providence, RI
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Joanna Mitri
- Harvard Medical School, Boston, MA
- Joslin Diabetes Center, Boston, MA
- Beth Israel-Deaconess Medical Center, Boston, MA
| | - Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Sai Katta
- State University of New York Upstate Medical University, Syracuse, NY
| | - Jasmin Lebastchi
- Rhode Island Hospital, Providence, RI
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Nadine E Palermo
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Gregory P Westcott
- Harvard Medical School, Boston, MA
- Beth Israel-Deaconess Medical Center, Boston, MA
| | | | - Donald C Simonson
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Hussein HJ, Ibrahim SA, Al-Shaibani SW, Abdulrudha NH. Association of Covid-19 with blood type A in relation to blood sugar, urea, and blood test (D-dimer and ferritin) in patients from Al-Najaf. J Med Life 2022; 15:180-187. [PMID: 35419105 PMCID: PMC8999108 DOI: 10.25122/jml-2021-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is an emerging infectious disease caused by the novel enveloped single-stranded RNA virus quickly declared a pandemic. This study aimed to investigate the severity of COVID-19 infection in patients with blood group type A. A cross-sectional study was conducted at Al-Amal specialized hospital, Al-Najaf (March 8 to March 20/2021). The study included 123 hospitalized patients (63 females and 60 males), aged between 15-95 years, diagnosed with COVID-19, tested for blood group, blood sugar, blood urea, D-dimer, and serum ferritin. Results indicated significant differences in blood sugar and D-dimer in patients with type A blood group at P>0.05. At the same time, no significant difference was found in blood urea and ferritin at P>0.05. The majority of patients showed elevated levels of blood sugar, blood urea, serum D-dimer and ferritin. COVID-19 can infect people of all ages and causes severe infection in all blood groups.
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Affiliation(s)
- Hayfaa Jaber Hussein
- Department of Basic Sciences, Faculty of Dentistry, University of Kufa, AL-Najaf, Iraq,Corresponding Author: Hayfaa Jaber Hussein, Department of Basic Sciences, Faculty of Dentistry, University of Kufa, AL-Najaf, Iraq. E-mail:
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He X, Liu C, Peng J, Li Z, Li F, Wang J, Hu A, Peng M, Huang K, Fan D, Li N, Zhang F, Cai W, Tan X, Hu Z, Deng X, Li Y, Mo X, Li L, Shi Y, Yang L, Zhu Y, Wu Y, Liang H, Liao B, Hong W, He R, Li J, Guo P, Zhuo Y, Zhao L, Hu F, Li W, Zhu W, Zhang Z, Guo Z, Zhang W, Hong X, Cai W, Gu L, Du Z, Zhang Y, Xu J, Zuo T, Deng K, Yan L, Chen X, Chen S, Lei C. COVID-19 induces new-onset insulin resistance and lipid metabolic dysregulation via regulation of secreted metabolic factors. Signal Transduct Target Ther 2021; 6:427. [PMID: 34916489 PMCID: PMC8674414 DOI: 10.1038/s41392-021-00822-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 12/13/2022] Open
Abstract
Abnormal glucose and lipid metabolism in COVID-19 patients were recently reported with unclear mechanism. In this study, we retrospectively investigated a cohort of COVID-19 patients without pre-existing metabolic-related diseases, and found new-onset insulin resistance, hyperglycemia, and decreased HDL-C in these patients. Mechanistically, SARS-CoV-2 infection increased the expression of RE1-silencing transcription factor (REST), which modulated the expression of secreted metabolic factors including myeloperoxidase, apelin, and myostatin at the transcriptional level, resulting in the perturbation of glucose and lipid metabolism. Furthermore, several lipids, including (±)5-HETE, (±)12-HETE, propionic acid, and isobutyric acid were identified as the potential biomarkers of COVID-19-induced metabolic dysregulation, especially in insulin resistance. Taken together, our study revealed insulin resistance as the direct cause of hyperglycemia upon COVID-19, and further illustrated the underlying mechanisms, providing potential therapeutic targets for COVID-19-induced metabolic complications.
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Affiliation(s)
- Xi He
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Chenshu Liu
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiangyun Peng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zilun Li
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fang Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Obstetrics and Gynecology, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jian Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ao Hu
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,Department of Immunology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Meixiu Peng
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kan Huang
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dongxiao Fan
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Na Li
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fuchun Zhang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weiping Cai
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinghua Tan
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhongwei Hu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xilong Deng
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yueping Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoneng Mo
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yaling Shi
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Li Yang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuanyuan Zhu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanrong Wu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huichao Liang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Baolin Liao
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wenxin Hong
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ruiying He
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jiaojiao Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Pengle Guo
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Youguang Zhuo
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lingzhai Zhao
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fengyu Hu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wenxue Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Wei Zhu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zefeng Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zeling Guo
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Zhang
- Wuhan Metware Biotechnology Co., Ltd, Wuhan, China
| | - Xiqiang Hong
- Wuhan Metware Biotechnology Co., Ltd, Wuhan, China
| | - Weikang Cai
- Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Lei Gu
- Max Planck Institute for Heart and Lung Research and Cardiopulmonary Institute (CPI), Bad Nauheim, Germany
| | - Ziming Du
- Department of Molecular Diagnostics, Sun Yat-sen Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yang Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Jin Xu
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Tao Zuo
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Deng
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,Department of Immunology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinwen Chen
- Guangzhou Regenerative Medicine and Health-Guangdong Laboratory (GRMH-GDL), Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China. .,Key Laboratory of Regenerative Biology of the Chinese Academy of Sciences and Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.
| | - Sifan Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China. .,Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Chunliang Lei
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
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6
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Lin L, Chen Z, Ding T, Liu H, Zhou F, Huang X, Zhang X, Liu W, Zhang BH, Yuan Y, Zhang P, Zhang XJ, She ZG, Cai J, Chen W, Li H. Newly-Diagnosed Diabetes and Sustained Hyperglycemia are Associated with Poorer Outcomes in COVID-19 Inpatients Without Pre-Existing Diabetes. Diabetes Metab Syndr Obes 2021; 14:4469-4482. [PMID: 34795494 PMCID: PMC8593357 DOI: 10.2147/dmso.s332819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/09/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To analyze the impact of hyperglycemia on the clinical outcome of COVID-19 in patients with newly diagnosed diabetes (NDD). PATIENTS AND METHODS We performed a retrospective study of 3114 cases of COVID-19 without pre-existing diabetes, 351 of which had NDD, in Hubei Province, China. The Cox regression model was used to calculate the risk of adverse clinical outcomes comparing the NDD vs non-NDD group before and after propensity score-matched (PSM) analysis. Patients with NDD were further divided into a sustained hyperglycemia group, a fluctuating group, and a remitted group based on their blood glucose levels during hospitalization as well as into hypoglycemic agent users and nonusers. RESULTS Compared to the non-NDD individuals, individuals with NDD had a significantly increased risk of all-cause mortality (adjusted HR after PSM, 2.65; 95% CI, 1.49-4.72; P = 0.001) and secondary outcomes involving organ damage during the 28-day follow-up period. Subgroup analyses indicated that among individuals with NDD, the individuals with remitted hyperglycemia had the lowest 28-day mortality, whereas those with sustained hyperglycemia had the highest (IRR 24.27; 95% CI, 3.21-183.36; P < 0.001). Moreover, individuals treated with hypoglycemic agents had significantly lower all-cause mortality than those not treated with hypoglycemic agents (IRR 0.08; 95% CI, 0.01-0.56; P < 0.001). CONCLUSION Our study reinforces the clinical message that NDD is strongly associated with poor outcomes in COVID-19 patients. Furthermore, resolved hyperglycemia in the later phase of the disease and the use of hypoglycemic agents were associated with improved prognosis in patients with NDD.
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Affiliation(s)
- Lijin Lin
- Department of Endocrinology, Huanggang Central Hospital, Huanggang, People’s Republic of China
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
| | - Ze Chen
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Ting Ding
- Department of Endocrinology, Huanggang Central Hospital, Huanggang, People’s Republic of China
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
| | - Hui Liu
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Neonatology of Gastroenterology, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan, People’s Republic of China
| | - Feng Zhou
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xuewei Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
| | - Xingyuan Zhang
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Weifang Liu
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Bing-Hong Zhang
- Neonatology Department, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Peng Zhang
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Xiao-Jing Zhang
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
| | - Jingjing Cai
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Wenping Chen
- Department of Endocrinology, Huanggang Central Hospital, Huanggang, People’s Republic of China
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
| | - Hongliang Li
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
- Correspondence: Hongliang Li; Wenping Chen Email ;
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