Hyperglycemia Is Associated With Increased Mortality in Critically Ill Patients With COVID-19

Objective: To explore the relationship between diabetes mellitus (DM), hyperglycemia, and adverse outcomes in critically ill patients with coronavirus disease 2019 (COVID-19). Research Design and Methods: The study population comprised 133 patients with COVID-19 admitted to an intensive care unit (ICU) at an academic, urban, quaternary-care center between March 10(th) and April 8(th), 2020. Patients were categorized based on the presence of DM and early-onset hyperglycemia (EHG), defined as a blood glucose >180 mg/dL during the first two days of ICU admission. The primary outcome was 14-day in-hospital mortality; also examined were 60-day in-hospital mortality and the levels of C-reactive protein (CRP), interleukin 6, procalcitonin, and lactate. Results: Compared to non-DM patients without EHG, non-DM patients with EHG exhibited higher adjusted hazard ratios (HR) for in-hospital mortality at 14 days (HR 5.76, p=0.008) and 60 days (HR 7.28, p=0.004). Non-DM patients with EHG also featured higher levels of mean CRP (322.3±177.7 mg/L, p=0.036), procalcitonin (34.75±69.33 ng/mL, p=0.028), and lactate (2.7±2.1 mmol/L, p=0.023). Conclusions: In patients with critical illness from COVID-19, those without DM with EHG were at greatest risk of 14-day and 60-day in-hospital mortality. The limitations of our study include its retrospective design, and relatively small cohort. However, our results raise the possibility that the combination of elevated glucose and lactate may identify a specific cohort of individuals at high mortality risk from COVID-19, and suggest that glucose testing and control are important in individuals with COVID-19, even in those without pre-existing diabetes.