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Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain

BACKGROUND: Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affec...

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Autores principales: Mayneris-Perxachs, Jordi, Russo, Maria Francesca, Ramos, Rafel, de Hollanda, Ana, Arxé, Arola Armengou, Rottoli, Matteo, Arnoriaga-Rodríguez, María, Comas-Cufí, Marc, Bartoletti, Michele, Verrastro, Ornella, Gudiol, Carlota, Fages, Ester, Giménez, Marga, Gil, Ariadna de Genover, Bernante, Paolo, Tinahones, Francisco, Carratalà, Jordi, Pagotto, Uberto, Hernández-Aguado, Ildefonso, Fernández-Aranda, Fernando, Meira, Fernanda, Castro Guardiola, Antoni, Mingrone, Geltrude, Fernández-Real, José Manuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593102/
https://www.ncbi.nlm.nih.gov/pubmed/34795637
http://dx.doi.org/10.3389/fendo.2021.741248
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author Mayneris-Perxachs, Jordi
Russo, Maria Francesca
Ramos, Rafel
de Hollanda, Ana
Arxé, Arola Armengou
Rottoli, Matteo
Arnoriaga-Rodríguez, María
Comas-Cufí, Marc
Bartoletti, Michele
Verrastro, Ornella
Gudiol, Carlota
Fages, Ester
Giménez, Marga
Gil, Ariadna de Genover
Bernante, Paolo
Tinahones, Francisco
Carratalà, Jordi
Pagotto, Uberto
Hernández-Aguado, Ildefonso
Fernández-Aranda, Fernando
Meira, Fernanda
Castro Guardiola, Antoni
Mingrone, Geltrude
Fernández-Real, José Manuel
author_facet Mayneris-Perxachs, Jordi
Russo, Maria Francesca
Ramos, Rafel
de Hollanda, Ana
Arxé, Arola Armengou
Rottoli, Matteo
Arnoriaga-Rodríguez, María
Comas-Cufí, Marc
Bartoletti, Michele
Verrastro, Ornella
Gudiol, Carlota
Fages, Ester
Giménez, Marga
Gil, Ariadna de Genover
Bernante, Paolo
Tinahones, Francisco
Carratalà, Jordi
Pagotto, Uberto
Hernández-Aguado, Ildefonso
Fernández-Aranda, Fernando
Meira, Fernanda
Castro Guardiola, Antoni
Mingrone, Geltrude
Fernández-Real, José Manuel
author_sort Mayneris-Perxachs, Jordi
collection PubMed
description BACKGROUND: Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19. METHODS: Consecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms. RESULTS: As expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels. CONCLUSIONS: Blood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.
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spelling pubmed-85931022021-11-17 Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain Mayneris-Perxachs, Jordi Russo, Maria Francesca Ramos, Rafel de Hollanda, Ana Arxé, Arola Armengou Rottoli, Matteo Arnoriaga-Rodríguez, María Comas-Cufí, Marc Bartoletti, Michele Verrastro, Ornella Gudiol, Carlota Fages, Ester Giménez, Marga Gil, Ariadna de Genover Bernante, Paolo Tinahones, Francisco Carratalà, Jordi Pagotto, Uberto Hernández-Aguado, Ildefonso Fernández-Aranda, Fernando Meira, Fernanda Castro Guardiola, Antoni Mingrone, Geltrude Fernández-Real, José Manuel Front Endocrinol (Lausanne) Endocrinology BACKGROUND: Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19. METHODS: Consecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms. RESULTS: As expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels. CONCLUSIONS: Blood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk. Frontiers Media S.A. 2021-11-02 /pmc/articles/PMC8593102/ /pubmed/34795637 http://dx.doi.org/10.3389/fendo.2021.741248 Text en Copyright © 2021 Mayneris-Perxachs, Russo, Ramos, de Hollanda, Arxé, Rottoli, Arnoriaga-Rodríguez, Comas-Cufí, Bartoletti, Verrastro, Gudiol, Fages, Giménez, Gil, Bernante, Tinahones, Carratalà, Pagotto, Hernández-Aguado, Fernández-Aranda, Meira, Castro Guardiola, Mingrone and Fernández-Real https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Mayneris-Perxachs, Jordi
Russo, Maria Francesca
Ramos, Rafel
de Hollanda, Ana
Arxé, Arola Armengou
Rottoli, Matteo
Arnoriaga-Rodríguez, María
Comas-Cufí, Marc
Bartoletti, Michele
Verrastro, Ornella
Gudiol, Carlota
Fages, Ester
Giménez, Marga
Gil, Ariadna de Genover
Bernante, Paolo
Tinahones, Francisco
Carratalà, Jordi
Pagotto, Uberto
Hernández-Aguado, Ildefonso
Fernández-Aranda, Fernando
Meira, Fernanda
Castro Guardiola, Antoni
Mingrone, Geltrude
Fernández-Real, José Manuel
Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain
title Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain
title_full Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain
title_fullStr Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain
title_full_unstemmed Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain
title_short Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain
title_sort blood hemoglobin substantially modulates the impact of gender, morbid obesity, and hyperglycemia on covid-19 death risk: a multicenter study in italy and spain
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593102/
https://www.ncbi.nlm.nih.gov/pubmed/34795637
http://dx.doi.org/10.3389/fendo.2021.741248
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