Effect of plasma glucose at admission on COVID-19 mortality: experience from a tertiary hospital.

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Plasma glucose has been correlated with in-hospital mortality among many diseases including infections. We aimed to study plasma glucose at admission of hospitalized patients with COVID-19 at a tertiary care referral hospital at Jodhpur, India and its relation with mortality.A hospital-based clinical study of plasma glucose of COVID-19 patients conducted from May 15th to June 30th, 2020 after ethical approval.Random blood samples at admission were collected for plasma glucose, interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP) after written informed consent. Plasma glucose was analyzed by automated analyzer, IL-6 by chemiluminescent immunoassay and hsCRP by immune-turbidimetric assay.A total of 386 patients studied (female 39.6%); 11.1% had severe disease and 4.1% expired. There were 67 (17.4%) patients with known diabetes mellitus (DM). Patients with history of DM had three times higher mortality (6/66, 9%) than those without DM (10/319, 3.1%). Patients with moderate and severe disease according to ICMR and WHO grading had higher plasma glucose than those with asymptomatic or mild disease (p<0.0001). Plasma glucose levels at admission were significantly higher in non-survivors when compared to those who survived (297±117 vs. 131±73; p<0.0001). COVID-19 patients showed increasing mortality with incremental plasma glucose levels. Hazard ratio for mortality was 1.128 (95%CI 0.86-14.860),1.883 (95%CI 0.209-16.970), and 4.005 (95%CI 0.503-32.677) in random plasma glucose group of >100-200, >200-300 and >300mg/dl respectively compared to those with random plasma glucose of <100mg/dl at admission. Plasma glucose was strongly correlated with hsCRP (p<0.001) and IL-6 (p<0.0001).Plasma glucose at admission in hospitalized COVID-19 patients is a strong predictor of mortality.

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Authors: Bharat Kumar, Madhukar Mittal, Maya Gopalakrishnan, Mk Garg, Sanjeev Misra