Glycemic control before admission is an important determinant of prognosis in patients with coronavirus disease 2019.
Glycemic control before admission is an important determinant of prognosis in patients with coronavirus disease 2019.
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入院前血糖控制是2019冠状病毒病患者预后的重要决定因素。
DOI：
10.1111/jdi.13431
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发表时间：
2021-06
影响因子：
3.2
通讯作者：
Zhang B
中科院分区：
文献类型：
--
作者：
Liu L;Wei W;Yang K;Li S;Yu X;Dong C;Zhang B
本研究旨在探讨2019年冠状病毒病入院前血糖控制与病情严重程度和死亡率的关系，并试图揭示其机制。将77例住院患者分为控制充分组（HbA 1c <6.5%，n = 49）和控制不充分组（HbA 1c ≥ 6.5%，n = 28）。回归模型用于分析临床数据。与HbA 1c <6.5的患者相比，HbA 1c ≥6.5的患者心率更高（101 vs 89 b. p.m.，P = 0.012），经皮血氧饱和度较低（93 vs 97%，P = 0.001），炎症的多个指标水平较高，如白色血细胞计数（7.9 vs 5.9 × 109/L，P = 0.019），中性粒细胞计数（6.5 vs 4.1 × 109/L，P = 0.001），高敏C反应蛋白患者入院时血清铁蛋白（1，287 vs 716 μg/L，P = 0.023）和淋巴细胞计数（0.7 vs 0.8 × 109/L，P = 0.049）水平较低。因此，HbA 1c ≥6.5的患者更可能发生继发性呼吸道感染（25例[89%] vs 33例[67%]，P = 0.032）和急性呼吸窘迫综合征（17 [61%] vs 14 [29%]，P = 0.006），导致危重患者比例更高（19例[68%] vs 18例[37%]，P = 0.009）和非存活者（13例[46%] vs 11例[22%]，P = 0.029）。调整潜在风险因素后，HbA 1c与院内死亡独立相关。HbA 1c是2019冠状病毒病患者预后不良的独立风险因素。严重的肺部感染和继发的急性呼吸窘迫综合征可能是血糖控制不佳患者的主要死亡原因。血红蛋白A1 c是与2019年冠状病毒病患者住院死亡相关的重要独立风险因素。严重肺部感染和随后的急性呼吸窘迫综合征，而不是肺外器官损伤，可能是入院前血糖控制不佳患者的主要死亡原因。
This study aimed to explore the association between glycemic control before admission with severity and mortality of coronavirus disease 2019, and tried to reveal the mechanism. A total of 77 inpatients were grouped into sufficient control group (glycated hemoglobin [HbA1c] <6.5%, n = 49) and insufficient control group (HbA1c ≥6.5%, n = 28). Regression models were used to analyze the clinical data. Compared with patients with HbA1c <6.5, patients with HbA1c ≥6.5 showed higher heart rate (101 vs 89 b.p.m., P = 0.012), lower percutaneous oxygen saturation (93 vs 97%, P = 0.001), higher levels of multiple indicators of inflammation, such as white blood cell count (7.9 vs 5.9 × 109/L, P = 0.019), neutrophil count (6.5 vs 4.1 × 109/L, P = 0.001), high‐sensitivity C‐reactive protein (52 vs 30 mg/L, P = 0.025) and serum ferritin (1,287 vs 716 μg/L, P = 0.023), as well as lower levels of lymphocyte count (0.7 vs 0.8 × 109/L, P = 0.049) at hospital admission. Thus, patients with HbA1c ≥6.5 were more likely to develop secondary respiratory infections (25 [89%] vs 33 [67%], P = 0.032) and acute respiratory distress syndrome (17 [61%] vs 14 [29%], P = 0.006) than patients with HbA1c <6.5, resulting in a higher proportion of critically ill patients (19 [68%] vs 18 [37%], P = 0.009) and non‐survivors (13 [46%] vs 11 [22%], P = 0.029). After adjustment for potential risk factors, HbA1c was independently associated with in‐hospital death. HbA1c was an independent risk factor for poor outcomes in coronavirus disease 2019 patients. Severe pulmonary infection and consequent acute respiratory distress syndrome might be the primary causes of death in insufficient glycemic control patients. Hemoglobin A1c was a significant independent risk factor associated with in‐hospital death of patients with coronavirus disease 2019. Severe pulmonary infection and consequent acute respiratory distress syndrome, but not extrapulmonary organ injuries, might be the primary cause of death in patients with insufficient glycemic control before admission.
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