Elevated glycohemoglobin is linked to critical illness in CoVID-19: a retrospective analysis
Samuel Windham1, Melissa P Wilson2, Connor Fling3
1Division of Infectious Disease, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.
Insights
Poorly controlled diabetes in COVID-19 patients, indicated by high hemoglobin A1c (HbA1c), significantly increases the risk of intubation or death. This finding highlights the critical role of diabetes management in COVID-19 outcomes.
Area of Science:
- Infectious Diseases
- Endocrinology
- Critical Care Medicine
Background:
- Numerous studies have investigated risk factors for hospitalization due to COVID-19.
- This study aimed to identify clinical factors, excluding lab or imaging data, linked to intubation or death within seven days of hospital admission.
Purpose of the Study:
- To identify clinical characteristics associated with severe outcomes (intubation or death) in COVID-19 patients within 7 days of admission.
- To assess the predictive value of specific clinical factors, including demographics and comorbidities, on COVID-19 severity.
Main Methods:
- A cohort of 436 hospitalized COVID-19 patients was analyzed.
- Data including demographics, comorbidities, and medications were collected via chart review.
- Multivariable logistic regression and MCP-regularized logistic regression were used to estimate associations and build predictive models.
Main Results:
- Increasing age, higher body mass index (BMI), and poorly controlled diabetes (HbA1c ≥ 8) were significantly associated with higher odds of intubation or death.
- Female sex was associated with lower odds of intubation or death.
- Each one-unit increase in HbA1c correlated with a 19% increase in the odds of death and/or intubation.
Conclusions:
- Worsening diabetes control, indicated by elevated HbA1c, is a significant predictor of increased risk for intubation or death in hospitalized COVID-19 patients.
- These findings reinforce the link between diabetes and severe COVID-19 outcomes.
- The predictive model's limited success suggests that unmeasured factors significantly influence COVID-19 disease severity.
Background:
Several studies have explored hospitalization risk factors with the novel coronavirus disease 2019 (COVID-19) infection. Our goal was to identify clinical characteristics outside of laboratory or radiologic data associated with intubation or death within 7 days of admission.
Methods:
The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed COVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median height for patients' sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction.
Results:
Participants had a mean [standard deviation (SD)] age 55 (17), BMI 30.9 (8.2), 55% were male and 80% were ethnic/racial minorities. Increasing age [aOR: 1.24 (1.07, 1.45) per 10 years], higher BMI (aOR 1.03 (1.00, 1.06), and poorly controlled diabetes [hemoglobin A1C (HbA1c) ⩾ 8] (aOR 2.26 (1.24, 4.12) were significantly (p < 0.05) associated with greater odds of intubation or death. Female sex [aOR: 0.63, 95% CI (0.40, 0.98); p value = 0.043] was associated with lesser odds of intubation or death. The odds of death and/or intubation increased 19% for every 1 unit increase in HbA1c value [OR: 1.19 (1.01, 1.43); p = 0.04]. Our final MCP model included indicators of A1C ⩾ 8, age > 65, sex, and minority status, but predicted intubation/death only slightly better than random chance [area under the receiver operating characteristic curve (AUC) = 0.61 (0.56, 0.67)].
Conclusion:
In a hospitalized patient cohort with COVID-19, worsening control of diabetes as evidenced by higher HbA1c was associated with increased risk of intubation or death within 7 days of admission. These results complement and help clarify previous associations found between diabetes and acute disease in COVID-19. Importantly, our analysis is missing some known predictors of severity in COVID-19. Our predictive model had limited success, suggesting unmeasured factors contribute to disease severity differences.
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