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Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death
Jordi Mayneris-Perxachs1,2,3, Maria Francesca Russo4, Rafel Ramos5,6,7
1Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain.
Insights
Blood hemoglobin levels significantly impact COVID-19 mortality risk in hyperglycemic patients. Monitoring hemoglobin is crucial for identifying high-risk individuals, especially men with severe hyperglycemia.
Area of Science:
- Infectious Diseases
- Endocrinology
- Hematology
Background:
- COVID-19 prognosis is independently worsened by hyperglycemia and obesity.
- The interplay between these factors and other confounders remains unclear.
- Understanding these interactions is vital for accurate risk stratification.
Purpose of the Study:
- To identify and assess confounding factors influencing the prognostic value of obesity and hyperglycemia.
- To evaluate the impact of these factors on COVID-19 mortality and intensive care unit (ICU) admission.
Main Methods:
- Logistic regression and machine learning (ML) algorithms were employed.
- Data collected from over 3,000 patients across Italian and Spanish hospitals and primary care centers.
- Analysis focused on COVID-19 mortality and ICU admission risk.
Main Results:
- Obesity and hyperglycemia independently predicted ICU admission.
- Hyperglycemia, hemoglobin, and bilirubin levels were linked to increased mortality risk by ML.
- Hemoglobin levels modulated mortality risk: hyperglycemic and obese patients with high hemoglobin had significantly higher mortality, particularly men.
Conclusions:
- Blood hemoglobin substantially modifies the effect of hyperglycemia on COVID-19 mortality risk.
- Hemoglobin monitoring is critical for identifying high-risk patients.
- Clinical settings should utilize hemoglobin levels for improved risk assessment in COVID-19 patients.
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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