Glycemic Gap Predicts Mortality in a Large Multicenter Cohort Hospitalized With COVID-19

Area of Science:

• Endocrinology
• Infectious Diseases
• Critical Care Medicine

Background:

• Diabetes and hyperglycemia are known risk factors for severe outcomes in COVID-19 patients.
• The impact of pre-existing glycemic control on COVID-19 hospitalization outcomes remains unclear.

Purpose of the Study:

• To investigate the association between admission variables, including glycemic gap, and adverse clinical outcomes in COVID-19 patients.
• To determine if glycemic gap is a better predictor of mortality than admission glucose or HbA1c alone.

Main Methods:

• A cohort of 1786 patients with diabetes or hyperglycemia admitted with COVID-19 was analyzed.
• Clinical predictors including acute (glucose) and chronic (HbA1c) glycemia were assessed.
• Outcomes included intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality.

Main Results:

• Admission glucose and age were associated with increased mortality, but HbA1c was not.
• The glycemic gap (admission glucose - estimated average glucose from HbA1c) was a stronger predictor of mortality than admission glucose or HbA1c alone.
• In multivariable analysis, glycemic gap, age, BMI, and diabetic ketoacidosis predicted higher mortality, while higher eGFR and diabetes medication use predicted lower mortality.

Conclusions:

• Relative hyperglycemia, indicated by the admission glycemic gap, is a crucial marker for mortality risk in COVID-19.
• Assessing the glycemic gap provides valuable prognostic information for hospitalized COVID-19 patients with diabetes or hyperglycemia.