Clinical and biological characteristics associated with hyperglycemia in hospitalized COVID-19 patients in Morocco

SARS-CoV-2 infection is frequently associated with metabolic disorders. This study aimed to analyze the epidemiological, clinical, and biological characteristics of patients hospitalized for COVID-19 in Morocco and to evaluate the factors associated with hyperglycemia at admission.

A retrospective, single-center observational study was conducted on 472 patients hospitalized for RT-PCR-confirmed COVID-19 at the El Jadida Provincial Hospital Center (Morocco). Patients were classified into three groups according to fasting plasma glucose and history of diabetes: normoglycemic patients, hyperglycemic patients, and type 2 diabetes (T2D) patients. Demographic, clinical, biological, and radiological data were collected from medical records for admissions between April 2020 and January 2021. Hyperglycemia was defined as a fasting plasma glucose ≥ 126 mg/dL with no prior diagnosis of diabetes.

Of the 472 patients included, 38.8% were normoglycemic, 31.3% had hyperglycemia without a history of diabetes, and 29.9% had T2D. Hyperglycemic patients presented with more severe forms of COVID-19, with lower oxygen saturation, more extensive lung involvement, and marked biological abnormalities, including elevated leukocytes, neutrophils, AST, ALT, and the neutrophil-to-lymphocyte ratio. Lymphopenia and eosinopenia were also more frequent in these patients. In univariate analysis, advanced age, low SpO₂, elevated AST and ALT levels, neutrophilia, and severe COVID-19 were significantly associated with hyperglycemia. After adjustment for age, sex, comorbidities, and COVID-19 severity, independent predictors of hyperglycemia included elevated ALT (OR = 1.68, p = 0.037), higher neutrophil count (OR = 1.11, p = 0.003), a higher neutrophil-to-lymphocyte ratio (OR = 1.13, p < 0.001), and lymphopenia (OR = 0.54, p = 0.014).

Admission hyperglycemia was associated with greater COVID-19 severity and marked biological abnormalities. As this cross-sectional study did not include post-discharge follow-up, these findings represent associations rather than evidence of incident diabetes; nonetheless, post-discharge metabolic monitoring of hyperglycemic patients appears warranted.