Usage of HbA1c as a marker to assess progression of COVID-19

Document Type : Original papers

Authors

Department of Critical Care Medicine, Faculty of Medicine, Beni-Suef University

Abstract

Background: Poor glycemic management has been linked to increased mortality from previous viral pandemics, including H1N1 flu and SARS. Incorporating diabetes status assessment into risk management for COVID-19 pneumonia patients is currently proposed by many investigations. Objective: Assessment of the impact of uncontrolled diabetes on the course of COVID-19 pneumonia in critically ill patients by measuring glycosylated hemoglobin (HbA1c) in the first 48 hours of admission. Methods: A retrospective cohort study was conducted on 40 critically ill patients from October 2021 to April 2022; recruiting patients admitted to the critical care department in Beni-Suef university hospital. HbA1c was measured in the first 48 hours from admission. Results: This study was conducted on 40 patients. Fifty per cent of the participants had diabetes, and 62.5% were hypertensive. There was a significant association between the higher HbA1c level (more than8.7%) and the need for mechanical ventilation (MV), higher length of stay in intensive care unit (ICU) and mortality in diabetic patients. The HbA1c had a statistically significant role in predicting the need for MV in diabetics. At a cut-off of 8.7%, HbA1c can predict the need for MV with 91% sensitivity and 63% specificity in diabetic patients. Likewise, the HbA1c had a statistically significant role in predicting mortality in the diabetic group. At a cut-off of 8.5%, HbA1c can predict mortality with 90.9% sensitivity and 89% specificity in diabetic patients. Conclusions:  High  HbA1c led to increasing sepsis parameters , the need for mechanical ventilation , hospital stay and  the mortality in diabetic patients with COVID-19 pneumonia.

Keywords

References

  1. Young BE, Ong SW, Kalimuddin S, Low JG, Tan SY, Loh J, Ng OT, Marimuthu K, Ang LW, Mak TM, Lau SK. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. Jama. 2020 Apr 21;323(15):1488-94.
  2. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, Zimmer T, Thiel V, Janke C, Guggemos W, Seilmaier M. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. New England journal of medicine. 2020 Mar 5;382(10):970-1.
  3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Yu T. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020 Feb 15;395(10223):507-13.
  4. Abdelgawad HA, Sayed A, Munir M, Elberry MH, Sayed IM, Kamal MA, Negida A, Ebada MA, Bahbah EI. Clinical review of COVID-19; pathogenesis, diagnosis, and management. Current Pharmaceutical Design. 2021 Nov 1;27(41):4232-44.
  5. AbdelGhaffar MM, Omran D, Elgebaly A, Bahbah EI, Afify S, AlSoda M, El-Shiekh M, ElSayed ES, Shaaban SS, AbdelHafez S, Elkelany K. Prediction of mortality in hospitalized Egyptian patients with Coronavirus disease-2019: A multicenter retrospective study. Plos one. 2022 Jan 11;17(1):e0262348.
  6. Omran D, Al Soda M, Bahbah E, Esmat G, Shousha H, Elgebaly A, Abdel Ghaffar M, Alsheikh M, El Sayed E, Afify S, Abdel Hafez S. Predictors of severity and development of critical illness of Egyptian COVID-19 patients: A multicenter study. Plos one. 2021 Sep 23;16(9):e0256203.
  7. Yang JK, Feng Y, Yuan MY, Yuan SY, Fu HJ, Wu BY, Sun GZ, Yang GR, Zhang XL, Wang L, Xu X. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabetic medicine. 2006 Jun;23(6):623-8.
  8. Badawi A, Ryoo SG. Prevalence of diabetes in the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus: a systematic review and meta-analysis. Journal of public health research. 2016 Dec 21;5(3):jphr-2016.
  9. Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes research and clinical practice. 2020 Jun 1;164:108214.
  10. Liu L, Wei W, Yang K, Li S, Yu X, Dong C, Zhang B. Glycemic control before admission is an important determinant of prognosis in patients with coronavirus disease 2019. Journal of Diabetes Investigation. 2021 Jun;12(6):1064-73.
  11. Holman N, Knighton P, Kar P, O'Keefe J, Curley M, Weaver A, Barron E, Bakhai C, Khunti K, Wareham NJ, Sattar N. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. The lancet Diabetes & endocrinology. 2020 Oct 1;8(10):823-33.
  12. Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, Lei F, Wang H, Xie J, Wang W, Li H. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell metabolism. 2020 Jun 2;31(6):1068-77.
  13. Agarwal S, Schechter C, Southern W, Crandall JP, Tomer Y. Preadmission diabetes-specific risk factors for mortality in hospitalized patients with diabetes and coronavirus disease 2019. Diabetes Care. 2020 Oct 1;43(10):2339-44.
  14. Cariou B, Hadjadj S, Wargny M, Pichelin M, Al-Salameh A, Allix I, Amadou C, Arnault G, Baudoux F, Bauduceau B, Borot S. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020 Aug;63(8):1500-15.
  15. Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, Boehm B, Amiel S, Holt RI, Skyler JS, DeVries JH. Practical recommendations for the management of diabetes in patients with COVID-19. The lancet Diabetes & endocrinology. 2020 Jun 1;8(6):546-50.
  16. Zhu Z, Mao Y, Chen G. Predictive value of HbA1c for in-hospital adverse prognosis in COVID-19: A systematic review and meta-analysis. Primary Care Diabetes. 2021 Dec 1;15(6):910-7.
  17. Fadini GP, Morieri ML, Boscari F, Fioretto P, Maran A, Busetto L, Bonora BM, Selmin E, Arcidiacono G, Pinelli S, Farnia F. Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. Diabetes research and clinical practice. 2020 Oct 1;168:108374.
  18. Lui DT, Li YK, Lee CH, Chow WS, Lee AC, Tam AR, Pang P, Ho TY, Cheung CY, Fong CH, To KK. A prospective study of the impact of glycaemic status on clinical outcomes and anti-SARS-CoV-2 antibody responses among patients with predominantly non-severe COVID-19. Diabetes research and clinical practice. 2022 Mar 1;185:109232.
  19. Pazoki M, Keykhaei M, Kafan S, Montazeri M, Mirabdolhagh Hazaveh M, Sotoodehnia M, Kazemian S, Talebpour M, Ashraf H, Shariat Moharari R, Majidi F. Risk indicators associated with in-hospital mortality and severity in patients with diabetes mellitus and confirmed or clinically suspected COVID-19. Journal of Diabetes & Metabolic Disorders. 2021 Jun;20:59-69.
  20. Unluguzel Ustun G, Keskin A, Aci R, Arslanbek Erdem M, Ari M. Association between Hb A1c and severity of COVID-19 patients. Hemoglobin. 2021 Mar 4;45(2):124-8.
  21. Windham S, Wilson MP, Fling C, Sheneman D, Wand T, Babcock L, MaWhinney S, Erlandson KM. Elevated glycohemoglobin is linked to critical illness in CoVID-19: a retrospective analysis. Therapeutic Advances in Infectious Disease. 2021 Jun;8:20499361211027390.
  22. Assaad M, Hekmat-Joo N, Hosry J, Kassem A, Itani A, Dahabra L, Abou Yassine A, Zaidan J, El Sayegh D. Insulin use in Type 2 diabetic patients: a predictive of mortality in covid‑19 infection. Diabetology & Metabolic Syndrome. 2022 Dec;14(1):1-8.
  23. Lu X, Cui Z, Pan F, Li L, Li L, Liang B, Yang L, Zheng C. Glycemic status affects the severity of coronavirus disease 2019 in patients with diabetes mellitus: an observational study of CT radiological manifestations using an artificial intelligence algorithm. Acta Diabetologica. 2021 May;58:575-86.
  24. Liu Z, Bai X, Han X, Jiang W, Qiu L, Chen S, Yu X. The association of diabetes and the prognosis of COVID-19 patients: a retrospective study. Diabetes research and clinical practice. 2020 Nov 1;169:108386.
  25. Yanagisawa S, Oikawa Y, Takagi S, Horikoshi Y, Satomura A, Imai K, Sakai J, Ishibashi N, Tarumoto N, Iida S, Nakayama H. HbA1c level may be a risk factor for oxygen therapy requirement in patients with coronavirus disease 2019. Journal of Diabetes Investigation. 2022 May;13(5):909-17.
  26. Jain S, Kasaliwal R, Gupta N, Vohra R, Mathur N, Yadav S, Jain A, Rijhwani P. AGE AND HBA1C IN PREDICTING MAJOR ADVERSE OUTCOME IN INDIAN HOSPITALISED PATIENTS WITH COVID-19 INFECTION: A PROGNOSTIC CLUE. J.Med.Sci.Educ. 2020 Nov.-December; 7(6): 79-87.
  27. Li H, Yan B, Gao R, Ren J, Su Z, Ma T, Yang J. Abnormal Glucose Metabolism Leads To Severe COVID-19 Due To Hyperinflammation: A Cross-Sectional Study. Research Square. 2021 December; 1-16.
  28. Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. American Journal of Physiology-Endocrinology and Metabolism. 2020 Apr 26.
  29. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endotheliitis in COVID-19. The Lancet. 2020 May 2;395(10234):1417-8.
  30. Coppelli A, Giannarelli R, Aragona M, Penno G, Falcone M, Tiseo G, Ghiadoni L, Barbieri G, Monzani F, Virdis A, Menichetti F. Hyperglycemia at hospital admission is associated with severity of the prognosis in patients hospitalized for COVID-19: the Pisa COVID-19 study. Diabetes care. 2020 Oct 1;43(10):2345-8.
  31. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020 Mar 28;395(10229):1054-62.
  32. Pititto BD, Ferreira SR. Diabetes and covid-19: more than the sum of two morbidities. Revista de saude publica. 2020 May 29;54.
  33. Bezuidenhout MC, Wiese OJ, Moodley D, Maasdorp E, Davids MR, Koegelenberg CF, Lalla U, Khine-Wamono AA, Zemlin AE, Allwood BW. Correlating arterial blood gas, acid–base and blood pressure abnormalities with outcomes in COVID-19 intensive care patients. Annals of Clinical Biochemistry. 2021 Mar;58(2):95-101.
  34. Bhandari S, Shaktawat AS, Sharma R, Dube A, Kakkar S, Banerjee S, Keshwani P, Sharma S, Mahavar S, Nawal CL, Mehta S. A preliminary clinico-epidemiological portrayal of COVID-19 pandemic at a premier medical institution of North India. Annals of Thoracic Medicine. 2020 Jul;15(3):146.
  35. Elibol A, Eren D, Erdoğan MD, Elmaağaç M, Dizdar OS, Celik I, Günal Aİ. Factors influencing on development of COVID-19 pneumonia and association with oral anti-diabetic drugs in hospitalized patients with diabetes mellitus. Primary Care Diabetes. 2021 Oct 1;15(5):806-12.

Files

Share

How to cite

Statistics